Bio-Engineering tissue and V.A.C. therapy: A new method for the treatment of extensive necrotizing infection in the diabetic foot

• Published in: Annali italiani di chirurgia Vol. 88; p. 268
• Main Authors: Armenio, Andrea, Cutrignelli, Daniela Anna, Nardulli, Maria Luisa, Maggio, Giulio, Memeo, Giuseppe, De Santis, Valerio, Giudice, Giuseppe, Ressa, Cosmo Maurizio
• Format: Journal Article
• Language: English
• Published: Italy 01.05.2017
• Subjects: Adult; Aged; Aged, 80 and over; Case-Control Studies; Combined Modality Therapy; Debridement; Diabetic Foot - complications; Diabetic Foot - pathology; Diabetic Foot - surgery; Diabetic Foot - therapy; Female; Fibroblasts - transplantation; Foot - blood supply; Humans; Male; Middle Aged; Nanoparticles; Necrosis; Negative-Pressure Wound Therapy; Neovascularization, Physiologic; Recurrence; Retrospective Studies; Silver; Tissue Engineering; Transplantation, Autologous; Treatment Outcome; Wound Healing; Wound Infection - etiology; Wound Infection - pathology; Wound Infection - surgery; Wound Infection - therapy
• ISSN: 2239-253X

The aim of the study is to compare the standard care for progressive necrotizing infection in diabetic foot with a treatment protocol based on the association between autologous fibroblast grafts and vacuum-assisted closure therapy (V.A.C.). A retrospective matched Case-Control study was carried out on 20 patients with diabetic foot infection, 10 treated with the standard care and 10 with our new protocol. Inclusion criteria were: acute diabetic foot necrosis (Wagner III and IV), ulcer size (30 to 80 cm2), tendon and bone exposure. Success in the treatment was evaluated as: percentage of healing at the 20th week, time of healing, deambulation, recurrence and major amputation rate. A 90% healing rate was observed after 20 weeks in the study group, compared to a 28.6% in the control group. The recurrence rate in the treated areas was 20% in the study group and 100% in the control group. None of the patients in either group required major amputations. We achieved very promising results by associating autologous fibroblasts grafts and V.A.C. therapy, in comparison with standard care. V.A.C. therapy seems to improve the growth rate of the fibroblasts, probably by sealing the wound and providing a moist environment following the fibroblast graft. The improved neoangiogenesis of the neo-dermis could explain the reduced recurrence rate of the study group. Despite the low number of patients involved and the retrospective nature of the analysis, this study showed a reliable, safe and cost-effective method of treating extensive infection in the diabetic foot. Bio-Engineered Tissue, Diabetic foot, Fibroblast graft, V.A.C.