Abstract
Impaired wound healing is a frequent and very severe problem in patients with diabetes mellitus, yet little is known about the underlying pathomechanisms. In this paper we review the biology of wound healing with particular attention to the pathophysiology of chronic wounds in diabetic patients. The standard treatment of diabetic ulcers includes measures to optimize glycemic control as well as extensive debridement, infection elimination by antibiotic therapy based on wound pathogen cultures, the use of moisture dressings, and offloading high pressure from the wound bed. In this paper we discuss novel adjuvant therapies with particular reference to the use of autologous skin transplants for the treatment of diabetic foot ulcers which do not respond to standard care.
Highlights
The diabetic foot syndrome is a very severe and common complication in patients with diabetes mellitus with a cumulative lifetime incidence of up to 25 percent [1]
Management is based on the simple principles of eliminating infection, the use of dressings to maintain a moist wound bed and to absorb exsudate, offloading high pressure from the wound bed, and debridement to accelerate endogenous healing and facilitate the effectiveness of topically applied substances [3]
Fahey et al demonstrated that altered leukocyte infiltration and wound fluid Interleukin 6 matrix metalloproteinases (MMPs) (IL-6) characterize the late inflammatory phases of wound healing in diabetes [12]. It seems that an altered pattern of cytokine appearance in the wound milieu may contribute to delayed wound healing in diabetes. This is substantiated by the fact that altered bioavailability of cytokines and growth factors have been implicated in the pathogenesis of chronic wounds
Summary
The diabetic foot syndrome is a very severe and common complication in patients with diabetes mellitus with a cumulative lifetime incidence of up to 25 percent [1]. Foot ulcers cause substantial morbidity, impair quality of life, are the most important risk factor for lowerextremity amputation, and result in high treatment costs and enormous economic losses [2]. The factors that delay wound healing in diabetes are multiple and relate both to the impaired glucose metabolism and to the effect of neurovascular complications. Diabetic foot ulcers readily become chronic; all too often these wounds do not heal primarily. There are often cases of persistent diabetic foot ulcers that do not respond to standard care. In such patients, skin replacement therapies either by autologous skin transplantation or by tissue-engineered human skin equivalents are second-line options which could prevent an amputation and should be considered
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