Wound Chronicity, Impaired Immunity and Infection in Diabetic Patients

作者：Nadia Rodríguez-Rodríguez, Indira Martínez-Jiménez, Ariana García‐Ojalvo, Yssel Mendoza‐Marí, Gerardo Guillén, David Armstrong, Jorge Berlanga‐Acosta · 发表于：MEDICC Review · 年份：2021 · DOI：10.37757/mr2021.v23.n3.8 · 被引用次数：141 · 研究领域：Diabetic Foot Ulcer Assessment and Management、Wound Healing and Treatments、Neutrophil, Myeloperoxidase and Oxidative Mechanisms

BACKGROUND: Diabetic foot ulcers are a common diabetic complication leading to alarming figures of amputation, disability, and early mortality. The diabetic glucooxidative environment impairs the healing response, promoting the onset of a 'wound chronicity phenotype'. In 50% of ulcers, these non-healing wounds act as an open door for developing infections, a process facilitated by diabetic patients' dysimmunity. Infection can elicit biofilm formation that worsens wound prognosis. How this microorganism community is able to take advantage of underlying diabetic conditions and thrive both within the wound and the diabetic host is an expanding research field. OBJECTIVES: 1) Offer an overview of the major cellular and molecular derangements of the diabetic healing process versus physiological cascades in a non-diabetic host. 2) Describe the main immunopathological aspects of diabetics' immune response and explore how these contribute to wound infection susceptibility. 3) Conceptualize infection and biofilim in diabetic foot ulcers and analyze their dynamic interactions with wound bed cells and matrices, and their systemic effects at the organism level. 4) Offer an integrative conceptual framework of wound-dysimmunity-infection-organism damage. EVIDENCE AQUISITION: We retrieved 683 articles indexed in Medline/PubMed, SciELO, Bioline International and Google Scholar. 280 articles were selected for discussion under four major subheadings: 1) normal healing processes, 2) impaired hea...