The Role of Cutaneous Microcirculatory Responses in Tissue Injury, Inflammation and Repair at the Foot in Diabetes

Abstract

Diabetic foot syndrome is one of the most costly complications of diabetes. Damage to the soft tissue structure is one of the primary causes of diabetic foot ulcers and most of the current literature focuses on factors such as neuropathy and excessive load. Although the role of blood supply has been reported in the context of macro-circulation, soft tissue damage and its healing in the context of skin microcirculation have not been adequately investigated. Previous research suggested that certain microcirculatory responses protect the skin and their impairment may contribute to increased risk for occlusive and ischemic injuries to the foot. The purpose of this narrative review was to explore and establish the possible link between impairment in skin perfusion and the chain of events that leads to ulceration, considering the interaction with other more established ulceration factors. This review highlights some of the key skin microcirculatory functions in response to various stimuli. The microcirculatory responses observed in the form of altered skin blood flow are divided into three categories based on the type of stimuli including occlusion, pressure and temperature. Studies on the three categories were reviewed including: the microcirculatory response to occlusive ischemia or Post-Occlusive Reactive Hyperaemia (PORH); the microcirculatory response to locally applied pressure such as Pressure-Induced Vasodilation (PIV); and the interplay between microcirculation and skin temperature and the microcirculatory responses to thermal stimuli such as reduced/increased blood flow due to cooling/heating. This review highlights how microcirculatory responses protect the skin and the plantar soft tissues and their plausible dysfunction in people with diabetes. Whilst discussing the link between impairment in skin perfusion as a result of altered microcirculatory response, the review describes the chain of events that leads to ulceration. A thorough understanding of the microcirculatory function and its impaired reactive mechanisms is provided, which allows an understanding of the interaction between functional disturbances of microcirculation and other more established factors for foot ulceration.

Prevalence of foot ulcers in diabetic patients in Punjab, Pakistan

“…Better prognosis is ensured by proper diabetic foot ulcer assessment and management. Emerging technologies may be considered for quantifying risks, prevention, and management of diabetic foot ulcers ( 31 , 32 ). Furthermore, minimally invasive surgery ( 33 – 35 ) is one the effective procedures for treating complicated foot ulcers, which may be considered in Pakistan for the treatment of foot ulcers.…”

Diabetes as an isolated cause of minor lower limb amputations

“…A review study reports that the protective role of microcirculation may be the missing link in the chain of events that leads to foot ulceration in people with diabetes. [ 11 ] It is known that microvasculature assists in tissue perfusion, homeostasis of fluids, cutaneous oxygen supply, and recruitment of collateral vessels to facilitate the healing process. [ 12 ] Simple activities such as exercise can improve plantar microcirculation and decrease plantar tissue hardness in people with T2DM.…”

Diabetes mellitus lowers the chance of short-term urinary continence recovery in prostate cancer patients undergoing radical prostatectomy

“…At present DM is one of the most frequent disease among elderly patients and prevalence of DM type 2 has rapidly increased in last decades in most industrialized countries due to lifestyle changes [ 29 ]. Both diabetic microangiopathy and diabetic neuropathy are known side-effects of DM, which are associated with prolonged, restrictive wound healing process [ 25 , 26 , 30 ]. As a consequence, we hypothesized that concomitant DM was associated with lower chances of short-term urinary continence recovery in PCa patients undergoing RP.…”

“…Moreover, among the three studies specifically investigating the effect of DM on short-term urinary continence, results were inconclusive [ 13 , 17 , 18 ]. In regards to the known negative effects of DM on wound healing, as well as diabetic microcirculation disorder and neuropathy, we hypothesized that concomitant DM is associated with lower chances or short-term urinary continence recovery [ 22 – 26 ]. To address this uncertainty, we relied on a most contemporary cohort of PCa patients (2018 to 2021) treated with RP.…”