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Pathophysiological aspects of wound healing in normal and diabetic foot The main cause of long-term healing of ulcers in patients with diabetic foot is considered to be direct mechanical damage when walking due to reduced sensitivity to due to neuropathy, hyperglycemia, infection and peripheral artery disease. These factors determine the standard approaches to the treatment of diabetic foot, which include: offloading, glycemic control, debridement of ulcers, antibiotic therapy and revascularization. Recently, however, disturbances in the healing process of the skin in diabetes recognized an additional factor affecting the timing of healing patients with diabetic foot. Improved understanding and correction of cellular, molecular and biochemical abnormalities in chronic wound in combination with standard of care for affords new ground for solving the problem of ulcer healing in diabetes.

Introduction: Mesenchymal stromal cells (MSCs) administration is an effective option for the treatment of diabetic foot ulcers (DFUs). However, to date, studies assessing long-term outcomes and evaluating skin parameters after cell-based therapy are lacking. We presented the clinical outcomes of 3 patients, treated for DFUs with the bone marrow MSCs 3 years earlier. Methods: Ultrasound examination was used to compare collagen density and epidermal thickness in areas of healed ulcers in comparison with non-affected skin used as a control. Ultrasound and dermatoscopy were used to exclude neoplasm formation, to assess scar contracture and wound recurrence. Results: In all patients, no ulcer recurrence was detected, which was lower than the expected 60% rate of re-ulceration in diabetic patients in a 3-year period (OD [odds ratio] = 0.095, P = 0.12). No neoplasm formation, no contracture of hypertrophic scar, and adjacent tissue were registered. Collagen ultrasound density was decreased by 57% (P = 0.053) and epidermal thickness was increased by 72% (P = 0.01) in the area of healed ulcers in all patients. Conclusion: MSCs therapy alone did not result in the complete restoration of the skin parameters within a 3-year period. MSCs may represent important adjuvant to the therapy, however, other novel approaches are required to achieve better results.

Aim. To evaluate effectiveness of unloading immobilization bandages manufactured from Soft Cast and Scotchcast materials. Materials and methods. The study included all patients (n=39) with diabetic foot ulcers treated with the use of total-contact cast technology (TCC)from 01.10.2007 to 01.03.2009. 31 patients presented with neuropathic foot ulcers and 8 with neuroischemic ulcers (in the absence of critical foot ischemia).26 and 13 were managed using non-removable and removable casts respectively. All were given standard local treatment of ulcers, supplementedby antibacterial therapy in 20 patients. Results. Treatment resulted in the healing of ulcers in 31 (79%) patients during 40.5?32.9 days (M?SD) (median 27, min 7, max 11 days). In 28(72%) of them, healing required 12 weeks to complete. TCC had to be removed in 8 (21%) patients because of low efficiency or complications. Newulcers or abrasions related to the use of TCC developed in 10 patients but treatment was discontinued only in one of them. We distinguished a subgroupof 12 patients comparable in terms of major characteristics (plantar stage 1A and 2A neuropathic ulcers according to Texas University classification)and unloading method (non-removable cast throughout the treatment period) with patients included in earlier randomized studies. In this subgroup,healing of 100% ulcers was completed within 12 weeks (median 22 (13-74) days). Conclusion. 1. Efficiency of TCC in our practice is comparable with that in earlier publications. 2. The use of TCC is indicated not only for thetreatment of uninfected plantar neuropathic ulcers but also in some cases of neuroischemic and non-plantar ulcers. 3. Skin lesions from TCC is oflittle clinical significance and can be avoided by specialized education of the medical personnel involved in TCC manufacture.

A growing number of studies report dermal malignancies mimicking diabetic foot ulcers (DFUs). We reviewed clinical cases reporting malignant tumours misdiagnosed to be DFU aiming to identify factors contributing to misdiagnosis. We systematically searched in PubMed for clinical cases reporting on misdiagnosis of DFU in patients with cancer. A chi-square analysis was conducted to show the link between the incidence of initial DFU misdiagnosis and patient age, gender and wound duration. Lesions misdiagnosed to be DFU were subsequently diagnosed as melanoma (68% of the cases), Kaposi's sarcoma (14%), squamous cell carcinoma (11%), mantle cell lymphoma, and diffuse B-cell lymphoma (both by 4%). Older age (≥65 years) was associated with a significantly increased risk of malignancy masked as DFU (OR: 2.452; 95% CI: 1.132 to 5.312; P value = .019). The risk of such suspicion in older patients (age ≥ 65 years) was 145% higher than in younger patients (age < 65 years).Clinicians should maintain a high level of awareness towards potentially malignant foot lesions in elderly patients with diabetes (age ≥ 65).diabetic foot ulcer, malignancy, melanoma, misdiagnosis, skin cancer Key Messages• reports of diabetic foot ulcer (DFU) are increasing in number, and there are several accounts of malignancies misdiagnosed as DFU • the vast majority of malignancies misdiagnosed as DFU are melanomas (71%) • patients at ages above 65 years have more than twice (Â2.5) higher chance of DFU misdiagnosis