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Diabetic Wound Healing Process

Diabetic Wound Healing Through Nutrition And Glycemic Control

Diabetic Wound Healing Through Nutrition And Glycemic Control

Diabetes has quickly become one of the most complex health challenges of the 21st century. In 2010, a total of 10.9 million US residents ages 65 years and older were reported to be living with diabetes.1 Currently, it is the seventh-leading cause of death in the US, totaling 4.6 million deaths in 2011 (with healthcare expenditures reaching more than $471 billion.)2 A condition that increases one’s risk for heart disease and stroke, diabetes is also the leading cause of kidney failure, new cases of blindness among adults, and non-traumatic lower-limb amputations. Approximately 15% of individuals who live with diabetes develop a foot ulcer, and 84% of this population will end up with lower-leg amputations.3 Several factors can disrupt wound healing. Without proper nutrition, a normal wound can rapidly become a chronic, infected wound. However, it is possible for wound care providers to reduce the huge economic burden and life-threatening complications of diabetes by implementing timely, easy-to-use interventions. Comprehensive diet and nutrition management have been shown to promote optimal glycemic control and facilitate wound prevention and healing. As such, all healthcare professionals should know how to adequately manage blood glucose levels to support wound healing in patients living with diabetes. This article explains how uncontrolled blood sugar impairs wound healing and offers practical nutrition recommendations and guidelines that promote healing, as well as simple suggestions to prevent further complications and comorbidities. Effect of Diabetes Diabetes often causes slow-healing wounds that can worsen rapidly — with elevated blood glucose levels serving as the initial barrier to healing. Thus, achieving optimal glycemic control is imperative. Hyperglycemia Continue reading >>

What Factors Help To Determine How Fast Wounds Heal For A Specific Person?

What Factors Help To Determine How Fast Wounds Heal For A Specific Person?

Wound healing is a dynamic physiological process, and the rate and quality of wound healing depends on many factors. Depending on the size, type, and location of wound the answer may vary a bit. Wound healing also depends on your psychological stress levels, any underlying health condition e.g., diabetes) and whether you are getting sufficient nutrients required to maintain optimum health. I happened to work on a project funded by the burn care unit of Shriners Hospitals for Children in Boston, specifically on understanding how isolation stress delays wound healing in pediatric patients with secondary and tertiary burn wounds, and how can we enrich their immediate environment to reduce their stress levels and promote faster wound healing. So my answer is based on what I learnt during the project. Here are some factors, I can think of, that affect the time and quality of wound healing. the amount of trauma on your tissues (depth of wound etc.) Blood supply to the wounded area. Infection Temperature of the wound bed (i.e. area of the wound) Moisture content of the wound bed Techniques used to manage the wound (dressings, bandages, sutures etc.) The general consensus among physicians I interacted with was that wound bed should be moist/wet for faster healing. Moist environment helps the inflammation stage of wound healing and reduces chances of infection. Moist environment results in slow and normal scab formation, beneath which debridement process starts where neutrophils and macrophages digest and remove dead (necrotic) tissues, cell debris, microbial contaminants, clearing the wound of any cellular barriers to healing process, and bring essential nutrients and oxygen through angiogenesis to the wound area to start epithelialization. Wound healing is a systemic process, Continue reading >>

6 Key Factors In Treating A Diabetic Wound

6 Key Factors In Treating A Diabetic Wound

Diabetic wound treatment methods require high attention to achieve healing. By 2030, it is estimated that more than 550 million people around the world will have diabetes. Approximately 25% of these diabetic patients will develop foot ulcers during their lifetime, which often require advanced diabetic wound treatment to prevent complications. To help achieve the optimal healing environment and protect against problems, there are six key factors to consider when treating diabetic wounds. 1. Wound Assessment Diabetic wounds fall into three categories: neuropathic, ischemic, and neuroischemic. Knowing the distinct features of each wound category is essential to identifying wound progression, infection, and healing. Failure to properly identify the type of wound that exists can lead to an ineffective diabetic wound treatment plan, causing long-term complications or amputation. 2. Tissue Debridement Wound debridement, or the removal of necrotic tissue from a wound, will reduce pressure, stimulate wound healing, allow for the inspection of underlying tissue, help with secretion or wound drainage, and optimize a wound dressing’s effectiveness. Clinicians typically recommend sharp debridement by scalpel or scissors, but there are other tissue-removal treatments they may recommend, including larval, autolytic, and ultrasonic. Only an experienced practitioner who knows which section of the tissue to remove without damaging blood vessels, nerves, or tendons should perform a debridement procedure. Understanding the importance of debridement to your diabetic wound treatment plan is often essential with advanced diabetic wounds. 3. Infection Control Infections are the top concern in any diabetic wound treatment plan. Due to the high morbidity and mortality rates associated with dia Continue reading >>

