Autologous fibroblasts to treat deep and complicated leg ulcers in diabetic patients

Large complicated leg ulcers, not responsive to standard therapy, after surgical debridement and under parenteral specific antibiosis, must be occlusively covered to improve wound healing. In 10 diabetic patients with deep (Wagner degree 3), large, and Staphylococcus aureus (n=7) or Pseudomonas aeruginosa (n=5)-infected leg (n=1), or foot (n=9) ulcers, we have applied, as a coverage, meshes of in vitro expanded autologous fibroblasts. Complete ulcer healing was observed in seven patients after 8, 12, 12, 14, 16, 18, and 20 weeks from the first graft application (2, 3). Two patients had >70% wound healing at 20 and 28 weeks after the first treatment. One patient, previously submitted to a bypass vascular procedure, died of acute myocardial infarction 16 weeks after the first fibroblast autograft application and with a healing wound evenly filled with granulation tissue. In our opinion, the application of autologous in vitro expanded fibroblasts is a satisfactory therapeutic option to treat large leg ulcers and is particularly indicated in patients with chronic diseases such as diabetes or autoimmune diseases on steroid treatment. Figure 2Open in figure viewerPowerPoint A case of infectious gangrene of the forefoot (A) treated by surgical removal of the infected necrotic tissues, parenteral antibiotic therapy (B), and autologous dermal grafts (C). The ulcer healed 8 weeks after the first graft application (D). Figure 3Open in figure viewerPowerPoint A case of flap necrosis after Lisfranc amputation with exposure of tarsal bones (A) treated by surgical removal of all necrotic tissues, specific parenteral antibiotic therapy, and autologous dermal grafts (B). A few weeks later, the ulcer was filled by granulation tissue (C) and healed 18 weeks after the first dermal graft (D).