Leduc Healthcare Consulting Group

Wound Healing
Johns Hopkins Diabetes Guide

🟦 What is Wound Healing?
• Wound healing is a regulated biologic process of tissue regeneration
• Occurs in 3 phases:
Inflammation → Proliferation → Remodeling
• Requires coordinated activity of:
keratinocytes, fibroblasts, macrophages, platelets & endothelial cells
• Successful healing =
new epithelium + smaller wound + no drainage 

🟦 Why Diabetic Wounds Heal Poorly
• Impaired wound healing (IWH) is linked to:
• Hyperglycemia & advanced glycation end-products (AGEs)
• Reduced growth factor response
• Endothelial dysfunction & poor angiogenesis
• Diabetics have:
• Fewer endothelial progenitor cells (EPCs)
• Reduced keratinocyte & fibroblast migration
• Excess matrix metalloproteinases (MMPs) that degrade healing tissue 

🟦 The Diabetic Foot

A syndrome of multiple interacting problems:
• Neuropathy
• Ischemia
• Ulceration
• Infection
• Charcot foot
• Gangrene

➡ The Diabetic Foot Ulcer (DFU) is the most characteristic and dangerous lesion 

🟦Epidemiology & Risk Factors
• 81% of amputations follow failure of wound healing after ulcers
• Predisposing factors:
• Abnormal inflammatory response
• Peripheral neuropathy
• Ischemia
• Additional factors that delay healing:
• Diabetes, aging, obesity
• Malnutrition
• Smoking
• Renal disease
• Poor oxygen delivery 

🟦 Wound Assessment (PEDIS)

Every diabetic wound must be assessed for:

P – Perfusion
E – Extent (size)
D – Depth
I – Infection
S – Sensation

Also evaluate:
• Wound location, color, odor, temperature, pus
• Use sterile probe to detect:
• Sinus tracts
• Abscess
• Bone or tendon involvement
• Depth predicts outcome 

🟦 Infection Severity
• Uninfected wounds → often painless due to neuropathy
• Painful wounds → suggest ischemia or infection

Moderate infection signs
• Cellulitis >2 cm
• Abscess
• Gangrene
• Bone, joint or tendon involvement

Severe infection
• Fever, tachycardia, hypotension
• Confusion, vomiting
• Leukocytosis, acidosis
• Severe hyperglycemia or renal failure 

🟦 Core Principles of Treatment

Every diabetic wound requires:
1. Clean wound (saline or wound cleanser)
2. Sharp debridement
3. Appropriate dressing
4. Off-loading (total contact cast = gold standard)
5. Infection control
6. Glycemic & metabolic control
7. Revascularization if ischemic