Foxo1 Deletion In Keratinocytes Improves Diabetic Wound Healing Through Mmp9 Regulation

Foxo1 Deletion In Keratinocytes Improves Diabetic Wound Healing Through Mmp9 Regulation

Keratinocyte migration is a key aspect of re-epithelialization during wound healing. Matrix metalloproteinase 9 (MMP9) contributes to this process and deficiencies in the MMP9 lead to impaired healing. Inappropriate expression of MMP9 also contributes to impaired re-epithelialization. Previously we demonstrated that FOXO1 was activated in wound healing but to higher levels in diabetic wounds. To address mechanisms of impaired re-epithelialization we examined MMP9 expression in vivo in full thickness dermal scalp wounds created in experimental K14.Cre+.Foxo1L/L mice with lineage-specific Cre recombinase deletion of floxed FOXO1 and compared the results to control littermates. MMP9 was induced during wound healing but at a significantly higher level in diabetic compared to normal wounds. FOXO1 deletion substantially blocked this increase. By chromatin immunoprecipitation FOXO1 was shown to bind to the MMP9 promoter, FOXO1 overexpression increased MMP9 transcriptional activity and increased MMP9 expression stimulated by high glucose was blocked by FOXO1 deletion or FOXO1 knockdown. We also show for the first time that high glucose impairs keratinocyte migration by inducing high levels of MMP9 expression and establish that it involves FOXO1. Thus, FOXO1 drives high levels of MMP9 expression in diabetic wound healing, which represents a novel mechanism for impaired re-epithelization in diabetic wounds. Chronic diabetic wounds are a common and potentially serious complication with considerable morbidity and associated financial costs. The disturbed physiologic function of epidermal keratinocytes plays a central role in the impaired wound healing in diabetes1. Factors involving keratinocytes that may contribute to the dysfunctional diabetic wound healing process include impair Continue reading >>

Diabetes And Its Effects On Wound Healing

Diabetes And Its Effects On Wound Healing

This article discusses the reasons why wounds in people with diabetes take longer to heal and are more susceptible to complications. The physiology of the wound healing process, and how this is affected by diabetes, is outlined. The article also explains why wounds in patients with diabetes are more prone to infection and discusses preventive measures. Correspondence [email protected] Nursing Standard. 25, 45,41-47. doi: 10.7748/ns2011.07.25.45.41.c8626 Peer review This article has been subject to double blind peer review You need a subscription to read the full article Continue reading >>

Chronic Wound

Chronic Wound

A chronic wound is a wound that does not heal in an orderly set of stages and in a predictable amount of time the way most wounds do; wounds that do not heal within three months are often considered chronic.[1] Chronic wounds seem to be detained in one or more of the phases of wound healing. For example, chronic wounds often remain in the inflammatory stage for too long.[2][3] To overcome that stage and jump-start the healing process a number of factors need to be addressed such as bacterial burden, necrotic tissue, and moisture balance of the whole wound.[4] In acute wounds, there is a precise balance between production and degradation of molecules such as collagen; in chronic wounds this balance is lost and degradation plays too large a role.[5][6] Chronic wounds may never heal or may take years to do so. These wounds cause patients severe emotional and physical stress and create a significant financial burden on patients and the whole healthcare system.[7] Acute and chronic wounds are at opposite ends of a spectrum of wound-healing types that progress toward being healed at different rates.[8] Signs and symptoms[edit] Chronic wound patients often report pain as dominant in their lives.[9] It is recommended that healthcare providers handle the pain related to chronic wounds as one of the main priorities in chronic wound management (together with addressing the cause). Six out of ten venous leg ulcer patients experience pain with their ulcer,[10] and similar trends are observed for other chronic wounds. Persistent pain (at night, at rest, and with activity) is the main problem for patients with chronic ulcers.[11] Frustrations regarding ineffective analgesics and plans of care that they were unable to adhere to were also identified. Cause[edit] In addition to poor circ Continue reading >>

What’s The Connection Between Diabetes And Wound Healing?

What’s The Connection Between Diabetes And Wound Healing?

