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Injecting growth factor into diabetic foot ulcers may kick-start healing

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Berlanga-Acosta J, Fernández-Montequín J, Valdés-Pérez et al (2017) Diabetic foot ulcers and epidermal growth factor: revisiting the local delivery route for a successful outcome. BioMed Research International. doi:10.1155/2017/2923759

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Diabetic foot ulcers are full-thickness wounds penetrating through the deep layers of the skin below the ankle in patients with diabetes.

They are much feared because they are difficult to heal and may lead to amputation of the limb.

Diabetes-related peripheral neuropathy and ischaemia due to vascular damage are responsible for the development and lack of healing of these ulcers.

Unlike in other wounds, there is a failure to trigger proliferation of granulation tissue, impaired wound contraction and alteration in the regrowth of epithelium.

Hyperglycaemia is the primary trigger for the toxic changes that lead to thickening of vessel walls, which reduces function in the vascular system.

Growth factor has a crucial role in development, and continues to have an effect on cell metabolism in health and disease. It is an ingredient in body fluids, including breast milk and saliva.

Once the skin barrier has been disrupted, the healing response normally starts with alarm signals from cells.

The response is led by growth factors that act as soluble messengers, establishing a communication network to release sources including platelets, immune inflammatory cells, fibroblasts, endothelial cells and keratinocytes.

It has been thought for many years that application of growth factor directly to diabetic ulcers may aid healing, but early experiments were disappointing.

It may be, however, that infiltrating growth factor by injecting it into the base of the wound could overcome the problems seen in simple topical application and so help kick-start healing in these potentially devastating ulcers.

Compiled by Ruth Sander, independent consultant in care of the older person

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