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What Is the Future of Diabetic Wound Care?

From the Department of Surgery (Dr Fann, Dr Yost); the Department of Pharmacology, Physiology, and Neuroscience (Dr Sweitzer); the Department of Cell and Developmental Biology and Anatomy (Dr Borg); and the Department of Chemistry and Biochemistry (Dr Baynes), University of South Carolina, School of Medicine, Columbia, South Carolina.

Correspondence to Sarah M. Sweitzer, PhD, Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina, School of Medicine, Columbia, SC 29208 (sweitzer{at}med.sc.edu).

With diabetes affecting 5% to 10% of the US population, development of a more effective treatment for chronic diabetic wounds is imperative. Clinically, the current treatment in topical wound management includes debridement, topical antibiotics, and a state-of-the-art topical dressing. State-of-the-art dressings are a multi-layer system that can include a collagen cellulose substrate, neonatal foreskin fibroblasts, growth factor containing cream, and a silicone sheet covering for moisture control. Wound healing time can be up to 20 weeks. The future of diabetic wound healing lies in the development of more effective artificial "smart" matrix skin substitutes. This review article will highlight the need for novel smart matrix therapies. These smart matrices will release a multitude of growth factors, cytokines, and bioactive peptide fragments in a temporally and spatially specific, event-driven manner. This timed and focal release of cytokines, enzymes, and pharmacological agents should promote optimal tissue regeneration and repair of full-thickness wounds. Development of these kinds of therapies will require multidisciplinary translational research teams. This review article outlines how current advances in proteomics and genomics can be incorporated into a multidisciplinary translational research approach for developing novel smart matrix dressings for ulcer treatment. With the recognition that the research approach will require both time and money, the best treatment approach is the prevention of diabetic ulcers through better foot care, education, and glycemic control.

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