Diabetes is a result of your body’s inability to produce or use insulin. Insulin is a hormone that allows your body to turn glucose, or sugar, into energy. If your body has difficulty metabolizing glucose, it can lead to high blood sugar levels. This can affect your body’s ability to heal wounds. In people with diabetes, wounds tend to heal more slowly and progress more quickly, so it’s important to know what to look out for. Although cuts, grazes, scratches, and blisters can occur anywhere on the body, the feet are one of the most common places of injury. A small wound on the foot can quickly develop into a foot ulcer. Foot ulcers can become serious if left untreated. Between 14 and 24 percent of people who have diabetes and develop an ulcer will end up having a lower limb amputation. For this reason, it’s crucial that you do regular self-checks and closely monitor any wounds closely. Catching wounds early is the only way to reduce your risk of complications. Keep reading to learn more about the healing process, ways to speed the healing process along, and how to improve your body’s healing powers long-term. When you have diabetes, a number of factors can affect your body’s ability to heal wounds. High blood sugar levels Your blood sugar level is the main factor in how quickly your wound will heal. When your blood sugar level is higher than normal, it: prevents nutrients and oxygen from energizing cells prevents your immune system from functioning efficiently increases inflammation in the body’s cells These effects slow down wound healing. Neuropathy Peripheral neuropathy can also result from having blood sugar levels that are consistently higher than normal. Over time, damage occurs to the nerves and vessels. This can cause the affected areas to lose sen Continue reading >>

How Diabetes Affects Wound Healing

How Diabetes Affects Wound Healing

Diabetes is characterized by the body’s inability to produce insulin and/or use it properly due to high blood glucose levels. The American Diabetes Association estimates that approximately 25 million people in the United States alone have diabetes, about 7 million of whom are undiagnosed. One of the most common complications of diabetes is chronic wounds that primarily affect the feet. Diabetes inhibits the body’s natural wound-healing capabilities, which means chronic wounds can quickly become severe and develop infections if left untreated. Diabetes affects wound healing in a variety of ways, including: Reduced circulation – High blood glucose levels can cause the blood vessels to constrict, which reduces blood flow to the extremities. Circulation is an essential part of the body’s natural wound-healing process, as the blood delivers oxygen to the wound and helps to fight infection. Neuropathy – Loss of circulation can cause nerve damage in the feet, which limits sensation. Someone with diabetic neuropathy may not realize they have developed wounds on their feet, or may be more prone to foot injuries. Immune system deficiency – High glucose levels can affect the body’s immune system, which can increase the risk of wound infection in the feet and inhibit the body’s natural healing process. You can also review our other online resources to learn more about When to Seek Professional Wound Care, Seven Tips for Preventing Foot Sores, and Nutritional Guidelines for Wound Care. Diabetic Wound Treatment in the Tampa Bay Area If you are suffering from diabetic foot ulcers, BayCare offers a variety of advanced wound treatments at our Tampa Bay area wound care centers. Treatments include hyperbaric oxygen chamber therapy, bioengineered wound grafting, total conta Continue reading >>

Original Research Sida Cordifolia Linn. Accelerates Wound Healing Process In Type 2 Diabetic Rats

Original Research Sida Cordifolia Linn. Accelerates Wound Healing Process In Type 2 Diabetic Rats

Abstract Sida cordifolia Linn. (Hindi—kungyi; Sanskrit—bala) is a shrub (family Malvaceae) grown all over India. In Ayurveda, the crushed leaves of the plant is used for the treatment and dressing of wounds. Traditionally, root juice is also used to promote the healing of wounds. This study was designed to evaluate the wound healing potential of hydrogel of methanolic extract of Sida cordifolia Linn. (MeOHSC) in diabetic rats. The methanolic extract in the form of hydrogel was applied topically for the management of wounds in fructose-fed streptozotocin-induced diabetic rats. The % wound contraction, period of epithelialization, hydroxyproline content, and histopathological examination were evaluated using the excision wound model, and tensile strength was measured using the incision wound model. The results showed that in both models, hydrogel of MeOHSC was found to have significant wound healing activity compared with diabetic wound control in terms of % wound contraction (p < 0.01), period of epithelialization (p < 0.01), and hydroxyproline content (p < 0.01) in the excision model, and tensile strength (p < 0.01) in the incision model. The presence of collagen fibers and stronger growth of epithelial cells were observed in hydrogel of MeOHSC than in the diabetic wound control group. Our findings suggest that hydrogel of MeOHSC has a potential benefit in enhancing the wound healing process in diabetic condition. This is possibly because of the presence of phenolic compounds and confirmation of gallic acid in the extracts. Continue reading >>

Healing Of Diabetic Foot Ulcers And Pressure Ulcers With Human Skin Equivalenta New Paradigm In Wound Healing

