The Structural Changes of the Skin Surrounding Ulcers in Diabetic Foot


Abstract Background: Diabetic foot is a serious complication of diabetes which aggravates the patient’s condition and abnormal regulation of the hemodynamics in the small vessels may contribute to the development of microangiopathy.Objective: To investigate the histological changes in the skin tissue covering the area surrounding the ulceration of the diabetic foot. Patients & Methods: In the present study 45 patients were collected from Al-Jumhuri Teaching Hospital in Mosul-Iraq during the period from December 2015 to December 2016.The patients were subdivided into 3 groups (15 for each group ).Group I were the control group (non-diabetic but have traumatic ulceration ); group II were insulin-dependent diabetics (Diabetes mellitus type-I) & group III were non-insulin dependent diabetes (Diabetes mellitus type-II). Specimens of skin were obtained from the area surrounding the diabetic ulcer.The specimens were fixed in 10% neutral buffered formalin for 24 hours then histological sections were prepared and stained by Hematoxylin and Eosin, and Orcein-VanGieson stains for examination by light microscope. All the work was done in the Department of Anatomy, Mosul College of Medicine. Results: The skin sections showed the presence of epidermal hyperkeratosis with regular acanthosis & chronic inflammatory cells infiltration in the dermis; fibrous tissue deposition in tunica media of the small arteries and arterioles; obvious degeneration of Schwann cells in the peripheral nerves & finally degeneration of regional sweat glands.Conclusions: The diabetic foot ulcer causes morphological & structural changes in the skin tissue surrounding it.More significant incidence of diabetic foot ulceration in female, smoker, hypertensive, and those having disturbance in renal functions and the severity of changes appeared to be more in non-insulin dependent diabetic patients.