Diabetes Cure Story
SUMMARY. The healing of burns in diabetic patients is delayed by the vascular obstruction due to the disease and by the effects of diabetes (insufficient inflammatory response, insulin insufficiency and/or resistance). Local treatment is thus of fundamental importance for the healing of the wounds and for metabolic compensation, which is closely related to healing and which in turn it affects. In their clinical practice, the authors of this paper use antibiotic salicylate vaseline as their elected topical treatment of burns in diabetic patients in the light of the fact that antibiotic salicylate vaseline has a keratolytic and antimicrobial effect, improves local circulation, and increases the activity of insulin.
Introduction
Various researchers in the past have proposed the use of salicylate vaseline with various concentrations of salicylic acid and of antibiotic antiseptic salicylate vaseline (AASV) in the local treatment of burns.
In patients with localized burns in particular body areas (face, neck, flexor folds, perineal area), in whom surgical escharectomy is difficult to perform, or in bad physical condition (serious damage to upper airways, serious shock, previously generally poor physical condition, etc.), in whom early escharectomy would be dangerous both aesthetically and quoad vitam, the use of the proposed method permits good and rapid chemical escharectomy, without blood loss. It also improves the prospects of good skin-graft take.
Antiseptics and antibiotics were added to the salicylate vaseline in order to increase salicylic acid's antimicrobial effect.
It happens ever more increasingly that Burn patients are unaware of their diabetic condition, which therefore went untreated. This and other physiopathological and clinical considerations regarding diabetes prompted us to study more deeply this method's possible local and more general effects on diabetes. We were also interested in its influence on the healing of the damaged areas.
It is well known that wounds in diabetic patients are extremely slow-healing. This delay is due to the combination of two factors:
- disturbances in local blood circulation
- the effects of hyperglycaernia (insulin insufficiency or resistance)
The circulation disorders are a consequence of the vascular obstructive disease. This affects above all the peripheral vessels, with negative consequences for oxygen flow (hypoxia) and for the nutritional substances reaching the wounds (malnutrition).
The inflammatory response in diabetic patients is insufficient, and the consequences of insulin deficiency (blockage of anaerobic glycolysis, from which the white blood cells receive most of their energy) are associated with those of hyperglycaemia. This condition inhibits phagocytosis and therefore the intracellular lysis of bacteria ingested by wound macrophages. This is why diabetics are so liable to infection.
Another important factor involved in the slow healing of diabetic patients' wounds is the direct effects of insulin deficiency on the fibroblasts as regards glucose absorption and protein synthesis, both of which are considerably reduced.
