The Microenvironment of DFU. Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetic foot team Diabetes and Endocrinology Unit Mansoura University. What happens when wound occur in the skin. wound healing start immediately and can be categorized into 4 stages. Coagulation
Mamdouh Radwan El-Nahas
Professor of Internal Medicine
Diabetic foot team
Diabetes and Endocrinology Unit
wound healing start immediately and can be categorized into 4 stages.
of fibrin and fibronectin
(type III, type I)
by enzymatic action
Matrix metalloproteinases (MMPs)
tissue inhibitors of metalloproteinases
Exudates from chronic wounds contain very high levels of inflammatory cytokines and proteases.
Removal of the excess exudates can be accomplished by:
The ancient Egyptians used a combination of:
(Goddess) of Healing
In microenvironmental terms we can think of Debridement as removal of old cells giving space to new cells to start wound healing.
low-energy laser has a stimulating effect on cell mitosis, keratinocyte migration, proliferation and cytokine production and it may lead to increased dermal angiogenesis
Silver-containing dressings are effective in sequestering matrix metalloproteinase-2 and -9 (walker et al 2007).
Walker et al: In vitro studies to show sequestration of matrix metalloproteinases by silver-containing wound care products. Ostomy Wound Manage. 2007 Sep;53(9):18-25.
PDGF gel (Regranex) improved healing quality, enhanced angiogenesis, cell proliferation and epithelialization (Li et al 2007).
Recombinant human epidermal growth factor (REGEN-D™ 150) has been found to result in healthy granulation and stimulate epithelization (Mohan 2007).
Successful in experimental animals (Galeano et al 2003) but clinical trials using VEGF therapy did not succeed in ameliorating healing as expected (Yla-Herttuala 2006)
The chronic wound is not the acute wound
Successful Treatment of DFU depends on how we understand the complex and dynamic interaction of multiple factors that contribute to chronicity of the wound.
Only then, when we put together what we
‘take off the wound’ (pressure)
what we ‘put on’ the wound (advanced dressings)
will we see any real improvement in wound healing