APPLICATIONS FOR POLYPEPTIDE GROWTH-FACTORS - EXPERIMENTAL, CLINICAL AND FINANCIAL ASPECTS

Clinical trials on exogenous application of polypeptide growth factors in chronic wounds have not fulfilled the high expectations derived fr om results of experimental studies. There is no convincing evidence th at growth factors may substitute for good wound care and efficient sur gical approaches to wound closure. The ultimate goal of treatment of c hronic ulcerations remains reconstitution of a durable skin envelope w ithout unstable scarring. Therefore, optimization of current methods o f wound therapy, including reconstructive vascular and plastic surgery and adequate metabolic and wound control, should be employed before a ny adjuvant growth factor therapy is attempted. As long as efficient a nd inexpensive therapy of chronic wounds by growth factors has not bee n demonstrated, empincal growth factor treatment should be rejected on scientific and economic grounds. Current use appears to be reasonable only under a regime of controlled clinical studies comparing growth f actor treatment with conventional wound therapy and operative measures according to the rules of ''good clinical practice''.