Aetiology of Diabetic Foot Ulceration: A Role for the Microcirculation?
Article first published online: 30 JUL 2009
1992 Diabetes UK
Volume 9, Issue 4, pages 320–329, May 1992
How to Cite
Flynn, M.D. and Tooke, J.E. (1992), Aetiology of Diabetic Foot Ulceration: A Role for the Microcirculation?. Diabetic Medicine, 9: 320–329. doi: 10.1111/j.1464-5491.1992.tb01790.x
- Issue published online: 30 JUL 2009
- Article first published online: 30 JUL 2009
- Diabetes mellitus;
- Diabetic foot;
Neuropathy, mechanical stress, and macrovascular disease are involved in the pathogenesis of diabetic foot ulceration. Implicit in the development of gangrene and ulceration is the recognition that these factors interact with the microcirculation, resulting in the failure of skin capillary flow to meet nutritive requirements. There is little evidence to associate structural microangiopathy with foot microcirculatory failure. Significant functional abnormalities of the microcirculation have been defined. In accord with the haemodynamic hypothesis early hyperaemia and capillary hypertension promote more sinister late functional abnormalities with increasing duration of diabetes. These late functional abnormalities include loss of autoregulation and reduced hyperaemic responses which interact with loss of neurogenic flow regulation, disturbed endothelial function, and abnormal rheology to produce the familiar clinical picture of the diabetic foot. Ischaemia secondary to multi-segment arterial disease induces additional abnormalities of microcirculatory function which are superimposed on the pre-existing diabetic microvascular structural and functional microangiopathy.