scholarly journals Clinical and morphological characteristics of wound healing in diabetic foot syndrome

10.14341/7704 ◽  
2017 ◽  
Vol 20 (2) ◽  
pp. 135-141 ◽  
Author(s):  
Elena Yur'evna Komelyagina ◽  
Eugenia Alexandrovna Kogan ◽  
Mikhail Borisovich Antsiferov
Keyword(s):  
Wound Healing ◽  
Granulation Tissue ◽  
Diabetic Foot ◽  
Morphological Characteristics ◽  
Glycated Haemoglobin ◽  
Late Complications ◽  
Ki 67 ◽  
Fibrotic Tissue ◽  
Significant Difference ◽  
Time Of Admission

Aim. To assess the clinical and morphological characteristics of neuropathic diabetic foot ulcers (DFUn) Materials and Methods.Forty-three specimens of DFUn were analysed. Depending on the outcome, samples were divided into 2 groups: group 1healed ulcers (30 samples), group 2unhealed ulcers (13 samples). The following characteristics were analysed: age, sex, glycated haemoglobin (HbA1c), ulcer duration, time of admission to the specialised clinic, severity of neuropathy, presence of late complications, plantar localisation, percentage of necrotic tissue, granulation and fibrotic tissue and, Ki-67expression. Results. Patients were similar in age, HbA1c, severity of late complications and plantar localisation. There was a significant difference in the time of admission to the specialised clinic [50 vs 132 days, p = 0.03], percentage of granulation [61 25 vs 32 21 %, р = 0.001] and fibrotic tissue [24 24 vs 49 22 %, р = 0.002], the granulation/fibrosis coefficient [7.5 8.1 vs 1.9 4.6 (%), р = 0,02] and expression of Ki-67 [15 8 vs 21 (%), р = 0.001] between groups. A multidimensional model revealed granulation tissue as the main parameter influencing healing. The probability of healing was 1.0 if the percentage of granulation tissue was 50%. If the percentage of granulation tissue was 50%, the prognosis of healing was determined by the expression of Ki-67. When Ki-67 levels were 7%, the probability of healing was 0.75. For Ki-67 levels 7%, the probability of healing was 0.17 and the probability of not healing was 0.83. Conclusion. The time at which a patient was admitted to the specialised clinic and the percentage of granulation tissue were key factors affecting the prognosis of wound healing in DFUn.

Polyethylene Glycol–Based Nanocerium Improves Healing Responses in Excisional and Incisional Wound Models in Rats

2020 ◽  
pp. 153473462091210
Author(s):  
Tara Kardan ◽  
Rahim Mohammadi ◽  
Saeed Taghavifar ◽  
Marzieh Cheraghi ◽  
Ashkan Yahoo ◽  
...  
Keyword(s):  
Wound Healing ◽  
Polyethylene Glycol ◽  
Granulation Tissue ◽  
Wistar Rats ◽  
Wound Area ◽  
Therapeutic Benefits ◽  
Significant Difference ◽  
Excisional Wound ◽  
Wound Healing Model ◽  
Healing Model

Applications of nanotechnology have gained progressive interest for regeneration of injured wound tissue. The aim of the present study was to evaluate effects of polyethylene glycol (PEG)-based nanocerium on excisional and incisional wound models in rats. For excisional wound healing model, 24 male white Wistar rats were randomized into 4 groups of 6 rats each: control group with creation of wounds and no treatment, PEG group with creation of wounds and dressing the wound with PEG, NanoCer group with application of 1 mL nanocerium on the wound, and PEG/NanoCer group with dressing the wound with PEG-based nanocerium. Wound size was measured on days 6, 9, 12, 15, 18, and 21 postsurgery. For incisional wound healing model, 24 healthy male Wistar rats were randomized into 4 groups of 6 rats each the same way in the excisional wound model. Reduction in wound area, hydroxyproline contents, and biomechanical parameters indicated that there was a significant difference ( P > .05) between PEG/NanoCer and other groups. Biomechanical testing was performed on day 9 postsurgery in the incisional model. Biochemical and quantitative histological studies demonstrated that there was a significant difference ( P > .05) between PEG/NanoCer and other groups. PEG/NanoCer offered potential advantages in wound healing acceleration and improvement through angiogenesis stimulation, fibroblast proliferation, and granulation tissue formation on early days of healing phases. Acceleration in wound repair was associated with earlier wound area reduction and enhanced tensile strength of damaged area by rearrangement of granulation tissue and collagen fibers. PEG-based nanocerium could have therapeutic benefits in wound healing.