Healing Of Diabetic Foot Ulcers And Pressure Ulcers With Human Skin Equivalenta New Paradigm In Wound Healing

Hypothesis In patients with diabetic foot and pressure ulcers, early intervention with biological therapy will either halt progression or result in rapid healing of these chronic wounds. Design In a prospective nonrandomized case series, 23 consecutive patients were treated with human skin equivalent (HSE) after excisional debridement of their wounds. Setting A single university teaching hospital and tertiary care center. Patients and Methods Twenty-three consecutive patients with a total of 41 wounds (1.0-7.5 cm in diameter) were treated with placement of HSE after sharp excisional debridement. All patients with pressure ulcers received alternating air therapy with zero-pressure alternating air mattresses. Main Outcome Measure Time to 100% healing, as defined by full epithelialization of the wound and by no drainage from the site. Results Seven of 10 patients with diabetic foot ulcers had complete healing of all wounds. In these patients 17 of 20 wounds healed in an average of 42 days. Seven of 13 patients with pressure ulcers had complete healing of all wounds. In patients with pressure ulcers, 13 of 21 wounds healed in an average of 29 days. All wounds that did not heal in this series occurred in patients who had an additional stage IV ulcer or a wound with exposed bone. Twenty-nine of 30 wounds that healed did so after a single application of the HSE. Conclusions In diabetic ulcers and pressure ulcers of various durations, the application of HSE with the surgical principles used in a traditional skin graft is successful in producing healing. The high success rate with complete closure in these various types of wounds suggests that HSE may function as a reservoir of growth factors that also stimulate wound contraction and epithelialization. If a wound has not fully h Continue reading >>

How Diabetes Affects Wound Healing

How Diabetes Affects Wound Healing

Diabetes is a condition in which the body does not effectively use sugar. It is estimated that there are nearly 18 million Americans with diabetes, and approximately 15 percent of diabetics will develop a foot ulcer at some point. Foot ulcers are the most common wounds for this patient population. Wound healing can be slowed when the patient is diabetic. An important point to remember about a diabetic patient wound is that it heals slowly and can worsen rapidly, so requires close monitoring. There are several factors that influence wound healing in a diabetic patient, and may include: Blood Glucose Levels It all starts here. An elevated blood sugar level stiffens the arteries and causes narrowing of the blood vessels. The effects of this are far-reaching and include the origin of wounds as well as risk factors to proper wound healing. Poor Circulation Narrowed blood vessels lead to decreased blood flow and oxygen to a wound. An elevated blood sugar level decreases the function of red blood cells that carry nutrients to the tissue. This lowers the efficiency of the white blood cells that fight infection. Without sufficient nutrients and oxygen, a wound heals slowly. Diabetic Neuropathy When blood glucose levels are uncontrolled, nerves in the body are affected and patients can develop a loss of sensation. This is called diabetic neuropathy. When there is a loss of sensation, patients cannot feel a developing blister, infection or surgical wound problem. Because a diabetic patient may not be able to feel a change in the status of a wound or the actual wound, the severity can progress and there may be complications with healing. Immune System Deficiency Diabetes lowers the efficiency of the immune system, the body's defense system against infection. A high glucose level ca Continue reading >>

Mechanism Identified Behind Impaired Wound Healing In Diabetics

Mechanism Identified Behind Impaired Wound Healing In Diabetics

A molecule has been identified by researchers at the University of Pennsylvania School of Dental Medicine that may explain why wound healing is impaired in people with diabetes. The scientists behind the discovery believe the molecule may also offer a new target for therapies that could improve healing. About 15% of diabetics will have a non-healing wound at some point in their lifetime, and in some cases, these non-healing open ulcers can be so severe that they lead to amputations. In 2013, a study found - contrary to previous research - that the Foxo1 molecule promotes healing by both protecting cells against oxidative stress and inducing a molecule called TGF-β1 that is critical for wound healing. The Penn team wanted to investigate whether these mechanisms are also implicated in the reduced capacity for wound healing among people with diabetes. To do this, the researchers first created small wounds on the tongues of mice with diabetes and a control group of non-diabetic mice. The wounds of the diabetic mice - as might be expected - healed more slowly than the control mice. The team then repeated this experiment in mice bred to lack Foxo1 in a type of cell called keratinocytes, which "fill in" the holes left by injuries. The researchers were surprised to find that the absence of the Foxo1 protein and FOXO1 gene in the keratinocytes appeared to cause the diabetic mice to heal more quickly. Next, the team experimented with cells in culture. The researchers found that cells grown in a "high-sugar media" were less able to move and proliferate, compared with cells grown in standard solution. The same slowed proliferation of cells was observed by the researchers in diabetic mice; because the cells were slow to proliferate, they closed the wound over the keratinocyte filli Continue reading >>

Why Are People With Diabetes Prone To Developing Chronic Wounds?

