In the chronic wound, the normal cascade of inflammation, granulation
and reconstruction phases of healing is interrupted. Cytokines are now
known to orchestrate different biochemical mediators resulting in the
restoration of the healing phases. Growth factors may play a signific
ant role in stimulating wound repair by stimulating growth and prolife
ration. Since growth factors stimulate a variety of functions dependin
g on cell type and wound stage and since wound-healing defects may occ
ur at any phase of healing, a mixed combination of growth factors woul
d be predicted to be more effective than a single factor. Factors that
may modulate the action of growth factors include electrical stimulat
ion, weight bearing, debriding and ischemia.