DEFINITION

• Wound Healing: the body’s natural process of dermal or epidermal tissue regeneration. Involves a well-organized cascade of events including: inflammation, proliferation and remodeling.
• Celllar activation of keratinocytes, fibroblasts, macrophages, platelets and endothelial cells is essential for healing. Healing consists of new epithelium, decreased area and depth of the wound and no drainage.
• Impaired wound healing (IWH): lack of orderly process of healing, associated with morbidity, amputations, mortality and health-care costs. IWH is associated with hyperglycemia and advanced glycation end products (AGE), decreased cell and growth factor response, and endothelial dysfunction with decreased local angiogenesis.
• Poor healing exhibits impaired angiogenesis and vasculogenesis with reduced vascular endothelial growth factor (VEGF) . Bone marrow-derived endothelial progenitor cells (EPCs), essential for neovascularization, are decreased in DM. Keratinocyte and fibroblast migration and proliferation also decreased. Matrix metaloproteinases (MMPs) also play a major role in wound healing and are in excess in wound fluid.
• "The diabetic foot": refers to a constellation of pathological conditions (neuropathy, ischemia, ulceration, infection "the fetid foot", the Charcot foot, and gangrene) of which the diabetic foot ulcer (DFU) is the most characteristic.