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Balasubramanian GV, Chockalingam N, Naemi R. The Role of Cutaneous Microcirculatory Responses in Tissue Injury, Inflammation and Repair at the Foot in Diabetes. Front Bioeng Biotechnol 2021; 9:732753. [PMID: 34595160 PMCID: PMC8476833 DOI: 10.3389/fbioe.2021.732753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/26/2021] [Indexed: 12/23/2022] Open
Abstract
Diabetic foot syndrome is one of the most costly complications of diabetes. Damage to the soft tissue structure is one of the primary causes of diabetic foot ulcers and most of the current literature focuses on factors such as neuropathy and excessive load. Although the role of blood supply has been reported in the context of macro-circulation, soft tissue damage and its healing in the context of skin microcirculation have not been adequately investigated. Previous research suggested that certain microcirculatory responses protect the skin and their impairment may contribute to increased risk for occlusive and ischemic injuries to the foot. The purpose of this narrative review was to explore and establish the possible link between impairment in skin perfusion and the chain of events that leads to ulceration, considering the interaction with other more established ulceration factors. This review highlights some of the key skin microcirculatory functions in response to various stimuli. The microcirculatory responses observed in the form of altered skin blood flow are divided into three categories based on the type of stimuli including occlusion, pressure and temperature. Studies on the three categories were reviewed including: the microcirculatory response to occlusive ischemia or Post-Occlusive Reactive Hyperaemia (PORH); the microcirculatory response to locally applied pressure such as Pressure-Induced Vasodilation (PIV); and the interplay between microcirculation and skin temperature and the microcirculatory responses to thermal stimuli such as reduced/increased blood flow due to cooling/heating. This review highlights how microcirculatory responses protect the skin and the plantar soft tissues and their plausible dysfunction in people with diabetes. Whilst discussing the link between impairment in skin perfusion as a result of altered microcirculatory response, the review describes the chain of events that leads to ulceration. A thorough understanding of the microcirculatory function and its impaired reactive mechanisms is provided, which allows an understanding of the interaction between functional disturbances of microcirculation and other more established factors for foot ulceration.
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Affiliation(s)
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom
| | - Roozbeh Naemi
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom
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Wang Y, Mu L, He Y, Tang Y, Liu C, Lu Y, Xu L. Heat transfer analysis of blood perfusion in diabetic rats using a genetic algorithm. Microvasc Res 2020; 131:104013. [DOI: 10.1016/j.mvr.2020.104013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 01/18/2023]
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Lázaro-Martínez JL, García-Madrid M, García-Alamino JM, Bohbot S, García-Klepzig JL, García-Álvarez Y. Increasing Transcutaneous Oxygen Pressure in Patients With Neuroischemic Diabetic Foot Ulcers Treated With a Sucrose Octasulfate Dressing: A Pilot Study. INT J LOW EXTR WOUND 2020; 21:450-456. [DOI: 10.1177/1534734620952244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Regarding the positive clinical outcomes of sucrose octasulfate impregnated dressing documented in neuroischemic diabetic foot ulcers (DFUs), we aimed to evaluate the microcirculatory status in patients with neuroischemic DFU through the use of sucrose octasulfate dressing. Eleven patients with neuroischemic DFU were included in a prospective pilot study between July 2019 and March 2020. We evaluated the effect in transcutaneous oxygen pressure (TcPO2; mm Hg) values within the use of a sucrose octasulfate dressing in the course of the healing process of neuroischemic DFUs (UrgoStart Contact, Laboratoires Urgo Medical). TcPO2 values were assessed at day 0 and monthly until wound healing was achieved. Additionally, wound healing process was evaluated using the Wollina score system and wound area surface, at day 0 and monthly until 20 weeks of follow-up or wound healing first occurred. TcPO2 values showed a significant increase between day 0 (29.45 ± 7.38 mm Hg) and wound closure (46.54 ± 11.45 mm Hg, P = .016), after dressing application. Wollina wound scores showed a significant improvement (4.2 ± 1.7 at day 0 to 5.4 ± 1.3 at the end of the study; P = .004). Median wound area at day 0 was 1.30 cm2, interquartile range [1.60-1] cm2, and 0.5 cm2 at week 4, interquartile range [1.1-0.1], P < .001. Median healing time was 8 weeks, interquartile range [8-5]. Treating a neuroischemic DFU with a sucrose octasulfate dressing in the standard of care showed an increase in skin oxygen pressure.