Why Are People With Diabetes Prone To Developing Chronic Wounds?

Wound Healing in Diabetes The diabetic ulcer is an excellent example of how multiple physiologic and biochemical defects can lead to impaired wound healing. Fifteen percent of patients suffering from DM will suffer a foot ulcer in their lifetime[1]. Patients with DM show a 5-50 fold higher risk of non-traumatic amputation compared with non-diabetic individuals[2]. Nearly 50% of all non-traumatic lower extremity amputations performed in the US are due to DM[3]. The reasons for poor wound healing in DM are many and varied. Diabetic foot ulcers are often caused by repetitive mechanical stress, unrecognised by the patient because of peripheral neuropathy and loss of protective sensation. In addition, the presence of peripheral vascular disease and infection can lead to poor healing of foot wounds and to the development of gangrene. An acute wound in a diabetic patient or a constant and persistent level of trauma, may lead to the development of one of these troublesome wounds. Chronic wounds appear to become “stuck” in the inflammatory and proliferative phases of wound healing. This allows for repeated injury, infection and inflammation. All of this impairs full wound closure. There is evidence to suggest that chronic and especially diabetic wounds are deficient in some of the key growth factors necessary for effective and efficient wound healing. Cooper et al showed that a number of growth factors were markedly reduced in the wound fluid of chronic wounds compared to acute wounds[4]. In a study by Grotendorst et al diabetic rats exhibited a 50% reduction in the amount of hydroxyproline present on days 20 and 30 of wound healing in streptozotocin induced diabetic rats as compared to normal rats[5]. Treatment with platelet derived growth factor (PDGF), restored the rate o Continue reading >>

Enluxtra Helps Heal Diabetic Wounds Faster

Enluxtra Helps Heal Diabetic Wounds Faster

ENLUXTRA Smart Self-Adaptive Dressing is the first and only self-regulating superabsorbent fiber dressing with adaptive absorbencyand built-in adaptive hydration function. The dressing utilises patented smart polymers for sensing the underlying tissue conditions and adapting local functions accordingly, in order to reliably maintain sustainable moist healing environment and gently cleanse a wound when needed. PRESCRIBING U.S. PROFESSIONAL? ​For diabetic foot patients, Enluxtra clinical studies show outstanding results. Diabetes makes healing process much more sensitive to deviations from ideal healing conditions. Enluxtra makes healing easier by continuously adapting the dressing's function to every part of the wound individually, down to every square millimeter. ​ Enluxtra is the only dressing that controls what is going on in the wound and adjusts its properties on the fly: 1. If parts of the wound are exuding large amounts of fluid, Enluxtra absorbs and retains the fluid inside itself, preventing maceration. 2. At the same time, if any part of the wound becomes too dry, Enluxtra is able to provide moisture exactly to that part, preventing desiccation. 3. Sustainable moist wound environment, created by Enluxtra, supports effective natural autolysis of non-viable tissues. Autolytic process is gentle and selective, it affects ONLY non-viable tissues while they are present in a wound, and STOPS when the wound becomes clean, so viable tissues are protected. 4. Unlike any other dressing, Enluxtra is able to effectively evacuate microorganisms, disintegrated biofilms, and liquefied components of slough and necrotic tissue, as well as other pro-inflammatory components, from the wound. This fast non-traumatic natural cleansing process stops chronic inflammation and accele Continue reading >>

Diabetic Wound Care

Diabetic Wound Care

What is a Diabetic Foot Ulcer? A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, 6 percent will be hospitalized due to infection or other ulcer-related complication. Diabetes is the leading cause of non-traumatic lower extremity amputations in the United States, and approximately 14-24 percent of patients with diabetes who develop a foot ulcer will require an amputation. Foot ulceration precedes 85 percent of diabetes-related amputations. Research has shown, however, that development of a foot ulcer is preventable. Causes Anyone who has diabetes can develop a foot ulcer. Native Americans, African Americans, Hispanics, and older men are more likely to develop ulcers. People who use insulin are at higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers. Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma, as well as duration of diabetes. Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of ability to feel pain in the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often can occur without pain, and one may not even be aware of the problem. Your podiatrist can test feet for neuropathy with a simple, painless tool called a monofilament. Vascular disease can complicate a foot ulcer, reducing the body's ability to heal and increasing the risk for an infection. Elevations in blo Continue reading >>

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