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Extracellular matrix (ECM) turnover is a widespread but in
completely understood process. Many studies have been con ducted
with the aim of discovering the general mechanisms which produce
and maintain the ECM in tissues. Wound re pair in animals has
always been a suitable "tool" for exploring these mechanisms. In
such a pathologic event, the different components of the healing
system can be readily observed since they are exaggerated. It has
now become clear that the regulation of protease/inhibitor activity
is one of the most im portant steps in maintaining the integrity of
ECM in the normal as well as in the pathologic state. As far as the
repair process is concerned, a failure in such regulation may
result in abnormal wound healing ranging from nonhealing wounds to
hyper trophic scarring. Experimental findings have been directly
applied in clinical practice. For example, the importance of
debridement in nor mal and especially in poorly healing wounds has
become much clearer in the recent past. Different methods have been
proposed to obtain an optimal wound bed in order to perform skin
transplantation. Both mechanical and physical debridement
procedures un doubtedly offer some advantages and are essential
when extensive third degree burns have to be treated. On the other
hand, pain, excessive blood loss, and overall broad and indi
scriminate debridement are common negative side effects. Thus, many
enzymic formulations have been proposed and used in practice by
clinicians all over the world."
This book is the fruit of lectures given during the symposium
"Proteolytic Enzymes and Wound Healing" at the Joint Meet ing of
the Wound Healing Society and the European Tissue Repair Society
held in Amsterdam, August 22-25, 1993. Look ing back, we can
conclude with satisfaction that the meeting was a great success,
with regard to both the number of partici pants and the scientific
level. Enormous progress is being made in the field of wound heal
ing and tissue repair. It was therefore of prime importance that
one fundamental aspect in the healing of chronic wound- the
proteolytic debridement of tissue necrosis - be given thorough
attention during the above-mentioned symposium. Renowned authors
dealt with the various aspects of proteoly tic enzymes and wound
healing, so that a unique overview was given. The lectures were
written up and arranged into the various chapters of this book,
which should provide the reader with a practical guide in
understanding and treating necrotic wounds. Wiete Westerhof, M. D.,
Ph. D. President of the Organizing Committee of the Joint Meeting
of the Wound Healing Society and the European Tissue Repair Society
Contents Pathobiology of Necrosis P. K. Das and W. Westerhof..
................................... ."
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