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Affiliation(s)
- José Luis Lázaro-Martínez
- Diabetic Foot Unit, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Marta García-Madrid
- Diabetic Foot Unit, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | - Serge Bohbot
- Global Medical Affairs Director, Laboratoires URGO, Paris, France
| | | | - Yolanda García-Álvarez
- Diabetic Foot Unit, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Balasubramanian G, Vas P, Chockalingam N, Naemi R. A Synoptic Overview of Neurovascular Interactions in the Foot. Front Endocrinol (Lausanne) 2020; 11:308. [PMID: 32528410 PMCID: PMC7256167 DOI: 10.3389/fendo.2020.00308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/22/2020] [Indexed: 12/13/2022] Open
Abstract
Diabetes is a worldwide public health concern as it is associated with various complications. One of the major complications of diabetes is diabetic foot syndrome that results in catastrophic events such as ulceration and amputation. Therefore, the main four strategies of diabetic foot care involve risk prediction, prevention, and early diagnosis and prompt intervention. The drivers of ulceration are multifactorial, and importantly, include microcirculatory changes in the diabetic skin. Cutaneous microcirculation on the foot is greatly influenced by the small fibers which mediate thermal sensation and pain perception in addition to sympathetic activities such as thermoregulation and vasodilation. The interdependence between the neurovascular elements means with the loss of small fiber functions, the corresponding microcirculatory responses may be compromised. Thus, it can be hypothesized that the impairment of the microcirculation may follow the order of the corresponding small fiber nerve dysfunction or vice versa. In this review, select neurovascular investigations that inform the cutaneous microcirculatory and small fiber nerve function in response to pain, cold, and heat and pressure stimuli are reviewed and discussed in this order of sensory loss: the loss of pain, cold, warmth, touch and deep pressure sensation. We also discuss the neurological and vascular characteristics of each of these neurovascular responses. This review highlights the influence of small fibers on cutaneous microcirculation and the need for prospective studies that can determine the course of microcirculatory impairment over time. This, in turn, may help clarify the exact role of microcirculatory changes in the pathway of ulceration. The insights from this review can be pertinent to understand key microcirculatory disturbances and given that the microcirculatory impairment develops at an early stage, relevant interventions can be implemented to possibly reverse or regress the course of the disease. Therefore, knowledge of the neurovascular interactions aids to map the disease progression for early diagnosis and prevention of adverse complications.
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Affiliation(s)
- Gayathri Balasubramanian
- Centre for Biomechanics and Rehabilitation Technologies, Science Centre, Staffordshire University, Stoke-on-Trent, United Kingdom
| | - Prashanth Vas
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Science Centre, Staffordshire University, Stoke-on-Trent, United Kingdom
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Roozbeh Naemi
- Centre for Biomechanics and Rehabilitation Technologies, Science Centre, Staffordshire University, Stoke-on-Trent, United Kingdom
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Behforootan S, Chatzistergos PE, Chockalingam N, Healy A, Naemi R. Localized pressure stimulation using turf‐like structures can improve skin perfusion in the foot. Microcirculation 2019; 26:e12543. [DOI: 10.1111/micc.12543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 02/15/2019] [Accepted: 03/05/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Sara Behforootan
- Department of Surgery & Cancer Faculty of Medicine, Imperial College London London UK
- Centre for Biomechanics and Rehabilitation Technologies Staffordshire University Stoke‐on‐Trent UK
| | | | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies Staffordshire University Stoke‐on‐Trent UK
| | - Aoife Healy
- Centre for Biomechanics and Rehabilitation Technologies Staffordshire University Stoke‐on‐Trent UK
| | - Roozbeh Naemi
- Centre for Biomechanics and Rehabilitation Technologies Staffordshire University Stoke‐on‐Trent UK
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Edmonds M. Vascular disease in the lower limb in type 1 diabetes. Cardiovasc Endocrinol Metab 2019; 8:39-46. [PMID: 31646297 PMCID: PMC6739894 DOI: 10.1097/xce.0000000000000168] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/18/2019] [Indexed: 01/13/2023]
Abstract
This review considers peripheral arterial disease (PAD) in the diabetic ischaemic lower limb including both macrovascular and microvascular aspects. The presentation of PAD is probably not significantly different in type 1 compared with type 2 diabetes. PAD in diabetic patients is diffuse and located distally being most severe in the crural and also the foot arteries. It is associated with arterial calcification and occlusion of the arteries rather than stenosis. Compared with the nondiabetic patient, PAD develops at a younger age, and women are equally affected as men. It is not known whether the presentation of ischaemic lower limb disease in diabetes can be explained by one disease, namely, atherosclerosis, which has particular features peculiar to diabetes such as distal arterial involvement, or by the occurrence of two separate diseases: first, classical atherosclerosis and, second, a diabetic macroangiopathy, a term for nonatherosclerotic arterial disease in diabetes that is characterized by medial arterial calcification. Furthermore, there is controversy with regard to the significance of structural changes in the microcirculation of the diabetic foot.
