By Erica Lloyd
About a quarter of diabetic foot ulcers don’t fully heal after a year. For some patients, the wound remains unhealed even though skin has regrown to cover the wound. In those cases, the new skin is not performing two of its most important jobs—to act as a barrier to pathogens and to keep enough moisture in.
Chandan Sen, director of the McGowan Institute for Regenerative Medicine at Pitt, calls these “invisible wounds.” Sen, professor of surgery, Pitt School of Medicine, and his team first observed such improperly healed wounds in pigs in 2014. These invisible wounds tend to reopen, he says. Yet, right now, doctors don’t have a way of distinguishing whether a wound has healed properly, so they release patients from their care when it appears it has closed.
Findings published May 30 in the journal Diabetes Care may change the standard of care for diabetic foot ulcers and give doctors a new metric for evaluating wounds. The stakes are high, as about one-third of people with diabetes will get foot ulcers. When the ulcers don’t heal properly, patients may face amputation, which happens in about 20% of those cases.
Sen was the principal investigator on the National Institute for Diabetes and Digestive and Kidney Diseases multicenter Diabetic Foot Consortium transepidermal water loss (TEWL) study.
While treating hundreds of patients with foot ulcers across the nation, TEWL clinical research teams incorporated something new: They measured water loss in the skin using a tool that’s already on the market—but not designed specifically for wound care. They found that water loss, a mark of a defective barrier function, is followed by high rates of wound recurrence. Sen is now working to develop TEWL diagnostics as a biomarker of recurrence of chronic wounds.
“This has opened the door to a new era in diabetic wound care,” says Sen. He would like to prevent amputation and related deaths by helping doctors provide additional care to patients until the wound has properly closed.