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Bioengineered skin substitute considerations in the diabetic foot ulcer
1From the Clinical Professor Surgery (Plastic), Director Laboratory for Tissue Engineering & Regenerative Medicine Aesthetic & Plastic Surgery Institute, University of California, Irvine and Adar Science Inc, Irvine, CA.
Annals of Plastic Surgery
|March 21, 2013
Summary
Diabetic foot ulcers, a major cause of amputations, can be treated with advanced skin substitutes. Newer therapies aim to improve healing by targeting underlying issues like poor blood vessel formation and inflammation caused by diabetes.
Area of Science:
- Biomedical Engineering
- Regenerative Medicine
- Diabetology
Background:
- Diabetic foot ulcers are a significant global health issue, leading to nontraumatic lower limb amputations.
- Hyperglycemia in diabetes impairs vasculogenesis and immune function, hindering wound healing and increasing infection risk.
Purpose of the Study:
- To explore the potential of novel bioengineered skin substitutes for treating stalled diabetic foot ulcers.
- To identify key pathophysiologic events in diabetic wound healing that can be targeted by advanced therapies.
Main Methods:
- Review of molecular biology advances in understanding diabetic wound pathophysiology.
- Analysis of the role of vasculogenesis impairment, advanced glycation end products, and inflammation in stalled wounds.
- Discussion of potential therapeutic agents for incorporation into next-generation skin substitutes.
Main Results:
- Identified impaired vasculogenesis due to hyperglycemia and advanced glycation end products as a primary barrier to healing.
- Highlighted the detrimental effects of glycation end products on immunity and inflammation, increasing infection susceptibility.
- Proposed incorporating agents like reactive oxygen species scavengers, methylglyoxal scavengers, and vascular endothelial growth factor stimulators into scaffolds.
Conclusions:
- Next-generation bioengineered skin substitutes offer a promising approach for focused treatment of diabetic foot ulcers.
- Targeting intrinsic healing mechanisms by addressing hyperglycemia-induced pathophysiology is crucial for sustained wound repair.
- Future interventions should focus on scaffolds incorporating specific agents to overcome key barriers in diabetic wound healing.
Related Concept Videos
01:31Diabetic Foot Ulcer
Definition A diabetic foot ulcer (DFU) is a chronic, non-healing wound that develops in individuals with diabetes. It typically occurs on pressure-bearing areas such as the heel, metatarsal heads, or hallux, and carries a high risk of infection and amputation.Pathophysiology • The development of DFUs can be explained by four interconnected mechanisms: neuropathy, ischemia, infection, and impaired wound healing. • Neuropathy is the most common factor. Sensory neuropathy reduces pain perception,...
01:19Clinical Applications of Epidermal Stem Cells
Epidermal stem cells (EpiSCs) are mainly located at the basal layer of the epidermis. These cells repair minor injuries of the skin and replace dead skin cells. However, EpiSCs’ cannot heal severe wounds such as major burns or those from diabetes or hereditary disorders. In such cases, culturing the epidermal stem cells from the patient is possible and has yielded successful treatment options, such as laboratory-grown skin grafts. These grafts are synthesized using a patient’s own EpiSCs...
01:22Burn Injuries
Burn injuries occur when the skin and underlying tissues are damaged due to exposure to heat, electricity, chemicals, radiation, or friction. They can vary in severity, from minor superficial burns to severe deep burns that can be life-threatening.
The damage results in the death of skin cells, which can lead to a massive loss of fluid. Dehydration, electrolyte imbalance, and renal and circulatory failure follow, which can be fatal. Burn patients are treated with intravenous fluids to offset...
The damage results in the death of skin cells, which can lead to a massive loss of fluid. Dehydration, electrolyte imbalance, and renal and circulatory failure follow, which can be fatal. Burn patients are treated with intravenous fluids to offset...