Combating The Impact Of Oxygen Free Radicals On DFU Healing

Start Page: 24
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Author(s): 
Jeffrey A. Niezgoda, MD, FACHM, FAPWCA, Kimberly Eldridge, RN, CWS, Richard Millis, PhD, Milton Kondiles, DPM, and Rebecca D. Snarski, PhD

   Moist dressings are helpful in creating a moist environment that can promote better healing than dry dressings.1 Whirlpool therapy is sometimes effective to clean wounds and stimulate circulation, particularly in necrotic wounds with high levels of exudate.5

   Even aggressive treatments with these procedures do not fully address or correct the underlying cause of diabetic foot ulcers. Neuropathy, tissue ischemia, tissue hypoxia and excess oxygen free radicals continue to place the patient with diabetes at risk for deterioration of the foot ulcers and ultimately at risk
for amputation.3

How Oxygen Free Radicals Impact Diabetic Wound Healing

Oxygen is an important part of good healing. By contrast, the healing process often generates oxygen free radicals, which can cause inflammation and slow healing, and can destroy surrounding healthy tissue.6,7 In healthy individuals, the cell damaging effects of oxygen-derived free radicals is mitigated by antioxidant defense and scavenging systems.6

   However, the presence of diabetes forces the oxidant/antioxidant balance into disequilibrium.6 Nonenzymatic protein glycosylation and glucose auto-oxidation are the two most cited factors that can disrupt the control of oxygen free radicals and antioxidants in patients who have diabetes. Diabetic wound healing can be so significantly compromised that mortality rates are very high with chronic foot wounds. In fact, up to 25 percent of all hospital admissions involving patients with diabetes are related to foot complications, including ulcers.8

   Combined with ischemic and neuropathic complications, the introduction of uncontrolled oxygen free radicals further serves to compromise patients with diabetes. Oxygen free radicals can cause damage at the cellular level, which can make treating diabetic foot wounds through traditional methods even less effective. However, there are some effective treatments to help re-oxygenate the wound and minimize the damage caused by radicals.

   Researchers have studied the effect of hypoxia in those with diabetes at length. Furthermore, diabetes results in many complications and cellular discrepancy, including the reduced ability to produce antioxidants, leading to an oxygen free radical imbalance. Numerous studies have shown a direct correlation between delayed wound healing and the presence of excess oxygen free radicals.9 Excessive amounts of reactive oxygen molecules can lead to exacerbation of diabetic foot disease, deterioration of foot ulcers and refractory healing of these wounds. Ultimately, the patient with diabetes is at high risk for amputation and extreme rates of morbidity.

A Closer Look At Modalities That May Address Oxygen Issues In Wound Healing

In order to mitigate the damaging effects of oxygen free radicals and to offset the complications of hypoxia and ischemia often present with diabetic foot ulcers, an increasingly popular treatment is hyperbaric oxygen therapy (HBOT).10 During hyperbaric treatment, the patient breathes 100 percent oxygen while being exposed to increased atmospheric pressure.3,10,11 An effective wound healing treatment for over 40 years, HBOT helps bring the healing effects of oxygen to a wound while decreasing inflammation, assisting white blood cells and helping to kill bacteria.3 While HBOT is often effective, it is time consuming and expensive as it often requires up to 30 treatments. Accordingly, the use of HBOT is typically limited to treating patients with infections or gangrene, who are at extreme risk for limb loss.12

   Wounds that heal quickly heal the most efficiently and with the fewest complications.13 It is clear that newer and alternative treatments are necessary for the proper, expeditious treatment of the diabetic foot. Novel therapies for the control of oxygen free radicals are under investigation. Topical gels with oxygen free radical scavenging properties have been developed and approved for patient use.

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