Why don't diabetic wounds heal

The independent diabetes portal DiabSite

Home> Updates> Diabetes News> Archives> 2017> 171021

New Fish Skin Matrix: Promising Research Results and Clinical Experience

Diabetes is often the cause of impaired wound healing

To enlarge please click on the picture.
Some wounds are considered chronic from the outset because their treatment requires therapy for the underlying disease. These include diabetic foot syndrome, wounds with peripheral arterial occlusive disease (PAD) or a so-called "open leg" (venous leg ulcer) due to chronic venous insufficiency. But even an acute wound after an operation or an accident can develop into a chronic wound with an often insidious, protracted course.

"We all know the principle of wound healing," says Prof. Dr. Dr. h.c. Diethelm Tschöpe gets to the heart of the matter. "Only a wound that closes can heal." Unfortunately, there are wounds in which the healing process is so disturbed that they do not close for weeks and months. Manfred Voigt (81) had such a problem with an injury that occurred on the foot between the toes. At first it was just annoying. However, the longer it lasted, the more the open wound affected his quality of life. "The bandage had to be changed every two days, and there was no improvement for months."

Diabetes is very often the cause of impaired wound healing. Due to sensory disturbances (polyneuropathies), wounds are sometimes noticed too late and become infected. "The longer the wound healing is delayed, the bigger the problem becomes", describe the senior physicians Dr. Tania-Cristina Costea and Dr. Katharina Kuczewski the typical course.

The wound healing center of the Diabetes Center at HDZ NRW, Bad Oeynhausen, examines, among other things. also the biochemical changes that chronic wounds exhibit and that impair healing cell activity in connective tissue. In the case of diabetic foot syndrome, this can lead to the amputation of individual toes, the forefoot or the joint. "Although the number of large amputations is falling, the number of minor amputations has increased," says Prof. Tschöpe, director of the Diabetes Center. The more time passes, the greater the risk of infection and the threat of amputation.

Anyone who has suffered from an open wound for more than three months should therefore put themselves in the hands of experts. Preferably those facilities that are certified as outpatient or inpatient wound healing centers help. Manfred Voigt only did that after a year. And was very pleased that a solution had been found after just four weeks.

Effects visible after seven days

He was helped by a new therapy with a transplant that is obtained from fish skin and which obviously stimulates the skin cells to grow again. The cell-free collagen matrix looks a bit like a crispbread, it is placed overlapping on the cleaned wound and fixed with a bandage.

Both initial research results and everyday clinical experience suggest that this type of cell migration and proliferation could possibly be superior to other forms of therapy. The Scandinavian product comes from the native Atlantic cod. Similar to human skin, the material has pores and has an antibacterial effect. These characteristics, like the omega-3 fatty acids they contain, seem to promote stem cell proliferation and wound healing.

"We have to wait for further study results", emphasizes Professor Tschöpe, who has so far recorded successful wound closures in all patients treated in the diabetes center, but does not ignore the fact that an individual assessment of the wound is the alpha and omega of therapy.

Which form of treatment is most suitable depends on the type and depth of the wound, on the possible underlying disease of the patient, but also on the location of the injury. "Compared to the ball of the foot or leg, it is very difficult to establish a tissue bridge on the Achilles tendon because there is almost no connective tissue here."

The primary goals of modern wound healing methods are wound closure and limb preservation. There are great advantages in the possibility of repeated application; a combination of different methods is also possible depending on the individual wound situation. "The first effects of wound healing can usually be seen after seven days, when the wound edges begin to close."

In many cases, a lot of rest and a correctly applied vacuum bandage help to stimulate blood flow and relieve the wound. Dead tissue can be cleaned up with maggot therapy, and existing tissue can be stimulated with stem cells. Cold plasma treatment has proven effective for venous wounds. For Manfred Voigt, the protracted story with his foot finally came to a happy end after almost a year: "Next time I'll go straight to the specialist!"

Caption: Manfred Voigt (81) can laugh again. The senior physicians Dr. Tania-Cristina Costea (r.) And Dr. Katharina Kuczewski (left) successfully treated the chronic wound on his foot.
Source: University Hospital of the Ruhr University Bochum - Heart and Diabetes Center North Rhine-Westphalia Bad Oeynhausen.
Photo: Anna Reiss

last modified: 10/21/2017