“…Diabetic foot ulcers are considered to be a multiplex mechanism involving various complications such as diabetic neuropathy (DN), peripheral vascular disease (PVD), retinopathy, myopathy and nephropathy, impairment in angiogenic response, impairment in neutrophils and macrophage function, production of pro-inammatory cytokines, microvascular complications such as atherosclerosis, impaired production of growth factors, impaired proliferation and migration of broblasts and keratinocytes in diabetic wound healing models. 43,44 In addition, blocking of nitrous oxide, impairment in inammatory functioning of cells, hyperglycaemia, glycation of hemoglobin, impairment in production of cytokines, impairment in MMPs, impairment in accumulation of collagen, down regulation in the expression of neuropeptides together with an inammatory response, 45 deciency of brinolysis inhibitor, 46 PDGF modication, 47 decreased amount of epidermal nerves and misbalance between the ECM and MMPs 48 are few other risk factors responsible for impaired diabetic wound healing, as shown in Fig. 3.…”