Non-Healing Diabetic Wounds, Vascularization & Amniotic Grafts

By Dr. Brian K. Bailey, Podiatric Physician & Surgeon

Non-Healing Diabetic  WoundsDiabetes is a complicated condition to gain control of, but one of the most painful parts of this disease is the development of diabetic wounds. Often these wounds become “nonhealing” due to the adverse effects of the systemic disorder. Millions of people with diabetes will suffer from diabetic foot ulcers more than once in their lifetimes. Diabetes is a progressive disease that is many times, not taken seriously enough by people predisposed to the disorder.

Diabetic foot ulcers (DFUs) represent one of the most common complications of diabetes. Approximately 25 percent of patients with diabetes will develop a lower extremity ulceration in their lifetime.1 Diabetic foot ulcers can have a profound impact on the morbidity, mortality, and quality of life of patients. For example, patients who develop DFUs have a higher risk of myocardial infarction and fatal stroke than those who have never had a wound.2

Nerve Damage & Wounds
High blood sugar damages various organs within the body, but also has a severely adverse effect on nerves. This nerve damage happens when the blood supply is limited. The small blood vessels, which supply blood and nutrients to the nerves, becomes impaired. When the nerves are no longer fed nutrients, they either die, or their signals to the brain are ineffective. The lack of brain signaling from the nerve endings makes it difficult for a person to feel pain in their foot, so often injuries and these disorders are overlooked. This syndrome is called peripheral diabetic neuropathy.

Because of this nerve damage, people with diabetes are at a higher risk of developing foot ulcers. A foot wound may not sound overly alarming to most people, but foot ulcers can be life-threatening. These small sores go undetected due to the lack of feeling. If a patient delays treatment, foot ulcers can lead to amputation, strokes, heart attacks, and severe infections that can spread throughout the entire body.

Diabetic Wounds & Vascularization
If you have ulcers and lacerations that never fully heal, you might have a chronic wound. These are most often caused by diabetes mellitus, which causes blood vessels in the feet and hands to grow smaller. The restriction of blood flow damages nerve areas and reduces sensation.

Chronic wounds can also be caused by venous stasis, a condition of the veins in the lower legs, which also deprives your feet of adequate blood flow. With both conditions, when you bump or cut your foot or when you develop an ulcer, the lack of blood flow makes it difficult for the wound to heal.

In the endothelial layer of the dermis, vascularization must take place in order to heal the wound. The neovascularization or also known as angiogenesis is when new microvessels, fibroblast, and collagen begin to proliferate and form along with an increase in oxygen uptake and micronutrients to help grow new tissue, and to build a strong vascular blood flow to supply the proper nutrients to the dermal layers.

In some cases, diabetic wounds can be challenging to treat and difficult to heal. When traditional therapies fail, new enhances have been made, including the use of amniotic grafts to treat advanced cases of nonhealing diabetic ulcers.

Wound Healing Properties of Amniotic Membrane3
Amniotic membrane has a number of characteristics that make it especially suited to wound healing.

Amniotic Membrane:3
• contains a significant number of cytokines and essential growth factors
• reduces pain when applied to a wound
• increases and enhances the wound healing process
• has antibacterial properties
• is non-immunogenic (will not be seen as foreign material)
• provides a biological barrier
• provides a matrix for migration and proliferation of cells
• reduces inflammation
• reduces scar tissue formation

Amniotic tissue grafts are the progressive option for treating nonhealing diabetic ulcers, as they offer the potential for accelerating wound healing, reducing the incidence of infection and preventing re-ulceration. Despite the remarkable outcomes, these grafts are not suited for every diabetic ulcer case, as traditional wound care, including medications, debridement, sterile dressings, and compounded ointments often are enough to heal these wounds.

For more information, please call the office at (606) 324-FOOT (3668).

Body Mind Spirit Podiatric Center
500 14th Street, Ashland, Kentucky, 41101
Phone (606) 324-FOOT

Brian K. Bailey, D.P.M., M.S., is a podiatrist with Body-Mind-Spirit Podiatric Center in Ashland, Ky. The office is located at 500 14th Street, at the intersection with Central Avenue. New patients are welcome. For more information, please call the office at (606) 324-FOOT (3668).

Dr. Brian K. Bailey is a Podiatric Physician & Surgeon with a private practice located in Ashland, KY. He is also a Clinical Professor of Podiatric Medicine & Surgery at Pikeville College of Osteopathic Medicine and a Personal Wellness Coach & Fitness Trainer. Dr. Bailey has written several books, including: Secrets to Happiness, Inner Peace and Health, Metabolic Syndrome 2011, Nutrients for Prostate Cancer Prevention and Eradication, Breast Cancer Prevention and Wholistic Treatment, and Prostate Cancer Prevention and Wholistic Treatment.

Dr. Bailey teaches his patients how to treat and sometimes cure type two diabetes. This is essential in his treatment of diabetic wounds.

References:
1. Metelko Z, Brkljacic Crkvencic N. Prevention of diabetic foot.
Acta Med Croatica.2013;67 (Suppl 1):35–44.
2. Brownrigg JR, Davey J, Holt PJ, Davis WA, Thompson MM, Ray
KK, Hinchliffe RJ. The association of ulceration of the foot with
cardiovascular and all-cause mortality in patients with diabetes:
a meta-analysis. Diabetologia. 2012;55(11):2906–12.
3. WoundSource, Amniotic Membrane, 2019,
https://www.woundsource.com/blog/amniotic-membrane-
explained-what-it-and-how-it-used-in-wound-care

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