scholarly journals Therapeutic Effect of Epidermal Growth Factor Combined With Nano Silver Dressing on Diabetic Foot Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Kaihua Zhang ◽  
Yiran Li ◽  
Jiarui He ◽  
Jiasheng Xu ◽  
Yanhua Wan ◽  
...  
Keyword(s):  
Wound Healing ◽  
Growth Factor ◽  
Epidermal Growth Factor ◽  
Diabetic Foot ◽  
Factor Group ◽  
Saline Control ◽  
Control Group ◽  
Nano Silver ◽  
Significant Difference ◽  
Epidermal Growth

Objective: To investigate the clinical efficacy of epidermal growth factor combined with nano silver dressing in the treatment of diabetic foot wounds.Methods: A total of 160 patients with diabetic foot ulcers admitted to the Second Affiliated Hospital of Nanchang University from 2015-06 to 2018-06 were selected to participate in the experiment. A randomized table method was used to randomly divide 160 patients into 4 groups: 40 in the epidermal growth factor group, 40 in the nano-silver dressing group, 40 in the combined group, and 40 in the saline control group (normal saline). The healing stage of the wound surface and the growth degree of granulation tissue were graded. Each group was given a dressing change every other day, and the time required for wound repairing to each healing stage was observed. After 2 and 4 weeks of treatment, the wound exudate was collected for bacterial culture.Results: There was no significant difference in the time between the four groups of patients reaching the effective phase of treatment (level 1). Compared with the control group, the epidermal growth factor group and the combined group achieved a shorter time for wound repairing to healing stages 2 and 3, and the difference was significant (p < 0.05). The combined group had a shorter wound repairing time than the epidermal growth factor group (p < 0.05). Compared with the control group, the positive rate of bacteria in the combined group and the silver nanoparticles group was significantly lower after 2 and 4 weeks of treatment.Conclusion: There is no significant difference in wound healing between the four groups during the clinically effective period. After this period, the combined use of recombinant epidermis Growth factors and nano-silver dressings have a significant effect on promoting wound healing and can effectively prevent infection.

scholarly journals Morphological research of the effectiveness of perioperative local use of anesthetics and antiseptics in patients with purulent-necrotic lesions of lower extremities in diabetes mellitus

2021 ◽  
Vol 27 (3) ◽  
pp. 22-28
Author(s):  
Yu.M. Babina ◽  
D.V. Dmyrtriiev ◽  
O.A. Nazarchuk ◽  
P.P. Hormash
Keyword(s):  
Diabetes Mellitus ◽  
Wound Healing ◽  
Granulation Tissue ◽  
Diabetic Foot ◽  
Povidone Iodine ◽  
Local Treatment ◽  
Lower Extremities ◽  
Diabetic Foot Syndrome ◽  
Patients With Diabetes ◽  
Infiltration Anesthesia

Ulcer-necrotic lesions of the feet are detected in 5-15% of patients with diabetes mellitus (DM). According to the literature today in Ukraine, patients with DM perform high amputation of the lower extremities with diabetic foot syndrome with a frequency of 19.6-42.6%, at the same time, mortality ranges from 8.9% to 25.0%, and the total mortality rate at the DM varies from 6.6% to 13.5%, often associated with the occurrence of postoperative complications. The aim of the work was to study morphological indicators of reparation of soft tissues of the lower extremities in patients with diabetic foot syndrome on the background of local treatment during the perioperative period. We investigated changes in histologic structure and character of reactions of skin tissues, muscles and fascia during the period of visceral disease in patients with diabetes mellitus after different types of local treatment. Then, samples of skin tissues, muscles and fascia were photographed and analyzed using a light microscope OLIMPUS BX 41. In the first group of the comparison, which used standard methods of anesthesia and local antiseptic povidone-iodine, granulation tissue was characterized by the complete absence of fibrous structures (collagen fibers) and the presence of a small number of newly formed small diameter vessels with blistered endothelium. Vessels of young granulation tissue were dilated, full-blooded, the endothelium was swollen, there was significant perivascular edema. In the second group of patients (where povidone-iodine and infiltration anesthesia with 2% lidocaine solution anesthetic was used locally) there were almost no remains of necrotic tissues in the affected tissues. It should be noted that there was better granulation development with fewer inflammatory-cell elements, more young forms of fibroblasts and a moderate pathological vascular reaction. In the first (control) group, wound healing by 3-7 days is characterized by somewhat slow regeneration. Wound healing was most favorable in patients of the second group, where infiltration anesthesia was used by local anesthetic and antiseptic povidone-iodine.

