Advanced dressings and growth factors in surgical wound healing of diabetic patients: A narrative review of nursing implications

Objectives Diabetes is a major challenge for healthcare systems due to its increasing prevalence. Surgical wounds in diabetic patients are relating with meaningful delays in healing and a high risk of infection and amputation due to pathophysiological disorders caused through chronic hyperglycemia, neuropathy, and angiopathy. This review study aimed to survey the role of advanced dressings and growth factors in the healing of surgical wounds in diabetic patients and to explain new nursing strategies in this field. Methods This study was conducted using a narrative review method. A comprehensive search was conducted in reputable databases including PubMed, Scopus, and Google Scholar using keywords related to diabetes, surgical wound, advanced dressing, silver, hydrogel, alginate, chitosan, and nursing care. Relevant articles, including reviews, clinical trials and basic studies that examined the pathophysiology of wound healing, types of advanced dressings, and the role of nurses in wound management, were reviewed. Findings Chronic hyperglycemia impairs tissue repair by inhibiting fibroblast migration, decreasing vascular endothelial growth factor (VEGF) production (up to 7-fold), and increasing matrix metalloproteinase 9 (MMP-9) (up to 3-fold). Diabetic neuropathy predisposes to pressure necrosis by eliminating protective sensation. Advanced dressings, including silver, hydrogel (with controlled drug delivery and moist environment), alginate (absorbing 15 to 20 times its weight), and chitosan, were identified as effective tools in the management of diabetic wounds. Nurses play a pivotal role in the success of treatment by performing sensory-vascular assessment, self-care education, continuous wound monitoring, and coordination within the multidisciplinary team. Telehealth programs such as telehealth program to promote wound healing (TPWHP) with remote monitoring have significantly improved wound healing. Conclusion Successful management of surgical wounds in diabetic patients requires an integrated and multifaceted approach including careful blood glucose control, effective debridement, pressure relief, evidence-based dressing selection, and comprehensive nursing care in an interdisciplinary collaboration. Execution of this approach can significantly suppress serious complications such as amputation and refine the quality of life of diabetic patients. Despite significant progress, larger clinical trials are required to compare the efficacy and usefulness of different dressings and develop smart and personalized technologies.