{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T18:47:10Z","timestamp":1785696430455,"version":"3.56.0"},"reference-count":176,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":131,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100001170","name":"Hitchcock Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001170","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Diabetic foot ulcers (DFUs) represent a growing clinical challenge, driven by an aging global population and the increasing prevalence of diabetes. Affecting millions worldwide, DFUs remain one of the most serious complications of diabetes, frequently progressing to infection, amputation, and elevated mortality. Standard treatments typically include pressure offloading, circulation improvement, infection control, and topical wound care; however, many chronic DFUs fail to respond to these interventions due to persistent inflammation, impaired vascularization, and microbial burden. These challenges have accelerated interest in regenerative medicine approaches, including stem cells, growth factors, and skin substitutes. Among these, skin substitutes have shown particular promise; among Food and Drug Administration-approved options, products such as the collagen-Manuka honey-hydroxyapatite patch from SweetBio (Apis\u00ae) have demonstrated improved outcomes in patients with chronic ulcers. Silk fibroin (SF), a natural biopolymer with established clinical use, has emerged as a promising platform for chronic wound management due to its biocompatibility, tunable degradation, and capacity for controlled bio-additive delivery. SF scaffolds can be fabricated through various methods tailored to wound-healing applications: electrospun fibrous mats with high surface-area-to-volume ratio, freeze-dried porous constructs with interconnected architecture, and hydrogels designed for controlled drug delivery. In this review, we critically examine how SF scaffolds enhanced with bio-additives modulate cellular responses, redirect dysregulated healing pathways, accelerate wound closure, and promote tissue regeneration in diabetic wounds. We synthesize recent advances in preclinical and clinical studies, identify key translational barriers, and outline future directions for advancing SF-based dressings toward clinical adoption. Collectively, this review positions bio-enhanced SF scaffolds as next-generation, disease-informed candidates for improving outcomes in chronic DFU care.<\/jats:p>","DOI":"10.1093\/burnst\/tkag035","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T11:42:05Z","timestamp":1778240525000},"source":"Crossref","is-referenced-by-count":0,"title":["Bio-enhanced silk fibroin-based scaffolds for chronic diabetic foot ulcers"],"prefix":"10.1093","volume":"14","author":[{"given":"Victoria Cubina","family":"Lopez","sequence":"first","affiliation":[{"name":"Thayer School of Engineering, Dartmouth College , 15 Thayer Drive, Hanover, NH 03755 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jewelia","family":"Durant","sequence":"additional","affiliation":[{"name":"Thayer School of Engineering, Dartmouth College , 15 Thayer Drive, Hanover, NH 03755 ,","place":["United States"]},{"name":"Geisel School of Medicine, Dartmouth College , 1 Rope Ferry Road, Hanover, NH 03755 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3094-5537","authenticated-orcid":false,"given":"Katherine R","family":"Hixon","sequence":"additional","affiliation":[{"name":"Thayer School of Engineering, Dartmouth College , 15 Thayer Drive, Hanover, NH 03755 ,","place":["United States"]},{"name":"Geisel School of Medicine, Dartmouth College , 1 Rope Ferry Road, Hanover, NH 03755 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"2026080210511567200_ref1","volume-title":"Diabetes in America","author":"Pilla","year":"2023"},{"key":"2026080210511567200_ref2","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1007\/s11892-025-01583-5","article-title":"Managing diabetes in older adults: current approaches in long-term care facilities","volume":"25","author":"Idrees","year":"2025","journal-title":"Curr Diab Rep."},{"key":"2026080210511567200_ref3","volume-title":"National Diabetes Statistics Report"},{"key":"2026080210511567200_ref4","doi-asserted-by":"publisher","first-page":"2077","DOI":"10.1016\/S0140-6736(24)02317-1","article-title":"Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants","volume":"404","author":"NCD Risk Factor Collaboration (NCD-RisC)","year":"2024","journal-title":"Lancet."},{"key":"2026080210511567200_ref5","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/S0140-6736(23)01301-6","article-title":"Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021","volume":"402","author":"GBD 2021 Diabetes Collaborators","year":"2023","journal-title":"Lancet."},{"key":"2026080210511567200_ref6","doi-asserted-by":"publisher","first-page":"107843","DOI":"10.1016\/j.diabres.2019.107843","article-title":"Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9th edition","volume":"157","author":"Saeedi","year":"2019","journal-title":"Diabetes Res Clin Pract"},{"key":"2026080210511567200_ref7","volume-title":"StatPearls","author":"Packer","year":"2025"},{"key":"2026080210511567200_ref8","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1248\/jhs.53.655","article-title":"Anti-diabetic activity of methanol leaf extract of Costus pictus D. 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