scholarly journals Observational study of the effects of silver-based dressing materials in 50 cases of diabetic foot ulcers

2019 ◽  
Vol 6 (2) ◽  
pp. 508
Author(s):  
Rushabh Maisuria ◽  
Jawansing Manza ◽  
Devendra Chaudhari ◽  
Divyang Dave
Keyword(s):  
Wound Healing ◽  
Observational Study ◽  
Granulation Tissue ◽  
Diabetic Foot ◽  
Healing Rate ◽  
Foot Ulcer ◽  
Purulent Discharge ◽  
Diabetic Patients ◽  
Wide Range ◽  
Dressing Materials

Background: Diabetic foot remains the most common chronic medical problem being the most common cause of the hospital visit and/or admission, amongst the diabetic patients. Topical antimicrobial dressings, including those that contain silver are used to prevent or manage infection in a wide range of wounds.Methods: This is the prospective, observational study which included 50 cases of diabetic foot ulcer patients and effects of silver-based dressing materials will be evaluated.Results: After application of silver based dressing materials for two weeks, wound was evaluated on the basis of discharge from the wound, healing rate, appearance of the granulation tissue and culture and sensitivity report which showed that out of 50 cases studied, 3 cases (6%) had purulent discharge from the wound, absent granulation tissue, culture report showed presence of micro-organism and thus poor healing rate while other 47 cases (94%) had minimal/serous discharge, presence of healthy granulation tissue, no organism on culture report and thus good healing rate.Conclusions: Silver based dressing materials are effective in terms of promoting wound healing and more patient compliance.

scholarly journals Topically Applied Connective Tissue Growth Factor/CCN2 Improves Diabetic Preclinical Cutaneous Wound Healing: Potential Role for CTGF in Human Diabetic Foot Ulcer Healing

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
F. R. Henshaw ◽  
P. Boughton ◽  
L. Lo ◽  
S. V. McLennan ◽  
S. M. Twigg
Keyword(s):  
Wound Healing ◽  
Granulation Tissue ◽  
Ulcer Healing ◽  
Diabetic Foot ◽  
Healing Rate ◽  
Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Fluid ◽  
Diabetic Wounds

Aims/Hypothesis. Topical application of CTGF/CCN2 to rodent diabetic and control wounds was examined. In parallel research, correlation of CTGF wound fluid levels with healing rate in human diabetic foot ulcers was undertaken.Methods. Full thickness cutaneous wounds in diabetic and nondiabetic control rats were treated topically with 1 μg rhCTGF or vehicle alone, on 2 consecutive days. Wound healing rate was observed on day 14 and wound sites were examined for breaking strength and granulation tissue. In the human study across 32 subjects, serial CTGF regulation was analyzed longitudinally in postdebridement diabetic wound fluid.Results. CTGF treated diabetic wounds had an accelerated closure rate compared with vehicle treated diabetic wounds. Healed skin withstood more strain before breaking in CTGF treated rat wounds. Granulation tissue from CTGF treatment in diabetic wounds showed collagen IV accumulation compared with nondiabetic animals. Woundα-smooth muscle actin was increased in CTGF treated diabetic wounds compared with untreated diabetic wounds, as was macrophage infiltration. Endogenous wound fluid CTGF protein rate of increase in human diabetic foot ulcers correlated positively with foot ulcer healing rate (r=0.406;P<0.001).Conclusions/Interpretation. These data collectively increasingly substantiate a functional role for CTGF in human diabetic foot ulcers.

scholarly journals Should Chopart Amputation be Performed in Diabetic Foot Ulcer Patients?

