A Comprehensive Review on Diabetic Foot Ulcer Addressing Vascular Insufficiency, Impaired Immune Response, and Microbial Dysbiosis
Summary: This narrative review examines the multifactorial pathogenesis of diabetic foot ulcers (DFUs), affecting 15-25% of diabetics and leading to 85% of amputations, driven by vascular insufficiency, peripheral neuropathy, hyperglycemia-induced immune defects, and microbial dysbiosis with biofilms. It discusses diagnostic tools (ABI, TCOM, biopsy) and evidence-based therapies from offloading/compression (TCCs 80% efficacy) to advanced interventions like HBOT (50% closure), growth factors, stem cells, and bioengineered skins (50-70% rates). Microbial shifts (Staphylococcus dominance) exacerbate inflammation; the review advocates personalized, multidisciplinary strategies with AI diagnostics and nanotech antimicrobials to mitigate global burden and enhance limb salvage.
Key Highlights:
- Vascular/Neuropathy: Ischemia impairs perfusion; neuropathy masks pain, delaying detection in 60% of cases.
- Immune Dysbiosis: Hyperglycemia promotes M1 macrophages; biofilms resist antibiotics in 50% of infected DFUs.
- Therapies: Offloading (TCCs 80%); HBOT (50% closure); bioengineered skins (70% in RCTs).
- Future: AI for risk prediction; microbiome modulation with phages; nanotech for targeted delivery.
- Burden: $15B U.S. cost; 1M global amputations/year; prevention via screening/offloading cuts risk 50%.
Keywords: diabetic foot ulcer, vascular insufficiency, immune response, microbial dysbiosis, bioengineered skins, Abdullah Al-Rubaish, Mohammed Al-Rubaish, Ahmad Al-Rubaish