Skin Substitutes Part I- Rebooting Wound Biology for Healing

This episode explains that diabetic foot ulcers are driven by "biological paralysis" rather than just skin loss, describing the four phases of wound healing and why wounds get stuck in chronic inflammation. Dr. G reviews key failure mechanisms—protease imbalance, fibroblast dysfunction, persistent M1 macrophages, angiogenic failure, and stem cell impairment—and how skin substitutes can replace extracellular matrix, rebalance cytokines, provide growth-factor signaling, and support tissue repair. The episode also covers when skin substitutes fail (infection, ischemia, inadequate debridement, and mechanical disruption) and emphasizes matching the graft to the wound biology rather than just wound size.