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0011
Author(s):  
James D. Brodell ◽  
Judith F. Baumhauer ◽  
Benefict F. DiGiovanni ◽  
A. Samuel Flemister ◽  
John P. Ketz ◽  
...  
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Patient Reported Outcomes ◽  
High Rate ◽  
Measurement Information ◽  
Prosthesis Fitting ◽  
Sf 36 ◽  
Significant Difference ◽  
Patient Reported ◽  
Syme Amputation

Category: Diabetes, Midfoot/Forefoot Introduction/Purpose: Diabetic foot ulcers (DFU) with deep infections and osteomyelitis often lead to partial or complete limb loss. Determination of the appropriate level for amputation is challenging, and is a complex decision based on the patient’s function at baseline, extent of infection, vascular patency and comorbidities. Although Chopart amputation preserves greater limb length than Syme amputation, additional procedures, such as Achilles tenectomy and tendon transfers are necessary to optimize residual foot function. Challenges with wound healing and prosthesis fitting have been reported. We aimed to investigate the functional and clinical outcomes including patient reported outcomes of Chopart and Syme amputations. Methods: A query utilizing current procedural terminology (CPT) codes was performed to identify patients who had undergone Syme or Chopart amputations for diabetic foot infections by an academic orthopaedic group between August 2013 and September 2018. Twenty-two patients with average age of 59.8 (range, 28-79) years, comprising 18 Chopart amputations and 4 Syme amputations were identified. Demographic characteristics, body mass index, hemoglobin A1c, medical comorbidities, major and minor post-operative complications, unplanned admission or return to OR, revision surgeries, and time to receiving a brace or prosthesis information were compiled. After informed consent was obtained, subjects completed three Patient-Reported Outcomes Measurement Information Systems (PROMIS) instruments (Pain Interference (PI), Physical Function (PF), and Depression), and the SF-36. Unpaired student t-tests and Fisher’s exact test were utilized to compare patient cohorts. Statistical analysis was performed using Stata®. Results: The majority (17/18) of Chopart and half (2/4) of Syme patients developed complications including wound dehiscence and recurrent/persistent infection. Readmission and unexpected return to the OR for irrigation and debridement or revision occurred in 11/18 (61%) of Chopart and 2/4 (50%) of Syme patients. Revision amputations occurred in 10/18 (56%) Chopart patients (2 Syme, 8 BKA), and 1/4 (25%) Syme patients (BKA). Half of Chopart patients never received a prosthesis due to delayed wound healing and revision amputation. All Syme amputation patients received a prosthesis and resumed ambulation. The average time to prosthesis was 4.5 and 6.5 months for Syme and Chopart patients, respectively. There was no significant difference between Syme and Chopart patients in all PROMIS domains, or the SF-36 (p-values > 0.05) (Table 1). Conclusion: We found a high rate of complications and revision procedures in Chopart amputation patients. In our patient cohort, there was a high likelihood that a patient who underwent a Chopart amputation ultimately received a below knee amputation. Even after wound healing, patients with Chopart amputations may struggle with obtaining a prosthesis suitable for ambulation. Syme amputation patients were less likely to require revision amputation, and received a prosthesis more rapidly relative to Chopart amputation patients. The complication and revision rates of Chopart amputations indicate that surgeons should exercise judicious patient selection prior to performing these procedures.

scholarly journals Genetic parameters of wound healing in patients with neuropatic diabetic foot ulcers

2017 ◽  
Vol 20 (5) ◽  
pp. 344-349
Author(s):  
Ekaterina L. Zaitseva ◽  
Alla Y. Tokmakova ◽  
Iya A. Voronkova ◽  
Vasily M. Petrov ◽  
Anatoly N. Tiulpakov ◽  
...  
Keyword(s):  
Wound Healing ◽  
Granulation Tissue ◽  
Diabetic Foot ◽  
Local Treatment ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Inflammatory Infiltration ◽  
Tissue Samples ◽  
Clinical Pictures ◽  
Collagen Genes

