Wound healing and diabetes mellitus☆

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Clinical presentation

Most chronic wound problems in diabetes mellitus involve the feet. Other areas may be involved, but for many reasons that are discussed later, feet are the most commonly affected area [2], [3]. The classic chronic ulcer in diabetes mellitus is a relatively small, punctate wound that lies on the plantar surface beneath a deformed metatarsal head. This site is most often affected because of neuropathy and anatomic changes in the arch. Because of insensitivity, pressure is a major contributor to

Factors contributing to altered healing

There are many factors that contribute to the altered tissue repair of diabetes mellitus [1], [2], [3], [4], [5], [6]. Some factors are related to a diabetic patient's predisposition to diseases such as atherosclerosis or renal failure. Another factor is related to the predisposition to the development of neuropathy. The reduced ability to deal with infection is another contributing factor. Finally, there are cellular, metabolic, and biochemical factors that have been found to contribute to

Treatment of diabetic wound problems

Once a diabetic patient develops an ulcer in a lower extremity, adequate care should be instituted to prevent infection and ultimately, amputation. The outcome for routine care of diabetic foot ulcers has been well documented and is actually quite discouraging (see Table 1 ). Oyibo et al [31] followed 194 patients with diabetic foot ulcers for 1 year. These patients were treated with routine saline soaked dressing changes. The mean age of the patients was 56.6 years, and the duration of

Summary

Diabetes mellitus is one of the major contributors to chronic wound healing problems. When diabetic patients develop an ulcer, they become at high risk for major complications, including infection and amputation. The pathophysiologic relationship between diabetes and impaired healing is complex. Vascular, neuropathic, immune function, and biochemical abnormalities each contribute to the altered tissue repair. Despite treatment of these chronic wounds, which involves tight glucose control and

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    This work was supported by the Shriners of North America.

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