New approaches to wound healing for diabetes 促进糖尿病患者伤口愈合的新方法
摘要
Diabetic foot wounds are a major cause of morbidity and mortality1 and, even in centers in which nearly half the patients with moderate or severe wounds undergo revascularization, these wounds have median healing times of 6 months or more, with one-third requiring amputation.2 Such resource-intensive care is simply not available in most of the world, where “water or even gauze dressings may be scarce or not available”.1 Therefore, topical formulations to assist in wound healing are of significant interest: they can be simply applied, are not invasive, do not require advanced training for application, and can be used in an outpatient setting at relatively low cost. Moreover, many wounded patients have gone through exhaustive treatment with offloading, daily wound care, and invasive procedures, all without successful healing.3 Topical agents for wound healing have been described and used since antiquity. The study reported in the current issue of the Journal of Diabetes4 is therefore of interest in exemplifying the importance of research to find novel approaches to effective topical agents. Opiate receptors are present in the skin and stimulate keratinocyte formation.5 Gupta et al.4 used a delayed excisional wound-healing model in Zucker diabetic fatty mice to compare topical fentanyl with a saline-containing cream, finding significantly greater wound closure at 18 and 28 days, with a reduction in wound edema and increased re-epithelialization, vascularization, and granulation tissue formation with greater levels of collagen deposition. There is emerging data for the use of a number of topical antimicrobial, debriding, angiogenic, and cellular therapies as agents for wound healing.6 Probiotics and nitroglycerin have been proposed as offering therapeutic potential.7, 8 Oxygen has been studied using a variety of application methods.9 Natural substances that have been studied include preparations based on beehive protectant propolis,10 aloe vera,11 Momordica charantia fr