APMA News - September/October 2017 - S1

SUPPLEMENT TO APMA NEWS

your

Trusted News and
Information for
Young Physicians

SEP T EMBER / O C T O BER 2017 / ISSUE 48

BRING YOUR EXPERTISE TO THE NATIONAL
The Call for Speakers is now open for the APMA 2018 Annual Scientific Meeting
(The National), taking place July 12-15 in Washington, DC. To learn more and
apply, visit www.apma.org/callforspeakers.
The wound care topics featured in this issue were presented during this year's
meeting in Nashville, TN. If you want to share your research with your colleagues
at the must-attend meeting for every podiatrist, act now; applications are due
October 2.

MATRIX METALLOPROTEINASE AND WOUND CARE
Brock Liden, DPM, Pinkerington, OH

M

atrix metalloproteinase (MMPs) are
enzymes that play critical roles in the
normal healing process, including
assisting in the removal of denatured matrix,
degrading capillary basement membrane to
allow new vessels to form in angiogenesis,
enabling contraction of scar matrix and
Repeated
Tissue Injury

Image 1

Ischemia
and
Bioburden-Biofilm

Prolonged
Elevated
Inflammation
↑Neutrophils
↑Macrophages
↑Mast cells

Chronic Wound
Pathophysiology

Imbalanced
Proteases and
Inhibitors
↑Proteases
↓ Inhibitors

extracellular matrix (ECM) by myofibroblasts,
migration of epidermal cells, and remodeling
of scar tissue. However, MMPs need to be
present in the right amounts, at the right
places, and at the right times to function
properly in normal healing.
In chronic wounds, the major factor driving inflammation is
the bioburden-biofilm.
The inflammation leads
to massive up-regulation of MMPs, leading
to significant impact
Destruction of
on the wound environEssential Proteins
ment. The chronic
↑ECM degradation
↓Growth factors/receptors
↓Cell migration
wound pathophysiolo↓Cell proliferation
gy starts with repeated
tissue injury, allowing
biofilm-bioburden
establishment. This
situation leads to prolonged inflammation,

Your APMA is supported through a generous
educational grant from Spenco Medical by Implus.
Editor
Design

Will Scott; wpscott@apma.org
Suzanne Kleinwaks Design

APMA IS SOCIAL: ARE YOU?

Mast, B., & Schultz, G. (1996). Interactions of cytokines, growth factors, and proteases in acute and chronic wounds. Wound Repair
and Regeneration, 4(4), 411-420.

@APMA
www.facebook.com/TheAPMA
www.youtube.com/user/TheAPMA
www.google.com/+APMAorgCommunity
www.pinterest.com/TheAPMA

allowing up-regulation of MMPs and
down-regulation of tissue inhibitory metalloproteinase. The increase in MMPs damages
ECM, destroys growth factors and growth
factor receptors, and decreases cell proliferation and migration. The cascade is an
amplifying cycle, which means that with each
pass, the amount of MMPs increases.
MMPs have been shown to have a direct
relationship to wound volume/healing.
MMPs fluctuate greatly in the wound bed
over a relatively short period of time. As
MMPs decrease, wounds will typically progress toward healing. Conversely, as MMPs
increase, wounds will stall or increase.
Dressings can help regulate MMPs back
to a more normal level. Several accepted
approaches exist to address MMPs in the
wound bed:
1. Collagen is the most accepted dressing
to alter MMPs. It acts as a sacrificial
substrate, allowing the MMPs to eat the
collagen dressing instead of the patient's
own tissue. The issue with collagen is that
it must be applied at the appropriate rate
to address the quantity of MMPs in the
wound bed. If there is too little collagen,
the MMPs overwhelm the dressing and
return to the wound bed, doing damage.
If there is too much, the collagen is not
optimized for the wound's benefit.
2. Debridement physically removes the MMPs
from the wound bed and, depending on
the debridement depth, will impact the
biofilm, slowing the cascade.
Continued on Page 2


http://www.apma.org/callforspeakers http://www.facebook.com/TheAPMA http://www.youtube.com/user/TheAPMA http://www.google.com/+APMAorgCommunity http://www.pinterest.com/TheAPMA

