Abstract
Wound healing is an intricate, dynamic process, in which various elements such as hyperglycemia, neuropathy, blood supply, matrix turnover, wound contraction, and the microbiome all have a role in this "out of tune" diabetic complex symphony, particularly noticeable in the complications of diabetic foot. Recently it was demonstrated that the fasciae have a crucial role in proprioception, muscular force transmission, skin vascularization and tropism, and wound healing. Indeed, the fasciae are a dynamic multifaceted meshwork of connective tissue comprised of diverse cells settled down in the extracellular matrix and nervous fibers; each constituent plays a particular role in the fasciae adapting in various ways to the diverse stimuli. This review intends to deepen the discussion on the possible fascial role in diabetic wounds. In diabetes, the thickening of collagen, the fragmentation of elastic fibers, and the changes in glycosaminoglycans, in particular hyaluronan, leads to changes in the stiffness, gliding, and the distribution of force transmission in the fasciae, with cascading repercussions at the cellular and molecular levels, consequently feeding a vicious pathophysiological circle. A clear scientific perception of fascial role from microscopic and macroscopic points of view can facilitate the identification of appropriate treatment strategies for wounds in diabetes and create new perspectives of treatment.
Highlights
In diabetic research there has been notable progress, but to date, diabetes complications management is restricted to treatment of the symptoms
Incomplete understanding of the entire molecular and cellular mechanisms underlying diabetes determines the low success of therapeutic strategies
Identification of potential risk factors, early diagnosis, and defining effective therapeutic strategies are some ongoing challenges for clinicians and researchers
Summary
One of the key problems is that the term ‘soft tissues’ includes many different tissues, such as muscle, tendons, ligaments, fat, fibrous tissue, lymph and blood vessels, fasciae, and synovial membranes. These tissues have different microscopic characteristics and respond in different ways to the various mechanical and metabolic inputs. Knowing all the factors that can act on the fascial structure, we can have a multidisciplinary targeted approach to patients with diabetic foot For this reason, the main purpose of this review is to understand the possible role of the fasciae in the pathology of the diabetic foot
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