Hindawi Publishing Corporation BioMed Research International Volume 2013, Article ID 849321, 5 pages http://dx.doi.org/10.1155/2013/849321 Clinical Study Interaction between a Regenerative Matrix and Wound Bed in Nonhealing Ulcers: Results with 16 Cases Alberico Motolese, 1 Francesca Vignati, 1 Roberto Brambilla, 2 Michele Cerati, 3 and Alberto Passi 4 1 Department of Dermatology, Macchi Foundation Hospital, Viale Borri 57, Varese, Italy 2 Zucchi Clinical Institute, Via Zucchi 24, Monza, Italy 3 Department of Histopathology, University of Insubria, Via Rossi 9, Varese, Italy 4 Department of Experimental and Clinical Biomedical Sciences, University of Insubria, Via Dunant 3, Varese, Italy Correspondence should be addressed to Alberico Motolese; alberico.motolese@ospedale.varese.it Received 29 May 2013; Accepted 26 June 2013 Academic Editor: Davide Vigetti Copyright © 2013 Alberico Motolese et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A chronic wound is a wound that is delayed in one of the wound-healing stages and cannot progress any further. A chronic wound leaves the patient at risk of infection and hospitalization. In these case series, 16 patients afected by venous ulcers underwent Hyalomatrix PA grating for reconstructive surgery. Hyalomatrix PA is a bilayered, sterile, lexible, and conformable three-dimensional matrix made of ibers of HYAFF, a benzyl ester of hyaluronic acid, and a semipermeable silicone membrane. Hyalomatrix PA acts as a substitutive and regenerative permanent matrix able to replace the dermis providing a three-dimensional matrix for cellular invasion and capillary growth. he silicon layer controls water vapor loss avoiding an excessive loss of luids and acts as a semipermeable barrier to the external agents. In the presented cases, the average area grated per procedure was 153 cm 2 . he length of followup ranged from 0.5 to 1 year. he inal results were considered to be good in 12 cases, fair in 3 cases, and poor in one case. his study suggests that the combination of wound bed preparation with application of the hyaluronic regenerative matrix can be a valid approach for treatment of partial thickness ulcers. 1. Introduction Chronic wound is a wound that does not heal in an orderly set of stages and in a predictable amount of time the way most wounds do; wounds that do not heal within three months are oten considered chronic. Chronic wounds seem to be detained in one or more of the phases of wound healing. For example, chronic wounds oten remain in the inlammation stage for too long. Many conditions are associated with abnor- mal cutaneous wound healing, and several examples illustrate the multifactorial nature of these condition. Examples are “trapping” of growth factors [1]; blood share alterations and prothrombotic factors response [2]; abnormalities in cell migration and proliferation [3]; persistence in inlammatory phase and secretion of inlammatory cytokines that are responsible of a long-lasting logistic condition in the wound [4, 5]; synthesis and secretion of extracellular matrix proteins and cytokines [6]; phenotypical cellular alterations [7]. Several studies concerning wound physiopathology can conirm each of these hypothesis, and particularly the per- sistence of inlammation is probably the most important factor that leads a wound into a steady, chronic condition of nonhealing. Venous ulcers are wounds that are thought to occur due to improper functioning of venous valves, usually of the legs. hey are the major cause of chronic wounds, occurring in 70% to 90% of chronic lesions [8]. he treatment of venous ulcers is mostly based on the employment of advanced wound care dressings, regenerative matrices, dermal substitutes, and skin grats. In the last few years dermal substitutes and regenerative matrices have been developed to treat diferent kinds of ulcers. Dermal