Understanding Diabetic Wounds: A Review of Mechanisms, Pathophysiology, and Multimodal Management Strategies
Authors: . Manisha , . Niharika , Gaur Praveen , Goel Radha , Lata Kanak , Mishra Rosaline 
Published: October 2024

Introduction:

Diabetic wounds are a prevalent and impairing consequence of diabetes
mellitus that significantly impacts people's lives and global healthcare systems. Because of disturbances
in the wound-healing cascade, these intricate, persistent wounds frequently refuse to heal.
Focusing on diabetic wound formation, this study seeks to clarify the complex mechanisms and
pathophysiology involved while offering a thorough overview of modern multimodal therapy techniques.
The etiology of diabetic wounds entails a complex interplay between tissue destruction
caused by hyperglycemia, neuropathy, ischemia, and compromised immune response. Extended inflammation,
abnormal protease activity, and low oxygen levels in the tissue exacerbate the healing
process. Comprehending these pathogenic mechanisms is essential for formulating efficacious therapeutic
strategies.

Methodology:

A thorough evaluation of the literature was done. Databases like SciFinder, ScienceDirect,
PubMed, Google, Google Scholar, and the Egyptian Knowledge Bank were used to
find pertinent publications. More than 200 articles and databases were studied to constitute this paper.
The accuracy of the retrieved data was carefully reviewed and cross-checked. The current review
aims to define wounds, various methods of classification, and various advancements for
wound management as mentioned in scheme 1. Several multidisciplinary strategies, including debridement,
unloading, antimicrobial stewardship, and innovative therapeutics, are currently needed
to manage diabetic wounds. Debridement—the excision of non-viable tissue—is necessary to create
an environment that is conducive to recovery. Biomechanical interventions and offloading help to
prevent additional tissue damage caused by repetitive stress. Antimicrobial treatments fight infections,
which are a common diabetic wound consequence. Promising supplementary treatments are
provided by developments in cellular and tissue-based products, ozone therapy growth factors, bioengineered
skin substitutes, and hyperbaric oxygen therapy.

Result:

After applying article selection criteria and reviewing the quality of the methodology a total
of 200 articles were selected to be included in the review. In this review, intricate interactions between
peripheral neuropathy, vascular insufficiency, and hyperglycemia in the pathophysiology of
diabetic wounds are explained. The efficacy of multimodal therapies is discussed in detail.

Discussion:

A thorough comprehension of the complex mechanisms that underlie diabetic wounds
is essential for efficient therapy. This review emphasizes how important multimodal approaches are
to treating the complex pathophysiology of these wounds. Clinicians can greatly enhance the prognosis
of patients with diabetic foot ulcers by addressing vascular insufficiency, neuropathy, infection,
and poor healing.

Conclusion:

Timely wound resolution remains a key difficulty despite the implementation of multimodal
methods. To customize therapies, personalized medicine strategies utilizing genetic and
proteomic biomarkers must be the main focus of future research. Furthermore, cutting-edge biotechnologies
with the potential to transform diabetic wound treatment include optogenetics and nanomedicine.