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Impaired autonomic neurovascular control opens dermal arterio\u2010venous anastomoses and shunts microcirculation away from the epidermis and impairs skin oxygenation and nutrition. Few recognise that diabetic neuropathy includes swelling\u2010induced entrapment neuropathy. Multiple peripheral nerves, swollen by the secondary polyol metabolic pathway, suffer local compressions at fibro\u2010osseous tunnels. This includes the C\u2010fibres controlling autonomic functions which constitute most of the nerve axons. No current standard of care therapy addresses the sympathetic\u2010regulated neurovascular impairment of skin microcirculation in diabetes. Epineurolysis surgery for peripheral nerve decompression relieves local axonal compressions and generates recovery of sub\u2010epidermal capillary flow. Clinical and animal diabetes studies have demonstrated objective improvements to epidermal hypoxia, demyelination and axonal histology. Seven surgery studies find an average 1.39% recurrence and zero amputations after prior Risk Class 3 wound healing in a mean of 1.78\u2009years of follow\u2010up. Deficits of electrophysiology, transcutaneous oxygenation and vasa nervorum circulation also improve. Surgically improved microcirculation is physiology\u2010based. Nerve decompression minimises diabetic peripheral neuropathy, avoids initial diabetic foot ulcers, promotes neuropathic diabetic foot ulcer healing and minimises ulcer recurrences and subsequent amputation. The observational studies of these important benefits suggest wide application to the complications of diabetes neuropathy and beg for academic attention to Level 1 EBM confirmation.<\/jats:p>","DOI":"10.1111\/iwj.70198","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T01:07:26Z","timestamp":1744765646000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Improving Microcirculation With Nerve Decompression: The Missing Link in Treatment of Diabetic Neuropathy and Diabetic Foot Ulcer"],"prefix":"10.1111","volume":"22","author":[{"given":"David Scott","family":"Nickerson","sequence":"first","affiliation":[{"name":"NE Wyoming Wound Care Clinic  Sheridan Wyoming USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dwayne Sonny","family":"Yamasaki","sequence":"additional","affiliation":[{"name":"Enso Medical Technologies, Inc.  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