Table 2

Factors and pathways that may contribute to delayed healing

Continuing trauma
Infection
Surface microorganisms not causing clinical infection
PAD
Neuropathies (potentially through multiple pathways)
Altered function of white blood cells, stem cells, and regenerating tissue, with abnormal cellular signaling
Abnormal wound biology, whether related to diabetes or its complications, to bacterial presence (with or without infection), or to effects resulting simply from the chronicity of the process
Patient-related factors, including impact of comorbidities and nonadherence to recommended management