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Diabetes mellitus (DM) is a metabolic disease characterized by chronic hyperglycemia caused by multiple factors. It occurs due to defects in insulin secretion and/or action. The classic symptoms of diabetes, known as "three mores and one loss", include polyuria, polydipsia, polyphagia and weight loss, often accompanied by itchy skin. Long-term metabolic disorders in carbohydrate, fat and protein metabolism can lead to a series of chronic complications, such as progressive lesions, dysfunction and failure of important organs such as eyes, kidneys, nerves, heart and blood vessels. Severe metabolic disorders can occur under the severity of the disease or under stressful situations, leading to the high global mortality rate associated with diabetes.
The main point of this paper
Challenges of Diabetic Foot Ulcers (DFUs):
Diabetic foot ulcers are a common and serious complication of diabetes, characterized by lower extremity ulcers and gangrene, which may lead to amputation or even death.
A leg is amputated every 30 seconds worldwide, 85% of which are patients with diabetic foot ulcers, and the mortality rate of amputees is as high as 22%.
Complexity of DFU Treatment:
DFU treatment is expensive because of challenges in the wound healing process, including factors such as peripheral neuropathy, deformity, and macrovascular disease.
Low fibroblast proliferation, receptor downregulation, and insufficient dermal protein matrix are also factors affecting DFU.
Application of nanofiber scaffolds in DFU treatment:
Nanofiber scaffolds have become a revolutionary drug delivery platform for promoting wound healing due to their high porosity, high specific surface area and structure that mimics the extracellular matrix
Electrospinning technology can precisely adjust the composition and size of fibers, making it a universal tool in the biomedical field, including medical implants, wound dressings, etc.
Electrospinning scaffolds have unique microstructures and suitable mechanical properties, which help absorb wound tissue exudates, promote gas exchange, and enhance skin tissue regeneration
Drug release ability of nanofiber scaffolds:
Nanofiber scaffolds support cell implantation, attachment, nutrient penetration and metabolic waste Discharge of substances, creating an optimal microenvironment for cell growth, proliferation, adhesion, migration and differentiation
Electrospun scaffolds provide the ability to load bioactive factors or drugs, such as antibiotics, anti-inflammatory drugs, etc., and the fiber structure can be adjusted to achieve precise control of drug release
Research progress of electrospun scaffolds:
The advantages of electrospun nanofiber scaffolds in the treatment of diabetic wounds have been widely studied, including their structural similarity with the extracellular matrix, the adjustability of composition and size, and porous properties
The study summarizes the various research results using different types of nanofiber scaffolds to treat diabetic wounds and reviews the drug loading methods on nanofiber scaffolds.
Characteristics of diabetic wounds:
Chronic and difficult to heal, with elevated levels of inflammatory cytokines, MMPs, and ROS.
Associated with impaired angiogenesis, persistent infection, and high hospitalization rates, it imposes an economic burden on patients.
In severe cases, it may lead to amputation or death.
Risks of diabetic foot ulcers (DFU):
Up to 25% of diabetic patients are at risk of foot ulcers in their lifetime.
More than 70% of DFU patients eventually require amputation.
Advantages of electrospun scaffolds:
The structure mimics the extracellular matrix (ECM) to promote fibroblast adhesion, growth, and migration.
Promotes the formation of new skin tissue at the wound surface.
The composition and size are easy to adjust, and drug release can be controlled.
Porosity is conducive to gas exchange and absorption of wound exudate.
The fiber surface is easy to modify to impart specific functions.
Advances in the treatment of diabetic wounds:
This article introduces the normal wound healing process and the pathological mechanism of diabetic wounds.
The advantages of electrospun nanofiber scaffolds in the treatment of diabetic wounds are discussed.
The research results of different types of nanofiber scaffolds for diabetic wounds are reviewed.
The method of drug loading on nanofiber scaffolds is discussed
Diabetes diagnosis rates are increasing rapidly worldwide, resulting in a significant rise in diabetic foot ulcers (DFUs). To meet the needs of patients, it is necessary to continuously innovate in treatment options to overcome current limitations. Electrospun scaffolds have shown promising results in diabetic wound healing and DFU treatment due to their similar structure and composition to the extracellular matrix (ECM). These scaffolds provide a favorable environment for cell adhesion, growth, and promotion of skin tissue healing and neovascularization.
This review reviews the pathological differences between normal and diabetic wounds, discusses the pathogenesis of DFUs, and emphasizes the urgent need for new treatments. Electrospun scaffolds with different fluids and structures and their applications in diabetic wounds are introduced. Most of these applications promote the regeneration of diabetic wounds through the inherent properties of drug-loaded scaffolds or electrospun scaffolds, such as stimulating cell migration, promoting angiogenesis, reducing inflammation and infection, and promoting tissue re-epithelialization.
