Diabetic ulcers, chronic wounds

Wounds can be categorized as acute (healing quickly on their own) or chronic (healing slowly, and often requiring medication). Chronic wounds, such as ulcers (Table 10.9), occur if some influence disrupts the normal healing process. Such influences can include diabetes, malnutrition, rheumatoid arthritis and ischaemia (inadequate flow of blood to any part of the body). Elderly people are particularly susceptible to developing chronic wounds, often resulting in the necessity for hospitalization. Ulceration (particularly of the limbs or extremities) associated with old age,... 

Shifts in the cutaneous microbiome have also been noted in chronic ulcer disease, such as those caused by venous stasis or diabetes (175). Patients with chronic ulcers treated with antibiotics have been shown to have an increased abundance of Pseudomonadaceae while an increase in Streptococcaceae has been noted in diabetic ulcers (175). A longitudinal shift in wound microbiota has also been shown to coincide with impaired healing in diabetic mice, and may interact with aberrantly expressed host cutaneous defense response genes leading to ulcerogenesis (176). When compared to controls, the feet of diabetic men has also been noted to have decreased populations of Staphylococcus species, a relative increase in the population of S. aureus and increased bacterial diversity, which may increase the risk for wound infections in diabetic patients (177). 

The key treatment for diabetic foot wounds is often debridement in its many guises. Despite the plethora of treatment available their success can be limited if the wound is not sufficiently prepared. The process of debridement removes non-viable tissue and the products remaining from an abnormal, sustained inflammatory response. Increased protease levels and an imbalance of matrix metal-loproteinases and their tissue inhibitors [10] maintain the chronic wound state and their removal with associated hyperaemia will encourage an influx of the biological components of healing. The level of debridement used will depend on the aetiopathogenesis and the morphology of the ulcer. 

A diabetic foot ulcer is an excellent example of a chronic wound that responds well to management using biofilm principles (Dowd et al, 2008). Bacteria within biofilms have been reported to be up to 500 times more resistant to antibiotics than planktonic (unattached, freely living) cells (Donlan, 2001 Donlan and Costerton, 2002). Most of the chronic wound pathogens, such a methicillin-resistant S. aureus (MRSA) and Pseudomonas... 

Zerm, R., 2013. Local treatment of chronic wounds in patients with peripheral vascular disease, chronic venous insufficiency and diabetes topical honey for diabetic foot ulcers. Deutsches Arzteblatt International 110 (21), 373. 

Figure 4. Healing of a chronic ulcer in the foot of a 71 years old diabetic patient. The wound did not close even 4ien treated for 9 months by conventional treatment (oral antibiotics, Acticoat Absorbent, Allevyn, Apligraf and sharp debridement).

Over five million people each year in the UK suffer from various kinds of wounds that require treatment. As the age profile of the population increases, chronic or hard to heal wounds resulting fi-om diabetes, pressure induced wounds, cancer and leg ulcers are becoming by far the most dominant and potentially most expensive types of wounds to treat. The cost to the NHS of caring for patients wiffi a chronic wound is conservatively estimated at per year (at 2005-2006 costsf. UK... 

Wound malodour is nq>idly becoming a critical issue, particularly wifi patients suffering with chronic illness that often result in wounds such as venous leg ulcers, diabetic ulcers, pressure ulcers and ftmgating (malignant cancerous) lesions. The malodour is usually just part of the vriiole chronic situation but it can affect the patient in numerous social and psychological ways. 

Early observations showed quicker healing, decreased infection, and reduced pain. Throughout the years, AM has been used to treat bums, surgical wounds, diabetic foot ulcers, chronic venous ulcers, and pressure ulcers. 

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