Faced with an ageing population, practitioners are increasingly confronted with issue of wound healingin elderly patients.
With age, local inflammatory response is diminished, proliferation is impaired by slow keratinocyte turnover, and tissue remodelling is characterised by a lack of metalloproteinase inhibition and thus excess of collagen destruction . All these changes have direct consequences on the healing process, making it slower and of poorer quality than in younger subjects.
Apart from these negative aspects, wound healing in the elderly offers certain advantages. Due to lower inflammatory reactions, pathological healing such as hypertrophic and/or keloid scars are rarely observed. In addition, in the case of skin removal, particularly in cancer cases involving a significant loss of substance at times, skin laxity generally allows easy suturing, without tension, producing satisfactory aesthetic results.
Finally, the comorbidities frequent in this population, especially malnutrition, venous and arterial insufficiency, but also multiple medications are all elements that often make healing complexand difficult.
1. Singer AJ, Clark RA. Cutaneous wound healing. N Engl J Med 1999;341: 738-46.
2. Eming SA, Krieg T, Davidson JM. Inflammation in wound repair: molecular and cellular mechanisms. J Invest Dermatol2007; 127: 514-25.
3. Suivi en ville des plaies chroniques : ulcère veineux de jambe, escarre, plaie du pied diabétique. Assurance maladie, octobre 2015.
4. Plaies aiguës en structure d’urgence. Référentiel de bonnes pratiques. SFMU, 2017: 32 p.
5. Sgonc R, Gruber J. Age-related aspects of cutaneous wound hea- ling: a mini-review. Gerontology 2013; 59: 159-64.
6. Majtan J. Honey: an immunomodulator in wound healing. Wound Repair Regen 2014; 22: 187-92.
7. Opletalová K, BlaizotX, Mourgeon B, et al. Maggot therapyfor wound debridement: a randomized multicenter trial. Arch Dermatol 2012; 148: 432-8.
8. van den Broek LJ, Limandjaja GC, Niessen FB, Gibbs S. Human hypertrophic and keloid scar models: principles, limitations and future challenges from a tissueengineering perspective. ExpDer- matol 2014; 23: 382-6.
9. Prise en charge de l’ulcère de jambe à prédominance veineuse hors pansement. Recommandations HAS, 2006.
10. La compression médicale dans les affections veineuses chroniques. Fiche de bon usage HAS, 2010.
11. Edmonds M, Lázaro-Martínez JL, Alfayate-García JM, et al. Sucrose octasulfate dressing versus control dressing in patients with neu- roischaemic diabetic foot ulcers (Explorer): an international, multi- centre, double-blind, randomised, controlled trial [published correction appears in Lancet Diabetes Endocrinol 2018]. Lancet Diabetes Endocrinol 2018; 6: 186-96.
12. Reinholz M, Poetschke J, Schwaiger H, Epple A, Ruzicka T, Gauglitz GG. The dermatology life quality index as a means to assess life quality in patients with different scar types. J Eur Acad Dermatol Venereol 2015; 29: 2112-9.