Skin wounds heal by coordinated induction of inflammation and tissue repair, but the initiating events are poorly defined. Here we uncover a fundamental role of commensal skin microbiota in this process and show that it is mediated by the recruitment and the activation of type I interferon (IFN)-producing plasmacytoid DC (pDC). Commensal bacteria colonizing skin wounds trigger activation of neutrophils to express the chemokine CXCL10, which recruits pDC and acts as an antimicrobial protein to kill exposed microbiota, leading to the formation of CXCL10–bacterial DNA complexes … read more
Excellent continued efforts in elucidating the role that perturbation of the wound matrix (via negative pressure wound therapy (NPWT)) has on angiogenesis, healing and regeneration. A recent study in Molecular Medicine Reports used label‑free quantitative mass spectrometry to analyze differences in granulation tissue protein expression profiles before and after NPWT for patients with diabetic foot ulcers (DFUs).1 They aimed to take a closer look at how NPWT promotes DFU healing. As such, the study identified multiple novel proteins altered by NPWT, paving the way for future studies in this area … read more
A series of great informational graphics from Dr. Armstrong …. read more
A growing body of research, as well as first-hand accounts from clinicians on the ground, indicate that a significant percentage of patients with chronic wounds have delayed preventative and emergent wound care during the COVID-19 pandemic.1 While it will take time to assess the full impact of these trends, existing evidence suggests delayed wound care can result in more severe infections, increased hospital admissions, and lead to more amputations.2 Therefore, it will be critical for providers, hospitals, outpatient departments, payers and policymakers to understand and plan for a surge in patients with untreated and unmanaged non-healing wounds and related acute-on-chronic complications as a result of delayed care during the COVID-19 pandemic … read more
Remission — rather than repair — needs to be the goal of treatment, according to Dr. David Armstrong, whose report on diabetic foot ulcers appears in the New England Journal of Medicine … Foot ulcers are a prevalent complication for millions of people with diabetes. Estimates indicate that as many as one-third of people with the disease will develop at least one foot ulcer over the course of their lifetime. These wounds can lead to further complications such as strokes, heart attacks, infections, loss of limbs and premature death … read more
in the young and middle-aged adult U.S. population
We are grateful to Linda Geiss and her coworkers at CDC for their always intriguing efforts at revealing the big picture to us. These data– which certainly aren’t welcome news– are supremely important. Do they signal what we’ve posited for some time? Did the increase in the “denominator” of people with diabetes in the mid-1990s initially reduced the proportionate pool of high risk patients (and thereby reduced amputation rates)? Was it better team care? Whatever the explanation, we have yet more data on which to ruminate … read more
Is a histologically hostile environment causing promising treatments for chronic wounds to fail? My coauthor and I tackle this question in a recent review for Nature Reviews Endocrinology.
As we say in the review, “As with so many other areas in medicine, the field of tissue repair and wound healing is littered with early-stage promise in preclinical models followed by late-stage disappointment in human trials.”1 If we understand that the wound environment is histologically hostile, many of the types of treatments we have endeavored to use in this area come into question … read more
Tuesday, September 25, 2018
Because neuroischemic complications are associated with a high rate of recurrence, this presentation proposes a slight shift in how health care providers counsel and communicate risk to their patients. If the epidemiology of this problem is comparable with that of cancer, and recurrences are common, then perhaps language commensurate with such risks should follow.
After initial healing of an index wound, patients are referred to not as being cured but rather as being “in remission.” This concept is easy for the patient and the rest of the team to understand, and it powerfully connotes the necessity for frequent follow-up and rapid intervention for inevitable minor and sometimes major complications.
This program will review tried-and-true as well as up-to-the-minute advances in biologics, consumer electronics, mechanics, medicine, and surgery that are “pushing the envelope” in extending ulcer-free, hospital-free, and activity-rich days in efforts to make prevention pay.
DPM, MD, PhD
University of Southern California
Professors David Armstrong and Charles Liu at first seemed to be an unlikely pair.
But the podiatric surgeon and neurosurgeon clicked on a personal level and promptly realized they had a lot to offer each other as Keck School of Medicine of USC collaborators.
Both were already studying how much information a person takes in through the nerves of the feet, how to preserve, repair or replace that information system, and how nerve damage can affect a patient’s mobility.
Armstrong is interested in metabolic health, mobility and neuropathy—the loss of nerve sensitivity that can occur in patients with diabetes, Liu noted.
“As a neurosurgeon, I’m interested in lower-extremity function and metabolic health, too,” he said. “In my work, I think about how to restore mobility to patients who can’t feel their legs. It’s a similar problem to diabetic foot ulcers.”