Neuropathy impacts on wound healing in diabetic foot ulcer. Discuss.

Despite the best efforts of clinicians involved in wound care, diabetic ulcers can be hard to resolve. The slow healing of a diabetic ulcer may be due to several factors including peripheral vascular disease, neuropathy and the presence of infection. Diabetic neuropathy impacts on a wound in many ways, for example leading to overloading of the area, affecting normal wound healing processes such as angiogenesis and affecting the immune cells locally. This essay will consider the potential impact of diabetic neuropathy on healing in a patient with a foot ulcer. The role of the neuropeptide Substance P will be included. The essay will include a critique of a research article (Krishana et al, 2007) supporting this topic area.

You will be required to submit a 2800-word assignment and this work should include:

1. A brief introduction

You will need to outline the relevance of the topic area. This should NOT be in terms of figures that mean little to the general reader but should demonstrate an understanding of why this topic is important to those managing the patient. You need to define the scope of the essay. The basic pathology of diabetes is NOT required (as it is assumed that you know the pathology of diabetes) but should focus on factors related to the development of wounds so that the introduction quickly leads on to become very specific to neuropathy. The introduction needs to identify what is included in the essay and why.

2. Main body of the first part of the essay

In the main part of this essay, you are expected to explore the impact of neuropathy on wound healing. You might give a brief overview as to why neuropathy develops in diabetes and you might consider how sensory / motor / autonomic neuropathy causes an ulcer. But remember, the focus of the essay is not about causing an ulcer, it should be moving your knowledge on to how the neuropathy prevents the ulcer from healing. The essay needs to include factors that are not simply about the ulcer not healing due to the causative factors remaining, it should be about how the neuropathy changes the process (the normal physiology) of wound healing. There are several neuropeptides involved but in this essay, you should only provide greater detail on Substance P.

You will need to show good academic writing skills to present the work fluently, showing the depth of information and the ability to link concepts. You need to be explaining clearly the pathology to a level that describes what is happening in tissues and cells. Any molecules/cells you describe need to be clearly explained and you should not assume the reader knows what the molecule/cell normally does. You should continually refer back to the main theme of the essay – the inability of the wound to heal.

You should use no more that twelve articles to support your work in this section. I have provided six articles that you should find useful and can include within those articles.

3. A critical exploration of the evidence.

One article has been provided (Krishnan et al, 2007) that has investigated whether the wound healing rate is related to neurovascular factors. You should write a critique of this paper.

4. A coherent conclusion

Your essay should finish with a summary of the key information given and perhaps a reflection about how the knowledge gained may impact on your management of a diabetic foot ulcer in your future practice.