Combating The Impact Of Oxygen Free Radicals On DFU Healing

Jeffrey A. Niezgoda, MD, FACHM, FAPWCA, Kimberly Eldridge, RN, CWS, Richard Millis, PhD, Milton Kondiles, DPM, and Rebecca D. Snarski, PhD

For those with diabetes, careful management of blood sugar is imperative to prevent any number of complications, including those that contribute to poor wound healing, which is so common in diabetes.

   One such problem is the development of foot ulcers, which reportedly affects 15 percent of individuals with diabetes.1,2 Diabetic foot ulcers are significant problems as they can lead to amputation of a patient’s foot or even the entire leg.1 In fact, more than half of the people who undergo lower limb amputations in the United States each year suffer from diabetes.3

   Due to the serious issue of wound healing in patients with diabetes, it is important for those living with the disease to understand the nature of foot wounds and the current technology available in wound care. This technology includes new treatments that can promote fast healing and prevent wounds from becoming chronic.

   While foot ulcers can sometimes be shallow, they are often quite thick, extending through multiple skin layers. These wounds usually have low oxygen levels due to poor circulation (ischemia) or include injury to the nervous system (neuropathy). Uncontrolled blood sugar levels can lead to both. Once a foot ulcer occurs, ischemia can lead to slow healing and tissue death while the neuropathic loss of sensation can cause the wound to go unnoticed and untreated. In patients with diabetes, foot ulcers often become chronically non-healing wounds and 85 percent of amputations are preceded by ulceration.2

   Other diabetic conditions can exacerbate these ulcers. Approximately 60 to 70 percent of patients with diabetes develop diabetic neuropathy.4 This is a form of nerve damage caused by prolonged abnormal elevations in blood sugar. Diabetic neuropathy places a person at significant risk for the development of foot ulcers as the nerve damage decreases the sensation in the foot. Patients with diabetic neuropathy can no longer sufficiently detect trauma as their pain sensation is blunted. It is common for a patient with diabetic neuropathy to walk all day on a blister or not notice the pain from a needle or nail that has punctured his or her foot. Accordingly, the wound goes untreated and may become more serious as a result.

   Those with diabetes frequently experience poor blood flow to their legs, feet and toes due to another complication of diabetes, peripheral arterial disease (PAD), the narrowing of the blood vessels that carry blood to the legs. Such circulation issues can make skin injuries worse or prevent healing in patients with diabetic foot ulcers. Decreased blood flow results in ischemia (the limitation of oxygen delivery to the tissues) or hypoxia (abnormal oxygen levels in blood and tissue).4 Since oxygen is a necessary component of cell regeneration, ischemic and hypoxic tissue is less likely to heal, and is also at higher risk for infection.

   The combination of neuropathy and PAD often results in foot ulcers that deteriorate rather than heal. Complications related to chronic diabetic foot ulcers include cellulitis, osteomyelitis and gangrene. All of these issues place the patient with diabetes at a high risk for amputation, making aggressive and early treatment of such foot wounds essential.

Do Traditional Treatments Address The Underlying Causes Of DFUs?

Traditionally, several different methods have been used to treat diabetic foot wounds or ulcers. Physicians sometimes prescribe casts and bed rest to reduce pressure and repeated trauma. While preventing additional injury is important, this does not help circulation or actual healing.

   While topical antibiotics can help prevent infection, they do not necessarily speed healing. Furthermore, overuse of antibiotics can lead to antibiotic resistance, which can be a serious problem for those with diabetes.

   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

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