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

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COD: 03_2017_16_2604 Categorie: ,

Andrea Armenio, Daniela Anna Cutrignelli, Maria Luisa Nardulli, Giulio Maggio, Giuseppe Memeo, Valerio De Santis, Giuseppe Giudice, Cosmo Maurizio Ressa

Ann Ital Chir, 2016 88, 3: 268-274
Epub Ahead of Print 6 December 2016

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AIM: 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.).
MATERIAL OF STUDY: 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.
RESULTS: 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.
DISCUSSION: 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.
CONCLUSIONS: 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.