Current Aspects in the Pathophysiology and Treatment of Chronic Wounds in Diabetes Mellitus

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.

Use of Honey in Management of Diabetic Foot Infection: Patient’s Satisfaction and Outcome

“…Increasing fasting plasma glucose levels and duration of diabetes were both associated with an increased risk of lower extremity amputation [7]. Early debridement is essential in controlling infection as delay may result in extension of tissue destruction and potentially in limb loss.…”

Wound Healing Process, Diabetes and Implications of Dipeptidyl Peptidase IV (DPP IV/CD26)

“…In diabetes, chemotaxis and phagocytosis are decreased in the early phase of wound healing, and the appearance of cytokine and growth factors in the wound is altered. Excessive deposition of collagens and fibronectin has also been reported in diabetic wounds [36,37].…”

G-CSF Administration Accelerates Cutaneous Wound Healing Accompanied With Increased Pro-Hyp Production In db/db Mice

“…With the increasing number of diabetic patients, treatment for delayed healing of wounds, including foot diseases and ulcerations, has become a serious medical concern worldwide [1]. Many approaches to treatment have been developed; Negative-pressure wound therapy is one option to remove the harmful excess fluid that results from delayed wound healing and improve blood circulation, leading to more favorable outcomes [2].…”