Wound healing is an intricate, dynamic process, in which various elements such as hyperglycemia,
neuropathy, blood supply, matrix turnover, wound contraction, and the microbiome all
have a role in this “out of tune” diabetic complex symphony, particularly noticeable in the complications
of diabetic foot. Recently it was demonstrated that the fasciae have a crucial role in proprioception,
muscular force transmission, skin vascularization and tropism, and wound healing. Indeed,
the fasciae are a dynamic multifaceted meshwork of connective tissue comprised of diverse cells
settled down in the extracellular matrix and nervous fibers; each constituent plays a particular role
in the fasciae adapting in various ways to the diverse stimuli. This review intends to deepen the
discussion on the possible fascial role in diabetic wounds. In diabetes, the thickening of collagen,
the fragmentation of elastic fibers, and the changes in glycosaminoglycans, in particular hyaluronan,
leads to changes in the stiffness, gliding, and the distribution of force transmission in the fasciae,
with cascading repercussions at the cellular and molecular levels, consequently feeding a vicious
pathophysiological circle. A clear scientific perception of fascial role from microscopic and macroscopic
points of view can facilitate the identification of appropriate treatment strategies for wounds
in diabetes and create new perspectives of treatment.
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