Wound healing and treatments for people with diabetic foot ulcers

Abstract

The factors that delay wound healing are multiple and relate both to diabetes and to the effect of its complications. Diabetic foot ulcers readily become chronic, and chronic ulcers have biological properties that differ substantially from acute ones. Much of the available information on the biology of wound healing relates to acute and experimental wounds and may not be directly relevant. It follows that there is limited evidence currently available to underpin protocols for the management of diabetic foot ulcers, or to guide choice of applications and dressings 1. Nevertheless, it is possible to define certain principles.GLYCAEMIC CONTROL: The first relates to glycaemic control. While chronic complications of diabetes such as peripheral vascular disease and neuropathy may be largely irreversible, aspects of structure and function of connective tissue and cells may be impaired by hyperglycaemia, and their function should be improved if normoglycaemia is achieved. PROMOTION OF HEALING: The second principle concerns attempts at active promotion of wound healing by (1) surgical revascularization, and (2) specific attempts to correct defined biological abnormalities thought to be hindering the healing process. These include the use of a variety of applications, dressings and technologies, which may stimulate healing by applying, or stimulating the release of, growth factors and cytokines. While this approach holds the greatest promise for the future, it will be dependent on defining defects which need correction in specific individuals, and having technologies available to address them. This field is in its infancy. WOUND CARE: The third broad principle concerns the management of the wound and its surrounding tissue in order to promote healing. This includes regular inspection, cleansing and removal of surface debris, elimination of pathogenic bacteria and creation of an appropriate environment to facilitate endogenous tissue regeneration. There are many applications and dressings that may be chosen to promote healing, but, whichever is selected, wound management has to be integrated into an effective programme of multidisciplinary care.

Hypoxia-induced changes in Ca2+ mobilization and protein phosphorylation implicated in impaired wound healing

“…Innervation is also critical for scarless fetal wound healing of the skin (48). Moreover, peripheral neuropathies that occur in diabetic patients may result in retardation of the wound-healing process (30).…”

Impaired Wound Healing after Cerebral Hypoxia—Ischemia in the Diabetic Mouse

“…These responses clearly mimic those seen in peripheral wound healing where impairments in the diabetic wounds are attributed to aberrations in macrophage responsiveness. Some success in reversing this situation has been achieved by the application of growth factors such as PDGF, FGF, TGF-b either separately or in combination both systemically and topically (for reviews see Greenhalgh (2003) and Jeffcoate et al (2004)). …”

The Diabetic Foot in End Stage Renal Disease

“…[13,19] Non-surgical modes of debridement include autolytic, enzymatic, mechanical (high-pressure irrigation, whirlpool hydrotherapy and ultrasound), and biological (use of sterile maggots) debridement. [93,94] Management of infection is the other critical issue. Diagnosis should remain clinical and be accompanied by a high level of suspicion.…”