Background. Tissue repair processes are impaired in diabetic foot ulcers (DFUs). Previous research has shown that glycaemic control, cytokines and growth factors play an important role in wound healing. Emerging evidence also suggests that genes play a role via their regulation of cell proliferation, collagen synthesis and granulation tissue formation. Aim. To evaluate collagen genes expression in different stages of wound healing in patients with DFUs. Materials and methods. Prospective study included four patients with neuropathic DFUs after surgical debridement. Tissue samples were taken for morphological and genetic tests on days 0, 10 and 15 of local treatment to evaluate expression of collagen genes (i.e. COL1A1, COL1A2, COL3A1) and to perform morphological tests. Results. The present study confirmed that the size of wounds decreased by 8.8 7% after 10 days of local treatment and by 18.3 8% after 15 days of local treatment. According to histological examination of wound biopsies at day 10, all patients showed a tendency for lower levels of inflammatory infiltrate, increased number of fibroblast-like cells, presence of maturing granulation tissue and emergence of connective tissue fibres. After 15 days, we detected inflammatory infiltration in the wounds, despite the formation of mature granulation tissue. According to results of genetic analysis on day 10 of local wound treatment, we found a tendency for increased expression of collagen genes relative to the baseline: COL1A1 increased by 3.2 1.3 times, COL1A2 by 2.0 1.0 times and COL3A1 by 1.25 1.1 times. On day 15 of local treatment, in contrast, we found a tendency for decreased expression of COL1A1, COL1A2 and COL3A1 relative to the baseline (1.7 0.6, 2.5 2 and 20.0 3 times, respectively). Conclusions. The expression of collagen genes (COL1A1, COL1A2, COL3A1) is more pronounced in proliferation phase and is subsequently reduced towards the end. These data were confirmed by morphological study and clinical pictures.

scholarly journals The efficacy of phenytoin dressing in healing of diabetic ulcer: a randomized control study

2017 ◽  
Vol 4 (10) ◽  
pp. 3311
Author(s):  
Vijay Gunasekaran ◽  
Saravanakumar Subbaraj ◽  
Tirou Aroul
Keyword(s):  
Wound Healing ◽  
Granulation Tissue ◽  
Diabetic Foot ◽  
Bacterial Load ◽  
Foot Ulcer ◽  
Control Group ◽  
Study Group ◽  
Gingival Hyperplasia ◽  
Diabetic Ulcer ◽  
Wound Swab

Background: Diabetic foot infection constitutes up to 10 percent of diabetes-related hospital admissions and the prevalence of diabetes is 2.4% in rural and 12-17% in urban settings. The quest for better wound healing agents for diabetic ulcers is perhaps one of the oldest challenges for medical practice. One such agent that has been tried in wound healing is phenytoin. A common side effect of phenytoin (diphenylhydantoin) treatment for epilepsy is gingival hyperplasia. This stimulatory effect of phenytoin on connective tissue suggested a possibility for its use in wound healing.Methods: 60 patients with diabetic foot ulcer admitted in General Surgery at Mahatma Gandhi Medical College and Research Institute, Puducherry, India were randomly assigned into two groups, the study group consisting of 30 patients who were treated with phenytoin dressing and 30 patients into control group who were treated with conventional saline dressing. Both groups underwent initial debridement and were started on parenteral antibiotics according to wound swab culture and sensitivity. Study group were treated with phenytoin dressing and the wound was assessed based on the rate of ulcer size reduction, the rate of granulation tissue, duration of hospital stays and antibacterial property of phenytoin. Patients were assessed weekly up to 21 days.Results: The rate of granulation tissue in phenytoin group was 90.36% which was statistically significant (p = 0.0011) as compared to control group which was 82.03%. Wound swab cultures repeated on day 21 revealed that there was 50% negative culture in phenytoin group when compared to control group of 24% which also was statistically significant. The mean hospital stay for the patient in phenytoin group was 29.2 days and in control group, it was 26.1 days. It was observed that surface area reduction in phenytoin group was 41.25cm2 to 18.38cm2 and in control group was 40.28cm2 to 20.23cm2 by the end of 21 days, but this was not statistically significant.Conclusions: Phenytoin dressing is effective in increasing the rate of granulation tissue by virtue of its action on stimulating fibroblast proliferation and decreasing collagenase activity. It not only hastens granulation tissue but also decreases bacterial load as compared to conventional dressing by virtue of its intrinsic antibacterial activity and indirectly through their effects on anti-inflammatory cells and neovascularization. Phenytoin prepares the foot ulcer for early grafting thereby improving the overall outcome.

scholarly journals Morphological characteristics of uterine tubes ampullae in elderly females

2020 ◽  
pp. 46-52
Author(s):  
Irina A. Balandina ◽  
Anna M. Nekrasova
Keyword(s):  
Old Age ◽  
Elderly Women ◽  
Single Cells ◽  
Morphological Characteristics ◽  
Outer Diameter ◽  
Ki 67 ◽  
Uterine Tube ◽  
Qualitative And Quantitative ◽  
Significant Difference ◽  
The Right