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Santesson P, Lins PE, Kalani M, Adamson U, Lelic I, von Wendt G, Fagrell B, Jörneskog G. Skin microvascular function in patients with type 1 diabetes: An observational study from the onset of diabetes. Diab Vasc Dis Res 2017; 14:191-199. [PMID: 28467200 DOI: 10.1177/1479164117694463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The development of disturbances in skin microcirculation in type 1 diabetes is not well characterised. We assessed skin microcirculation longitudinally from the onset of diabetes up to 29 years of duration to investigate when such disturbances start. MATERIAL AND METHODS Seventeen adult patients with type 1 diabetes participated. Skin microvascular function in digit IV of the left hand was investigated by laser Doppler fluxmetry (LDF, arbitrary units [AU]). LDF was carried out at rest and following one-min arterial occlusion. Time to peak LDF (s) and percentage increase of LDF (post-occlusive reactive hyperaemia, PRH%) were determined. Retinopathy was assessed from fundus photographs or ophthalmoscopic recordings. RESULTS Skin microvascular function remained normal during the first five years. Compared with baseline and a non-diabetic reference group, time to peak LDF was prolonged after 7-9 years of diabetes ( p < 0.01). PRH% was lower than in the reference group after 7-9 years ( p < 0.01), and lower than baseline after 24-29 years of diabetes ( p < 0.05). All but one patient developed retinopathy and the first signs were found after 10 years of diabetes. CONCLUSIONS Functional disturbances in total skin microcirculation were observed after seven years in patients with type 1 diabetes and preceded diabetic complications such as retinopathy.
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Affiliation(s)
- Pia Santesson
- 1 Microcirculatory Laboratory, Division of Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Per-Eric Lins
- 1 Microcirculatory Laboratory, Division of Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Majid Kalani
- 2 Division of Cardiovascular Medicine, Department of Clinical sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Ulf Adamson
- 1 Microcirculatory Laboratory, Division of Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Isak Lelic
- 1 Microcirculatory Laboratory, Division of Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Gunvor von Wendt
- 3 Department of Medical Retina, Karolinska Institutet, St. Erik Eye Hospital, Stockholm, Sweden
| | - Bengt Fagrell
- 4 Department of Medicine, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Gun Jörneskog
- 1 Microcirculatory Laboratory, Division of Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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Fiordaliso F, Clerici G, Maggioni S, Caminiti M, Bisighini C, Novelli D, Minnella D, Corbelli A, Morisi R, De Iaco A, Faglia E. Prospective study on microangiopathy in type 2 diabetic foot ulcer. Diabetologia 2016; 59:1542-1548. [PMID: 27121168 DOI: 10.1007/s00125-016-3961-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 03/24/2016] [Indexed: 01/07/2023]
Abstract
AIMS/HYPOTHESIS We investigated the significance of microangiopathy in the development of foot ulcer, which is still disputed. METHODS We assessed microangiopathy by histological analysis of the capillary ultrastructure using transmission electron microscopy and capillary density and arteriolar morphology in paraffin-embedded sections from the skin of type 2 diabetic patients: 30 neuroischaemic patients (Isc) revascularised with peripheral angioplasty and 30 neuropathic patients (Neu) with foot ulcer, compared with ten non-diabetic volunteers. RESULTS In the diabetic patients, capillaries in the dermal papillary layer were fewer (-22.2%, 159 ± 43 vs 205 ± 52 mm(2) in non-diabetic volunteers, p < 0.01). They also showed detrimental remodelling, with a 2.2-fold increase in capillary basement membrane thickness (3.44 ± 1.19 vs 1.53 ± 0.34 μm in non-diabetic volunteers, p < 0.001) and a 57.7% decrease in lumen area (14.6 ± 11.1 vs 34.7 ± 27.5 μm(2), p < 0.001). No differences were observed between the diabetic Isc or Neu patients. Isc were more prone to develop arteriolar occlusion than Neu (16.8 ± 6.9% vs 6.7 ± 3.7%, respectively, p < 0.001). No patient had been amputated at 30 days and healing time was significantly longer in Isc (180 ± 120 vs 64 ± 50 days in Neu, p < 0.001). CONCLUSIONS/INTERPRETATION Capillary microangiopathy is present in equal measure in neuroischaemic and neuropathic diabetic foot skin. The predominance of arteriolar occlusions with neuroischaemia indicated the existence of an additional 'small vessel disease' that did not affect an effective revascularisation and did not worsen the prognosis of major amputations but slowed the healing process of the neuroischaemic foot ulcer. TRIAL REGISTRATION ClinicalTrials.gov NCT02610036.
