SLR - May 2016 - Archibald J. Loch

Title: Débridement and Autologous Lipotransfer for Chronic Ulceration of the Diabetic Foot and Lower Limb Improves Wound Healing
 
Reference: Stasch T, Hoehne J, Huynh T, De Baerdemaeker R, Grandel S, Herold C.  Débridement and Autologous Lipotransfer for Chronic Ulceration of the Diabetic Foot and Lower Limb Improves Wound Healing. Plast Reconstr. Surg. 2015 Dec;136(6): 1357-66.  

Scientific Literature Review

Reviewed By: Archibald J. Loch, DPM
Residency Program: Massachusetts General Hospital, Boston, MA

Podiatric Relevance: Few things are more challenging and frustrating than a non healing foot wound or ulceration. Over the last several decades numerous wound care products and advanced therapies have been held up as “the answer” to this problem. Despite these advances, pedal wounds can still be difficult to treat. Lipotransfer is used frequently in plastic surgery but is rarely discussed in relation to chronic lower extremity ulcerations. This study aims to offer another technique to achieve wound healing in chronic pedal wounds that have failed other available treatments.

Methods: This study was a retrospective review. Twenty-six patients with non healing wounds were treated with surgical debridement and autologous lipotransfer. On average 2cc per square cm of wound bed was required and fat was harvested from the thigh or abdomen. Inclusion criteria for adult patients were recalcitrant non healing lower limb ulcers (present for over two months); a surface dimension of larger than 2 cm squared; and causes including only venous, arterial, diabetogenic, postsurgical, posttraumatic, or pressure ulcers. Exclusion criteria were greater than 10 cm squared and available alternative treatments including revascularization. The mean age of the wounds before intervention was 16.7. Wound size after débridement averaged 5.1 ± 2.6 cm2. On average, 7.1 ± 3.3 cc of lipoaspirate was transferred into the wound area. Vacuum-assisted closure and strict bed rest were maintained for 4-5 days following the procedure. Darco Wound Care Shoe System with limited weight bearing was utilized until the wound was healed.

Results: Twenty-two of 25 wounds (88 percent) healed completely within a mean of 68.0 ± 33.0 days. A reduction of wound size by 50 percent was achieved after an average of four weeks. In one patient with an ulcer within particularly scarred tissues on the lower limb, a repeated session of lipotransfer led to complete wound healing after another 57 days.

Conclusions: The technique used in this study may be useful in augmenting care of chronic ulcerations in your clinic or wound center. This method has shown to improve wound healing in diabetic feet and chronic lower limb ulcers with a background of peripheral vascular disease, where other interventional options to achieve wound healing have failed. It is important to note, as the authors do in the paper, that all non healing wounds should be biopsied based on clinical suspicion for malignancy.

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