The aim of the study is to determine the size and to identify the features of histoarchitectonics of the uterine tube ampulla of an old-aged female. Materials and methods. The ampulla of both uterine tubes was examined in 26 nulliparous and 78 giving birth elderly women using morphometric, histological, immunohistochemical, and micrometric research methods. Results. The length and outer diameter of uterine tubes at the points of transition of isthmus into the ampulla and ampulla into the infundibulum as well as in the central part of ampulla are characterized by the absence of a statistically significant difference in parameters in nulliparous and giving birth women. The histoarchitectonic features of the ampullae of the uterine tubes in nulliparous and giving birth women in old age consist in the flattening of the epithelium of the mucous membrane, which forms many closely spaced thickened folds that create an uneven narrowing of the ampulla lumen, and the proliferation of connective tissue between the bundles of muscle fibers of the muscular membrane. The presence of Ki-67 expression in single cells of less than 1%, as well as a thin layer of epithelial membrane antigen in the epithelium of the ampulla along with the complete absence of its expression in the stroma reflect normal tissue regeneration and act as an equivalent to the anatomical norm in elderly females. When comparing lumen areas of ampulla and its wall at mid-section as well as the circumference of epithelial lining, a predominance of parameters in the right uterine tube was revealed (p<0.01). Conclusion. The study showed the similar qualitative and quantitative morphological characteristics of the uterine tube ampullae both in nulliparous and giving birth females in old age.

scholarly journals Clinical and morphological characteristics with markers of reparation in neuropathic diabetic foot ulcers.

2015 ◽  
Vol 18 (3) ◽  
pp. 70-76 ◽  
Author(s):  
Elena Yurievna Komelyagina ◽  
Evgenia Aleksandrovna Kogan ◽  
Mikhail Borisovich Antsiferov
Keyword(s):  
Smooth Muscle ◽  
Diabetic Foot ◽  
Smooth Muscle Actin ◽  
Morphological Characteristics ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Muscle Actin ◽  
Ki 67 ◽  
Group 3 ◽  
Group 1

Aim. To compare the clinical and morphological characteristics of chronic diabetic foot ulcers and the markers of repair.Materials and Methods.We included 26 patients with neuropathic diabetic foot syndrome who had signs of severe peripheral neuropathy. Biopsies were performed from the margin and central part of the lesion and were fixed in a 10% formalin solution before being placed on paraffin slides and stained with hematoxylin and eosin. We assessed the percentages of necrotic, granulation and fibrotic tissues and the severity of vascular hyalinosis. Immunohistochemistry was performed with initial antibodies to Ki-67 (a marker of proliferation), smooth muscle actin (a marker of myofibroblast synthesis) and cytokeratin (a marker of epithelisation). For analysis, the samples were divided into three groups by the length of time the ulcer had been present: group 1 (≤90 days; 9 samples), group 2 (91–365 days; 10 samples) and group 3 (365 days; 9 samples).Results. The patients of group 3 were older than those of groups 1 and 2 (53.7±2.7 vs 51.7±5.9 vs 59.9±5.6 years; p=0.04). There were no differences in the duration of diabetes, glycated haemoglobin or severity of neuropathy. The percentage of necrotic tissue was higher in group 1 (33.7%±21.7% vs 11.0%±3.9% vs 12.8%±6.1%; p=0.02) and the percentage of fibrotic tissue was highest in group 3 (21.1%±21.0% vs 35.5%±19.8% vs 54.4%±23.9%; p=0.001). However, the amount of granulation tissue was not different between the groups (45.2%±21.1% vs 53.5%±21.1% vs 32.8%±26.3%; p=0.4). There was also no difference in the severity of vascular hyalinosis between the groups (p=0.9). Expression of Ki-67 was higher in groups 1 and 2, implying a greater capacity to regenerate. The expression of smooth muscle actin and cytokeratin was higher in groups 1 and 2 but without statistical significance.Conclusion. The morphological characteristics and regenerative capacities of neuropathic diabetic foot ulcers differ with the duration the ulcer has been present. Patients with ulcers for less than 1 year were characterised by higher cell proliferation but lower fibrosis. Neuropathic diabetic foot ulcers that are unable to heal over a year are characterised by incomplete regeneration and higher levels of fibrosis. Thus, different treatment approaches are needed depending on how long an ulcer has been present.

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