Norton Paul, Trus Pavlos, Wang Fengyi, Thornton M Julie, Chang Chien-Yi
School of Dental Sciences Faculty of Medical Sciences Newcastle University Newcastle Upon Tyne UK.
Biosciences Institute Faculty of Medical Sciences Newcastle University Newcastle Upon Tyne UK.
Skin Health Dis. 2024 May 30;4(4):e399. doi: 10.1002/ski2.399. eCollection 2024 Aug.
Notoriously known as the silent pandemic, chronic, non-healing diabetic foot ulcers (DFUs), pose a significant rate of incidence for amputation and are a major cause of morbidity. Alarmingly, the treatment and management strategies of chronic wounds represent a significant economic and health burden as well as a momentous drain on resources with billions per annum being spent in the US and UK alone. Defective wound healing is a major pathophysiological condition which propagates an acute wound to a chronic wound, further propelled by underlying conditions such as diabetes and vascular complications which are more prevalent amongst the elderly. Chronic wounds are prone to infection, which can exacerbate the condition, occasionally resulting in amputation for the patient, despite the intervention of modern therapies. However, amputation can only yield a 5-year survival rate for 50% of patients, highlighting the need for new treatments for chronic wounds.
The dynamic cutaneous microbiota is comprised of diverse microorganisms that often aid wound healing. Conversely, the chronic wound microbiome consists of a combination of common skin commensals such as and , as well as the opportunistic pathogen . These bacteria have been identified as the most prevalent bacterial pathogens isolated from chronic wounds and contribute to prolific biofilm formation decreasing the efficiency of antimicrobials and further perpetuating a hyper-inflammatory state.
Here, we review recent advances and provide a new perspective on alternative treatments including phage and microbiome transplant therapies and how the definitive role of the cutaneous microbiota impacts the aetiology of DFUs.
慢性、不愈合的糖尿病足溃疡（DFUs）被称为无声的大流行疾病，其截肢发生率很高，是发病的主要原因。令人担忧的是，慢性伤口的治疗和管理策略带来了巨大的经济和健康负担，也是资源的重大消耗，仅在美国和英国每年就花费数十亿美元。伤口愈合缺陷是一种主要的病理生理状况，它会使急性伤口发展为慢性伤口，而糖尿病和血管并发症等潜在疾病会进一步加剧这种情况，这些疾病在老年人中更为普遍。慢性伤口容易感染，这会使病情恶化，尽管有现代疗法的干预，但偶尔仍会导致患者截肢。然而，截肢只能使50%的患者获得5年生存率，这凸显了对慢性伤口新治疗方法的需求。
动态皮肤微生物群由多种微生物组成，这些微生物通常有助于伤口愈合。相反，慢性伤口微生物群由常见皮肤共生菌（如 和 ）以及机会致病菌 组成。这些细菌已被确定为从慢性伤口中分离出的最普遍的细菌病原体，它们会导致大量生物膜形成，降低抗菌药物的效率，并进一步维持炎症状态。
在此，我们回顾了近期的进展，并就包括噬菌体和微生物群移植疗法在内的替代治疗方法以及皮肤微生物群的决定性作用如何影响糖尿病足溃疡的病因提供了新的视角。
