Impaired microvascular hyperaemic response to minor skin trauma in type I diabetes.

Rayman, Gerry; Williams, Shirley; Spencer, Peter; Smaje, L. H.; Wise, P. H.; Tooke, John E.

doi:10.1136/bmj.292.6531.1295

Cited by 197 publications

(107 citation statements)

References 11 publications

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“…The inability of skin microcirculation in diabetic patients to respond normally to injury (17,18) and even to nonnoxious stimulation, such as the local pressure applied in the present study, may be an important factor in the development of ulceration.…”

Section: Discussionmentioning

confidence: 92%

Early Decrease of Skin Blood Flow in Response to Locally Applied Pressure in Diabetic Subjects

et al. 2002

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Pressure ulcers are common debilitating complications of diabetes that are caused by tissue ischemia. Skin blood flow in response to locally applied pressure might be impaired in diabetic patients because of the combined effects of a typically low skin temperature and alterations in microcirculatory function, and could be worsened by neuropathy. We measured skin blood flow by laser Doppler flowmetry over the internal anklebone in response to local pressure applied at 5.0 mmHg/min in three groups of diabetic patients (with clinical and subclinical neuropathy and without neuropathy) and in healthy matched control subjects at usual room temperature. Compared with in matched control subjects with comparable skin temperatures (29.3 ؎ 0.4 vs. 28.7 ؎ 0.4°C), in diabetic patients the skin blood flow response to locally applied pressure was further impeded, even in those without neuropathy. Indeed, skin blood flow decreased significantly from baseline at much lower applied pressure (7.5 mmHg) in diabetic subjects, again even in those without neuropathy, than in control subjects (48.8 mmHg). The large difference between these pressures could partially explain diabetic patients' high risk of developing decubitus and plantar ulcers. Diabetes 51:1214 -1217, 2002 P ressure ulcers are common debilitating complications of diabetes (1). Diabetes disturbs the autonomic regulation of skin microcirculation, even in the absence of neuropathy. Moreover, sensory diabetic neuropathy mainly affects unmyelinated primary afferent fibers (2) and impairs the vasodilation related to normally functioning unmyelinated C fibers (3,4). We recently reported on cutaneous pressure-induced vasodilation (PIV) in humans (5,6) and rats (7) as a physiological response to an increase in nonnoxious progressive local pressure. This mechanism allows skin blood flow to increase in response to locally applied pressure, whereas in its absence, skin blood flow is progressively decreased with application of increased local pressure. Although it results from nonpainful stimulation, this mechanism has been shown to disappear after chronic treatment with capsaicin in animals and humans (5,7), suggesting that it is dependent on the normal function of capsaicin-sensitive primary nervous afferents. Because temperature and blood flow in cutaneous microcirculation are highly correlated (8), skin temperature may have a major effect on skin blood flow response to applied pressure. Therefore, we hypothesized that the skin blood flow response to locally applied pressure would be impaired in diabetic patients because of the combined effects of their typically low skin temperature and diabetes-induced alterations of the vascular and nervous systems. To verify this hypothesis, we measured the effects of locally applied pressure on skin blood flow over the internal anklebone in diabetic patients with clinically apparent or subclinical neuropathy and without neuropathy and in healthy matched control subjects at usual ambient temperature. RESEARCH DESIGN AND METHODSSubjects. Subj...

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Section: Discussionmentioning

confidence: 92%

Early Decrease of Skin Blood Flow in Response to Locally Applied Pressure in Diabetic Subjects

et al. 2002

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“…3 This thickened membrane impairs leukocytes migration and hampers the normal hyperemic or vasodilatory response to injury, thus simultaneously increasing the susceptibility to injury while also blunting the typical manifestations of such an injury. 4 Because of this blunted neuroinflammatory response, diabetic patients lack a crucial component of the body's natural first line of defense against pathogens and thus are more susceptible to an ensuing foot infection. 5 The present study will provide knowledge of interventions that lead to healing of wounds infected with S. aureus.…”

Section: Introductionmentioning

confidence: 99%

Interventions for wound healing among diabetic patients infected with Staphylococcus aureus: a systematic review

