Pay Attention to Small Wounds. Chronic Inflammation Due to Diabetes May Lead to Ulceration and Amputation.

(Characteristics of Diabetic Foot Ulcer Wounds)

"Why do small foot wounds become so difficult to heal, even developing into ulcers that may require amputation?" This is a question that puzzles many diabetic patients, and the key factor lies in "chronic inflammation".

The Healing Process of General Wounds

The healing process of general wounds can be divided into four stages, which must occur in a specific order at the right time, and be maintained with optimal intensity for the appropriate duration to ensure wound healing1

Hemostasis： Vascular constriction and platelet aggregation stop bleeding.
Inflammatory Phase： Immune cell activation, with the wound showing signs of redness, swelling, heat, and pain.
Proliferative Phase： About 4-5 days later, inflammation subsides, microvascular formation begins, and tissue cells start to proliferate.
Remodeling Phase： Collagen synthesis provides strength to the newly healed tissue.

It is known that multiple factors may affect the wound healing process, and for diabetic patients, the activity of immune cells may be one of the most critical factors2.

Chronic Inflammation Prevents Wound from Entering the Proliferative Phase

Macrophages play an important role in the inflammatory and proliferative phases of wound healing. For example, in the inflammatory phase, type 1 (inflammatory) macrophages promote inflammation and clear pathogens; in the proliferative stage, macrophages convert to type 2 (proliferative), reducing inflammation and aiding new blood vessel formation and tissue generation.

Research shows that diabetic patients, due to long-term hyperglycemia, are prone to vascular sclerosis, blockage, and other conditions, resulting in more inflammatory factors in the wound environment. This causes macrophages to remain in the inflammatory type 1 state for an extended period, leading to persistent inflammation and suppressing wound repair2.

Chronic Wounds Require Active Care

The wound environment of diabetic foot ulcers is quite complex, and more research is needed to clarify the reactions involving various inflammatory factors and immune cells. Currently, new ointments targeting macrophage activity and regulating the chronic inflammation of DFU wounds have been approved by health authorities3, bringing a glimmer of hope to the treatment of diabetic foot ulcers.

Guo S, DiPietro L et al. J Dent Res. 2010 Mar; 89(3): 219–229.
Aitcheson SM, et al. Molecules. 2021 Aug 13;26(16):4917.
Lin CW, et al. JID Innov. 2022 Jun 2;2(5):100138.