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Diabetic foot ulcers often pose a difficult problem for health care professionals. The normal course of acute wound repair involves a well-described series of events, starting with hemostasis, proceeding through a limited inflammatory stage, the closing of the lesion through the formation of granulation tissue and re-epithelialization, continuing with scar formation and finally remodeling. The orderly and efficient progression of this sequence of events is orchestrated through cellular communication, much of which is transmitted in the form of growth factors and cytokines. In diabetic ulcers, however, the wound remains in the inflammatory stages and the acute process stops. In diabetes, proteins are modified by glycation, and in some tissues microcirculatory changes occur that include the thickening of the basement membrane, reminiscent of fibrin cuffs. In addition to extracellular changes, fibroblasts isolated from diabetic foot ulcers exhibit decreased cellular activity. Polymicrobial nature of diabetic foot infection has also been well documented. The purpose of this article is to provide readers with a compendium of the treatment of diabetic ulcers. This article presents normal wound healing process, features of diabetic ulcers, and advanced treatments for diabetic ulcers including cell therapy. (J Korean Wound Care Soc 2007;3:38-41)
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