et al. 2011

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CONTEXT AND OBJECTIVE: Staphylococcus aureus is the most frequent agent isolated in diabetic foot infections and may be associated with changes to wound healing times. The aim of this study was to perform a systematic review of the literature, including studies that assessed the efficacy of any clinical or surgical intervention, as well as oral or topical therapy for diabetic ulcers infected with S. aureus. DESIGN AND SETTING:Systematic review with a search conducted in databases. METHODS:We conducted a systematic review with a comprehensive search in the Lilacs, SciELO, PubMed/Medline, Old Medline, Embase and Cochrane Library databases, for articles published from 1966 to 2010. The articles selected were limited to studies on diabetic patients with wounds infected with S. aureus for whom their healing was followed up, with the use of either antibiotics or experimental treatments. Animal studies and those that did not report the wound healing, as well as review articles, were excluded. RESULTS:Five studies that met the inclusion and exclusion criteria were analyzed. CONCLUSIONS:There are few studies reporting the healing of wounds infected with S. aureus in diabetic patients, although this is the most commonly found pathogen in this type of wound and it frequently consists of methicillin-resistant S. aureus (MRSA). There is insufficient evidence to support early use of broad-spectrum antibiotics against MRSA to promote healing of diabetic ulcers, since antibiotic resistance may develop from such treatment.This highlights the need for further studies on the subject. RESUMOCONTEXTO: Staphylococcus aureus é o agente mais frequentemente isolado nas infecções de pé em pacientes diabéticos e pode estar associado a mudança no tempo de cicatrização de feridas. O objetivo deste estudo foi realizar uma revisão sistemática da literatura, incluindo estudos que avaliaram a eficácia de qualquer intervenção clínica, cirúrgica, bem como terapia oral ou tópica para o tratamento de úlceras diabéticas infectadas com o S. aureus. TIPO DE ESTUDO E LOCAL:Revisão sistemática com busca realizada em bancos de dados. MÉTODOS:Realizamos uma revisão sistemática com uma busca abrangente nos bancos de dados Lilacs, SciELO, PubMed/Medline, Old Medline, Embase e no banco de dados da biblioteca Cochrane, publicados entre 1966 e 2010. Os artigos selecionados foram limitados aos estudos com feridas infectadas por S. aureus de pacientes diabéticos, que tiveram cicatrização relatada, quer pela utilização de antibióticos ou por substâncias experimentais. Foram excluídos os estudos com animais e os que não relataram a cicatrização das feridas, bem como artigos de revisão. RESULTADOS:Foram analisados cinco estudos que obedeceram aos critérios de inclusão e exclusão.CONCLUSÕES: Raros estudos relataram cicatrização de feridas infectadas com S. aureus em pacientes diabéticos, embora este seja o patógeno mais comumente encontrado neste tipo de ferida, sendo frequentemente resistente à meticilina MRSA (methicillin-resistant S. aureus). Não há evidê...

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“…NO synthesis occurs during wound healing and regulates important parts of wound healing, such as chemotaxis, angiogenesis, cellular proliferation, and epithelialization [18][19]. Moreover, NO, as a vasodilator, has an important role in the increase of blood flow to ischemic tissue [20][21][22][23]. Available evidence demonstrate that NO level reduces in the wound environment in diabetic animals [24][25].…”

Section: Introductionmentioning

confidence: 99%

Effect of low-intensity direct current on expression of vascular endothelial growth factor and nitric oxide in diabetic foot ulcers

et al. 2014

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Abstract-This study investigated the effect of low-intensity cathodal direct current on the release of plasma vascular endothelial growth factor (VEGF) and nitric oxide (NO) in diabetic foot ulceration. Twenty type 2 diabetic patients with foot ulceration and thirteen age-matched healthy subjects were enrolled. Patients were randomly assigned to electrical stimulation (ES) (n = 10) or sham ES (placebo, n = 10) groups. The ES group received cathodal direct current (1.48 +/-0.98 mA) for 1 h/d, 3 d/wk for 4 wk (12 sessions). Blood samples were collected for VEGF and NO measurement in the first and last treatment sessions before and after intervention. Wound surface area and skin temperature were measured at the 1st, 6th, and 12th sessions. VEGF significantly increased in the ES group compared with the placebo group after the 1st (106.61 +/-79.50 and 40.88 +/-26.20, respectively) and 12th sessions (109.28 +/-67.30 and 34.79 +/-13.20, respectively). NO level also increased significantly in the ES group compared with the placebo group after the 12th session (44.21 +/-14.00 and 35.25 +/-11.00, respectively). The increase of skin temperature was significantly higher in the ES group than the placebo group. Application of low-intensity ES increases the expression of VEGF and NO, which may lead to improved blood flow and tissue temperature and, consequently, wound healing in diabetic foot ulceration.

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Impaired microvascular hyperaemic response to minor skin trauma in type I diabetes.

Cited by 197 publications

References 11 publications

Early Decrease of Skin Blood Flow in Response to Locally Applied Pressure in Diabetic Subjects

Early Decrease of Skin Blood Flow in Response to Locally Applied Pressure in Diabetic Subjects

Interventions for wound healing among diabetic patients infected with Staphylococcus aureus: a systematic review

Effect of low-intensity direct current on expression of vascular endothelial growth factor and nitric oxide in diabetic foot ulcers

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