THE DIABETIC FOOT Optimizing Wound Prevention and Healing

Wound healing proceeds in a By Cornelius M. Donohue, DPM, Larry R. Goss, DPM, Frederick B. LaVan, MD, Michael S. Weingarten, MD, and Mazen A. Abboud, DPM Objectives 1) Review the stage of wound healing, including the major molecular and cellular events. 2) Review the classification and common causes of lower extremity wounds as well as factors affecting wound healing. 3) Introduce a ten-step clinical model and clinical algorithm (template) for wound prevention, diagnosis and treatment. 4) Explain the value of an integrated multidisciplinary approach to wound prevention and care. 5) Demonstrate the potential impact on wound prevention and healing outcomes using this approach both in the developed and developing world. The authors introduce a ten-step model with a clinical algorithm and discuss the importance of developing a consistent and methodical approach to wound prevention, diagnosis and treatment that is based on fundamental principles and evidence-based medicine. 138 www.podiatrym.com PODIATRY MANAGEMENT • NOVEMBER/DECEMBER 2004 TABLE 1 Stages of Wound Healing with Prominent Findings and Molecular and Cellular Events Stage Time Prominent Findings Cellular events Molecular events Inflammatory / 0-4 Days Injury / Infection Platelets Cytokines Substrate Coagulation Neutrophils Growth factors Inflammation Macrophages Chemokines Nitric oxide Fibroblastic / Lag 5-20 Days Angiogenesis Fibroblasts Receptors Migration Myofibroblasts Proteases Proliferation Vascular endothelial cells Protease inhibitors Remodeling / 21 DaysEpithelialization Keratinocytes Maturation Years Scar maturation Mature epithelial cells Continued on page 139 healing settings has consistently demonstrated improved prevention and healing outcomes. Co nt inu ing Me dic al Ed uc ati on Molecular and Cellular Components of Wound Healing: A Model Figure 1 Optimizing...