Table of Contents for the Digital Edition of APMA News - September/October 2017

Contents
APMA News - September/October 2017 - Cover1
APMA News - September/October 2017 - Cover2
APMA News - September/October 2017 - 3
APMA News - September/October 2017 - 4
APMA News - September/October 2017 - 5
APMA News - September/October 2017 - 6
APMA News - September/October 2017 - 7
APMA News - September/October 2017 - Contents
APMA News - September/October 2017 - 9
APMA News - September/October 2017 - 10
APMA News - September/October 2017 - 11
APMA News - September/October 2017 - 12
APMA News - September/October 2017 - 13
APMA News - September/October 2017 - 14
APMA News - September/October 2017 - 15
APMA News - September/October 2017 - 16
APMA News - September/October 2017 - 17
APMA News - September/October 2017 - 18
APMA News - September/October 2017 - 19
APMA News - September/October 2017 - 20
APMA News - September/October 2017 - 21
APMA News - September/October 2017 - 22
APMA News - September/October 2017 - 23
APMA News - September/October 2017 - 24
APMA News - September/October 2017 - 25
APMA News - September/October 2017 - 26
APMA News - September/October 2017 - 27
APMA News - September/October 2017 - 28
APMA News - September/October 2017 - 29
APMA News - September/October 2017 - 30
APMA News - September/October 2017 - 31
APMA News - September/October 2017 - 32
APMA News - September/October 2017 - 33
APMA News - September/October 2017 - 34
APMA News - September/October 2017 - 35
APMA News - September/October 2017 - 36
APMA News - September/October 2017 - 37
APMA News - September/October 2017 - 38
APMA News - September/October 2017 - 39
APMA News - September/October 2017 - 40
APMA News - September/October 2017 - 41
APMA News - September/October 2017 - 42
APMA News - September/October 2017 - 43
APMA News - September/October 2017 - 44
APMA News - September/October 2017 - 45
APMA News - September/October 2017 - 46
APMA News - September/October 2017 - 47
APMA News - September/October 2017 - 48
APMA News - September/October 2017 - 49
APMA News - September/October 2017 - 50
APMA News - September/October 2017 - 51
APMA News - September/October 2017 - 52
APMA News - September/October 2017 - 53
APMA News - September/October 2017 - 54
APMA News - September/October 2017 - 55
APMA News - September/October 2017 - 56
APMA News - September/October 2017 - 57
APMA News - September/October 2017 - 58
APMA News - September/October 2017 - 59
APMA News - September/October 2017 - 60
APMA News - September/October 2017 - 61
APMA News - September/October 2017 - 62
APMA News - September/October 2017 - 63
APMA News - September/October 2017 - 64
APMA News - September/October 2017 - 65
APMA News - September/October 2017 - 66
APMA News - September/October 2017 - 67
APMA News - September/October 2017 - 68
APMA News - September/October 2017 - 69
APMA News - September/October 2017 - 70
APMA News - September/October 2017 - 71
APMA News - September/October 2017 - 72
APMA News - September/October 2017 - 73
APMA News - September/October 2017 - 74
APMA News - September/October 2017 - 75
APMA News - September/October 2017 - 76
APMA News - September/October 2017 - 77
APMA News - September/October 2017 - 78
APMA News - September/October 2017 - 79
APMA News - September/October 2017 - 80
APMA News - September/October 2017 - 81
APMA News - September/October 2017 - 82
APMA News - September/October 2017 - 83
APMA News - September/October 2017 - 84
APMA News - September/October 2017 - 85
APMA News - September/October 2017 - 86
APMA News - September/October 2017 - 87
APMA News - September/October 2017 - 88
APMA News - September/October 2017 - 89
APMA News - September/October 2017 - 90
APMA News - September/October 2017 - Cover3
APMA News - September/October 2017 - Cover4
APMA News - September/October 2017 - S1
APMA News - September/October 2017 - S2
APMA News - September/October 2017 - S3
APMA News - September/October 2017 - S4
https://www.nxtbook.com/nxtbooks/apma/news_20210506
https://www.nxtbook.com/nxtbooks/apma/news_20210304
