Bioengineering and the diabetic foot ulcer : basic science review

Diabetic disease is increasing exponentially on a global scale. Diabetic foot ulcers (DFUs) are the leading cause of non-traumatic lower limb amputations. The pathophysiological events need to be considered when designing new interventions. Bioengineered skin substitutes (BSS) are accepted in the therapeutic armamentarium for DFU treatment. However, newer designs are likely to offer more targeted approaches to the disease process. This relates to the stimulation of vasculogenesis in particular. This can be achieved by using interactive scaffolds that stimulate endothelial progenitor cells to increase vascular endothelial growth factor production and reverse some of the damage that is caused by glycation end-products that are characteristic of diabetes.