EPA (mainly
MMP 9, MMP-8 and elastase) and inflammatory factors present in the wound bed (such as
IL-1, IL-6, and TNFa) account for the catabolic state of non-healing ulcers. The availability
of wound dressings that modulate EPA has added new therapeutic options for treating
non-healing ulcers. The literature confirms advantages obtained by reducing protease
activity in the wound bed, with better outcomes achieved by using these dressings
compared with traditional ones. New technologies also allow a physician to know the
status of the wound bed environment, particularly EPA, in a clinical setting. These may be
helpful in guiding a clinician’s options in treating very difficult-to-heal ulcers.