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Affiliation(s)
- Fabio Fiordaliso
- Unit of Bio-Imaging, Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Via La Masa 19, 20156, Milan, Italy.
| | - Giacomo Clerici
- Diabetic Foot Center, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Serena Maggioni
- Unit of Bio-Imaging, Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Via La Masa 19, 20156, Milan, Italy
| | - Maurizio Caminiti
- Diabetic Foot Center, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Cinzia Bisighini
- Unit of Bio-Imaging, Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Via La Masa 19, 20156, Milan, Italy
| | - Deborah Novelli
- Unit of Bio-Imaging, Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Via La Masa 19, 20156, Milan, Italy
| | - Daniela Minnella
- Diabetic Foot Center, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Alessandro Corbelli
- Unit of Bio-Imaging, Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Via La Masa 19, 20156, Milan, Italy
| | - Riccardo Morisi
- Department of Orthopedics, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Alberto De Iaco
- Department of Ophthalmology, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Ezio Faglia
- Diabetic Foot Center, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
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Fernando ME, Seneviratne RM, Tan YM, Lazzarini PA, Sangla KS, Cunningham M, Buttner PG, Golledge J. Intensive versus conventional glycaemic control for treating diabetic foot ulcers. Cochrane Database Syst Rev 2016; 2016:CD010764. [PMID: 26758576 PMCID: PMC8627701 DOI: 10.1002/14651858.cd010764.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The estimated likelihood of lower limb amputation is 10 to 30 times higher amongst people with diabetes compared to those without diabetes. Of all non-traumatic amputations in people with diabetes, 85% are preceded by a foot ulcer. Foot ulceration associated with diabetes (diabetic foot ulcers) is caused by the interplay of several factors, most notably diabetic peripheral neuropathy (DPN), peripheral arterial disease (PAD) and changes in foot structure. These factors have been linked to chronic hyperglycaemia (high levels of glucose in the blood) and the altered metabolic state of diabetes. Control of hyperglycaemia may be important in the healing of ulcers. OBJECTIVES To assess the effects of intensive glycaemic control compared to conventional control on the outcome of foot ulcers in people with type 1 and type 2 diabetes. SEARCH METHODS In December 2015 we searched: The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; EBSCO CINAHL; Elsevier SCOPUS; ISI Web of Knowledge Web of Science; BioMed Central and LILACS. We also searched clinical trial databases, pharmaceutical trial databases and current international and national clinical guidelines on diabetes foot management for relevant published, non-published, ongoing and terminated clinical trials. There were no restrictions based on language or date of publication or study setting. SELECTION CRITERIA Published, unpublished and ongoing randomised controlled trials (RCTs) were considered for inclusion where they investigated the effects of intensive glycaemic control on the outcome of active foot ulcers in people with diabetes. Non randomised and quasi-randomised trials were excluded. In order to be included the trial had to have: 1) attempted to maintain or control blood glucose levels and measured changes in markers of glycaemic control (HbA1c or fasting, random, mean, home capillary or urine glucose), and 2) documented the effect of these interventions on active foot ulcer outcomes. Glycaemic interventions included subcutaneous insulin administration, continuous insulin infusion, oral anti-diabetes agents, lifestyle interventions or a combination of these interventions. The definition of the interventional (intensive) group was that it should have a lower glycaemic target than the comparison (conventional) group. DATA COLLECTION AND ANALYSIS All review authors independently evaluated the papers identified by the search strategy against the inclusion criteria. Two review authors then independently reviewed all potential full-text articles and trials registry results for inclusion. MAIN RESULTS We only identified one trial that met the inclusion criteria but this trial did not have any results so we could not perform the planned subgroup and sensitivity analyses in the absence of data. Two ongoing trials were identified which may provide data for analyses in a later version of this review. The completion date of these trials is currently unknown. AUTHORS' CONCLUSIONS The current review failed to find any completed randomised clinical trials with results. Therefore we are unable to conclude whether intensive glycaemic control when compared to conventional glycaemic control has a positive or detrimental effect on the treatment of foot ulcers in people with diabetes. Previous evidence has however highlighted a reduction in risk of limb amputation (from various causes) in people with type 2 diabetes with intensive glycaemic control. Whether this applies to people with foot ulcers in particular is unknown. The exact role that intensive glycaemic control has in treating foot ulcers in multidisciplinary care (alongside other interventions targeted at treating foot ulcers) requires further investigation.