https://www.nxtbook.com/nxtbooks/apma/news_20210102
https://www.nxtbook.com/nxtbooks/apma/news_20201112
https://www.nxtbook.com/nxtbooks/apma/news_20200910
https://www.nxtbook.com/nxtbooks/apma/news_20200708
https://www.nxtbook.com/nxtbooks/apma/news_20200506
https://www.nxtbook.com/nxtbooks/apma/news_20200304
https://www.nxtbook.com/nxtbooks/apma/news_20200102
https://www.nxtbook.com/nxtbooks/apma/news_20191112
https://www.nxtbook.com/nxtbooks/apma/news_20190910
https://www.nxtbook.com/nxtbooks/apma/news_20190708
https://www.nxtbook.com/nxtbooks/apma/news_20190506
https://www.nxtbook.com/nxtbooks/apma/news_20190304
https://www.nxtbook.com/nxtbooks/apma/news_20190102
https://www.nxtbook.com/nxtbooks/apma/news_20181112
https://www.nxtbook.com/nxtbooks/apma/news_20180910
https://www.nxtbook.com/nxtbooks/apma/news_20180708
https://www.nxtbook.com/nxtbooks/apma/news_20180506
https://www.nxtbook.com/nxtbooks/apma/news_20180304
https://www.nxtbook.com/nxtbooks/apma/news_20180102
https://www.nxtbook.com/nxtbooks/apma/news_20171112
https://www.nxtbook.com/nxtbooks/apma/news_20170910
https://www.nxtbook.com/nxtbooks/apma/news_20170708
https://www.nxtbook.com/nxtbooks/apma/news_20170506
https://www.nxtbook.com/nxtbooks/apma/news_20170304
https://www.nxtbook.com/nxtbooks/apma/news_20170102
https://www.nxtbook.com/nxtbooks/apma/news_20161112
https://www.nxtbook.com/nxtbooks/apma/news_20160910
https://www.nxtbook.com/nxtbooks/apma/news_20160708
https://www.nxtbook.com/nxtbooks/apma/news_20160506
https://www.nxtbook.com/nxtbooks/apma/news_20160304
https://www.nxtbook.com/nxtbooks/apma/news_20160102
https://www.nxtbook.com/nxtbooks/apma/news_20151112
https://www.nxtbook.com/nxtbooks/apma/news_20150910
https://www.nxtbook.com/nxtbooks/apma/news_20150708
https://www.nxtbook.com/nxtbooks/apma/news_201506
https://www.nxtbook.com/nxtbooks/apma/news_201505
https://www.nxtbook.com/nxtbooks/apma/news_201504
https://www.nxtbook.com/nxtbooks/apma/news_201503
https://www.nxtbook.com/nxtbooks/apma/news_201502
https://www.nxtbook.com/nxtbooks/apma/news_201501
https://www.nxtbook.com/nxtbooks/apma/news_20141112
https://www.nxtbook.com/nxtbooks/apma/news_201410
https://www.nxtbook.com/nxtbooks/apma/news_201409
https://www.nxtbook.com/nxtbooks/apma/news_20140708
https://www.nxtbook.com/nxtbooks/apma/news_201406
https://www.nxtbook.com/nxtbooks/apma/news_201405
https://www.nxtbook.com/nxtbooks/apma/news_201404
https://www.nxtbook.com/nxtbooks/apma/news_201403
https://www.nxtbook.com/nxtbooks/apma/news_201402
https://www.nxtbook.com/nxtbooks/apma/news_201401
https://www.nxtbook.com/nxtbooks/apma/news_201311
https://www.nxtbook.com/nxtbooks/apma/news_201310
https://www.nxtbook.com/nxtbooks/apma/news_201309
https://www.nxtbook.com/nxtbooks/apma/news_201308
https://www.nxtbook.com/nxtbooks/apma/news_201306
https://www.nxtbook.com/nxtbooks/apma/news_201305
https://www.nxtbook.com/nxtbooks/apma/news_201304
https://www.nxtbook.com/nxtbooks/apma/news_201303
https://www.nxtbook.com/nxtbooks/apma/news_201302
https://www.nxtbook.com/nxtbooks/apma/news_201301
https://www.nxtbook.com/nxtbooks/apma/news_201211
https://www.nxtbook.com/nxtbooks/apma/news_201210
https://www.nxtbook.com/nxtbooks/apma/news_201209
https://www.nxtbook.com/nxtbooks/apma/news_20120708
https://www.nxtbook.com/nxtbooks/apma/news_201206
https://www.nxtbook.com/nxtbooks/apma/news_201205
https://www.nxtbook.com/nxtbooks/apma/news_201204
https://www.nxtbook.com/nxtbooks/apma/news_201203
https://www.nxtbook.com/nxtbooks/apma/news_201202
https://www.nxtbook.com/nxtbooks/apma/news_201201
https://www.nxtbook.com/nxtbooks/apma/news_201111
https://www.nxtbook.com/nxtbooks/apma/news_201110
https://www.nxtbook.com/nxtbooks/apma/news_201109
https://www.nxtbook.com/nxtbooks/apma/news_201107
https://www.nxtbook.com/nxtbooks/apma/news_201106
https://www.nxtbook.com/nxtbooks/apma/news_201105
https://www.nxtbook.com/nxtbooks/apma/news_201104
https://www.nxtbook.com/nxtbooks/apma/news_201103
https://www.nxtbook.com/nxtbooks/apma/news_201102
https://www.nxtbookmedia.com