HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: dc07-1421v1 30/12/3058    most recent Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Krishnan, S. T.M. Articles by Rayman, G. Search for Related Content PubMed PubMed Citation Articles by Krishnan, S. T.M. Articles by Rayman, G. Social Bookmarking                What's this?

Neurovascular Factors in Wound Healing in the Foot Skin of Type 2 Diabetic Subjects

¹ Diabetes Centre, Ipswich Hospital, Ipswich, U.K
² Division of Cardiovascular Medicine, University of Manchester and Manchester Royal Infirmary, Manchester, U.K
³ Division of Regenerative Medicine, University of Manchester, Manchester, U.K

Address correspondence and reprint requests to Dr. G. Rayman, MD, FRCP, The Ipswich Diabetes Centre, Ipswich Hospital, National Health Service Trust, Heath Road, Ipswich, IP4 5PD. E-mail: gerry.rayman{at}ipswichhospital.nhs.uk

OBJECTIVE—Delayed wound healing in diabetic patients without large-vessel disease has been attributed to microvascular dysfunction, neuropathy, and abnormal cellular and inflammatory responses. The role of these abnormalities has mainly been examined in animal models. Few studies have been undertaken in diabetic patients, and those that have are limited due to analysis in wounds from chronic ulcers. In this study, we quantified the rate of wound healing in relation to skin neurovascular function and structure following a dorsal foot skin biopsy in type 2 diabetes.

RESEARCH DESIGN AND METHODS—Twelve healthy control subjects and 12 type 2 diabetic subjects with neuropathy but without macrovascular disease were studied. We quantified rate of wound healing and related it to skin microvascular function (laser Doppler imager [LDI]_max), blood vessel density, small nerve fiber function (LDI_flare) and nerve fiber density, vascular endothelial growth factor (VEGF) and its receptor (FLK1), and hypoxia-inducible factor (HIF)-1 expression.

RESULTS—The rate of wound closure was identical between control subjects and diabetic patients despite a significant reduction in maximum hyperemia (LDI_max), epidermal and dermal VEGF-A, and epidermal and dermal blood vessel VEGFR-2 expression as well as the neurogenic flare response (LDI_flare) and dermal nerve fiber density. There was no significant difference in HIF-1 and dermal blood vessel density between control subjects and diabetic patients.

CONCLUSIONS—In conclusion, the results of this study suggest that wound closure in subjects with type 2 diabetes is not delayed despite significant alterations in neurovascular function and structure.

Abbreviations: HIF, hypoxia-inducible factor • LDI, laser Doppler imager • VEGF, vascular endothelial growth factor • VEGFR, receptor of VEGF

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				S.-B. Catrina and K. Brismar Neurovascular Factors in Wound Healing in the Foot Skin of Type 2 Diabetic Subjects: Response to Krishnan et al. Diabetes Care, February 1, 2008; 31(2): e6 - e6. [Full Text] [PDF]

				S. T.M. Krishnan and G. Rayman Neurovascular Factors in Wound Healing in the Foot Skin of Type 2 Diabetic Subjects: Response to Catrina and Brismar Diabetes Care, February 1, 2008; 31(2): e7 - e7. [Full Text] [PDF]