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Affiliation(s)
- Malindu E Fernando
- College of Medicine and Dentistry, James Cook UniversityVascular Biology Unit, Queensland Research Centre for Peripheral Vascular DiseaseTownsvilleQueenslandAustralia4814
- Kirwan Community Health CampusPodiatry ServiceTownsvilleQueenslandAustralia
| | - Ridmee M Seneviratne
- College of Medicine and Dentistry, James Cook UniversityVascular Biology Unit, Queensland Research Centre for Peripheral Vascular DiseaseTownsvilleQueenslandAustralia4814
| | - Yong Mong Tan
- The Townsville HospitalDepartment of Diabetes and Endocrinology100 Angus Smith DriveTownsvilleQueenslandAustralia4814
| | - Peter A Lazzarini
- Queensland HealthAllied Health Research CollaborativeLevel 315 Butterfield StreetHerston, BrisbaneQueenslandAustralia4029
- Queensland University of TechnologySchool of Clinical SciencesBrisbaneQueenslandAustralia
| | - Kunwarjit S Sangla
- The Townsville HospitalDepartment of Diabetes and Endocrinology100 Angus Smith DriveTownsvilleQueenslandAustralia4814
| | - Margaret Cunningham
- University of StirlingNursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU)StirlingStirlingshireUKFK9 4LA
| | - Petra G Buttner
- Tropical Health Solutions Pty Ltd72 Kokoda StTownsvilleQueenslandAustralia4811
| | - Jonathan Golledge
- College of Medicine and Dentistry, James Cook UniversityVascular Biology Unit, Queensland Research Centre for Peripheral Vascular DiseaseTownsvilleQueenslandAustralia4814
- The Townsville HospitalDepartment of Vascular and Endovascular SurgeryTownsvilleQueenslandAustralia4814
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Fernando ME, Seneviratne RM, Cunningham M, Lazzarini PA, Sangla KS, Tan YM, Buttner PG, Golledge J. Intensive versus conventional glycaemic control for treating diabetic foot ulcers. Cochrane Database Syst Rev 2013. [DOI: 10.1002/14651858.cd010764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
Diabetic foot ulceration results from factors extrinsic to the foot such as repeated trauma, ischaemia and infection, as well as intrinsic factors that lead to impairment of wound healing. Intrinsic factors are less well understood, but include deficiency of growth factors, changes in extracellular matrix components with excess proteases, reduced fibroblast activity, cellular abnormalities, deficiencies of angiogenesis, nitric oxide abnormalities and hyperglycaemia. The scientific rationale of therapy is to correct both the external factors that cause diabetic foot ulcers and the internal factors that lead to impairment of wound healing. Current research is leading to new therapies that can be divided into the following classes: growth factors, skin substitutes, extracellular matrix proteins, stem cell therapy, gene therapy, protease inhibitors, angiogenesis stimulants, nitric oxide-releasing agents, adenosine agonists, immunostimulants, vasoactive compounds and granulating agents. These therapies should be considered when existing treatments to correct extrinsic factors have failed to heal ulceration in the diabetic foot.
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Affiliation(s)
- Nina Petrova
- Research Fellow, King's College Hospital, Diabetic Foot Clinic, London SE5 9RS, UK
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