Adjunct Methods of the Standard Diabetic Foot Ulceration Therapy
Table 4
Wound healing process and the alternative methods.
Elements of wound healing
Methods
HBOT
MT
PRPT
Inflammation
Bactericidal and bacteriostatic effects on both aerobic and anaerobic bacteria through the action of the super oxide enzyme
Antibacterial potential effect of alkaline pH of maggot secretion [77, 78] Wound bacteria are killed as they pass through the maggot’s digestive tract Presence of a potent bactericide present in maggot secretions Cytokine regulation and enhanced phagocytosis [75]
Suppresses cytokine release and limits the amount of inflammation, interacting with macrophages to improve tissue healing Enhances phagocytosis and chemotaxis [54] Antimicrobial host defence enriched with growth factors and other active substances [83]
Granulated tissue formation—epithelialization
Increases epidermal cells and fibroblast proliferation and differentiation [29]
The healing of wounds is an interactive process (regulators as growth factors, cytokines and chemokines) [42] Synthesized and released locally proteins or polypeptides [42, 43] Increases fibroblast proliferation through maggots excretions and secretions [75]
Influences on chemotaxis, mitogenesis, and differentiation Promotes healing by stimulating fibroblast and keratinocyte proliferation Promotes granulation tissue formation [55, 61] and epithelialisation
Matrix formations
Increases fibroblast proliferation and collagen production
Stimulates extracellular matrix and remodeling processes [45]
Stimulates the deposition of extracellular matrix and collagen [56]
Angiogenesis
The oxygen gradient promotes the formation of new vessels required for wound healing [28, 35, 68]
Growth factors, cytokines, and chemokines provide significant vasodilation and increased capillary permeability to the wound site, allowing the infusion of recruited polymorphonuclear leucocytes (PMNs) and macrophages [48, 84]
