Abstract
Given their severity and non-healing nature, diabetic chronic wounds are a significant concern to the 30.3 million Americans diagnosed with diabetes mellitus (2015). Peripheral arterial diseases, neuropathy, and infection contribute to the development of these wounds, which lead to an increased incidence of lower extremity amputations. Early recognition, debridement, offloading, and controlling infection are imperative for timely treatment. However, wound characterization and treatment are highly subjective and based largely on the experience of the treating clinician. Many wound dressings have been designed to address particular clinical presentations, but a prescriptive method is lacking for identifying the particular state of chronic, non-healing wounds. The authors suggest that recent developments in wound dressings and biosensing may allow for the quantitative, real-time representation of the wound environment, including exudate levels, pathogen concentrations, and tissue regeneration. Development of such sensing capability could enable more strategic, personalized care at the onset of ulceration and limit the infection leading to amputation. This review presents an overview of the pathophysiology of diabetic chronic wounds, a brief summary of biomaterial wound dressing treatment options, and biosensor development for biomarker sensing in the wound environment.
Highlights
Diabetes mellitus, an increasing health concern that affects more than 9% of the population over the age 18, is the seventh leading cause of death in North America [1,2]
Resistance is related to the amount of extracellular fluid (ECF) in a given sample of tissue; reactance is related to the cell mass and is a good indicator of cell accumulation and proliferation; and phase angle corresponds to the vitality of the tissue and is a good prognosis of tissue nutrition [87]
There is a limited number of options for successfully treating diabetic chronic wounds and the need to discover a solution that considers all parameters involving inflammation and repair is vital
Summary
An increasing health concern that affects more than 9% of the population over the age 18, is the seventh leading cause of death in North America [1,2]. A number of severe health concerns are associated with diabetes, such as peripheral arterial disease, neuropathy, limited joint mobility, abnormal foot pressures, minor trauma, and foot deformity. Chronic wounds associated with diabetes include foot, venous and pressure ulcers [4]. The lack of response to what may initially be minor incidents, combined with the poor blood circulation and impaired healing capacity of diabetic patients eventually leads to ulceration [6]. Those affected by DFUs and other chronic wounds are at increased risk for lower extremity amputation due to the threat of osteomyelitis and/or sepsis resulting from wound infection. Several studies have concluded that 85% of amputations are preceded by ulcers [7], and the incidence of new ulcer formation at a collateral wound site may be up to 50% [8]
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