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Preparation of the Wound Bed of the Diabetic Foot Ulcer

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The Diabetic Foot

Part of the book series: Contemporary Diabetes ((CDI))

Abstract

Diabetic ulcers are chronic wounds which, despite recent advanced therapies, still fail to heal; they result in infection and high amputation rates. Hyperglycemia induces the majority of micro- and macrovascular complications associated with impaired wound healing. Wound bed preparation (WBP) is an essential step of diabetic wound management in order to accelerate endogenous healing and/or facilitate the effectiveness of other therapies. The aim of WBP is to remove the barriers that impair wound healing, including the presence of necrotic tissue, senescent cells, altered extracellular matrix, hypoxia, high bacterial burden, and inflammatory enzymes within the wound bed. There are several steps for achieving WBP, including debridement, reduction of the bacterial burden, management of edema and exudate, and correction of resident cell abnormalities. Here we provide an overview of the current status, role, and key elements of WBP in the context of diabetic ulcers. We will also introduce a reappraisal of WBP.

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Abbreviations

bFGF:

Basic fibroblast growth factor

DNA:

Deoxyribonucleic acid

ECM:

Extracellular matrix

EGF:

Epithelial growth factor

EPCs:

Bone marrow-derived endothelial progenitor cells

FDA:

Food and Drug Administration

HBOT:

Hyperbaric oxygen therapy

iPSCs:

Human induced pluripotent stem cells

M1:

Macrophages proinflammatory phenotype

M2:

Macrophages anti-inflammatory and prohealing phenotype

MMP-9:

Metalloproteinase-9

MSC:

Mesenchymal stem cells

PDGF-BB:

Platelet-derived growth factor BB

PRP:

Plasma rich in platelets

rhEGF:

Human recombinant epidermal growth factor

TGF-β:

Transforming growth factor beta

TIME:

Necrotic Tissue, Infection/Inflammation, Moisture balance, healing of Edge of wound

VEGF:

Vascular endothelium growth factor

WBP:

Wound bed preparation

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Authors and Affiliations

  1. Department of Dermatology, Boston University School of Medicine, Boston, MA, USA

    Marta Otero-Viñas PhD & Vincent Falanga MD, FACP

  2. Faculty of Sciences and Technology, The Tissue Repair and Regeneration Laboratory, University of Vic—Central University of Catalonia, Vic, Spain

    Marta Otero-Viñas PhD

  3. Department of Biochemistry, Boston University School of Medicine, Boston, MA, USA

    Vincent Falanga MD, FACP

Authors
  1. Marta Otero-Viñas PhD
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  2. Vincent Falanga MD, FACP
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Correspondence to Vincent Falanga MD, FACP .

Editor information

Editors and Affiliations

  1. Rongxiang Xu, MD, Professor of Surgery, Harvard Medical School Director, The Rongxiang Xu, MD, Center for Regenerative Therapeutics Research Director, Joslin-Beth Israel Deaconess Foot Center Beth Israel Deaconess Medical Center, Boston, MA, USA

    Aristidis Veves

  2. Chief, Division of Podiatry, Beth Israel Deaconess Medical Center, Associate Professor of Surgery, Harvard Medical School, Co-director, Joslin-Bl Deaconess Diabetic Foot Center Consultant, Joslin Diabetes Center, Boston, MA, USA

    John M. Giurini

  3. Associate Professor of Surgery, Harvard Medical School, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Joslin Diabetes Center, Boston, MA, USA

    Raul J. Guzman

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Otero-Viñas, M., Falanga, V. (2018). Preparation of the Wound Bed of the Diabetic Foot Ulcer. In: Veves, A., Giurini, J., Guzman, R. (eds) The Diabetic Foot. Contemporary Diabetes. Humana, Cham. https://doi.org/10.1007/978-3-319-89869-8_16

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