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Rapid healing of intractable diabetic foot ulcers with exposed bones following a novel therapy of exposing bone marrow cells and then grafting epidermal sheets.

Abstract

BACKGROUND

Diabetic foot ulcers with exposed bones commonly result in amputation.

OBJECTIVES

To determine whether exposure of bone marrow cells and subsequent grafting of epidermal sheets accelerates healing and reduces the need for amputation.

METHODS

Thirty-eight patients with chronic wounds caused by diabetes mellitus were enrolled in this study. Epidermal sheets obtained from suction blisters of each patient were grafted on to diabetic foot ulcers without exposed bones (n = 10) and were compared with the standard treatment of local wound care, debridement with a scalpel when indicated, bed rest and parenteral antibiotics (n = 8). In another group of patients, diabetic wounds with exposed bones were treated either with the standard procedure (n = 9) or with a newly developed experimental procedure (n = 11). In that new procedure, the affected bone was initially exposed by debridement with a scalpel, followed by partial excision with a bone scraper until fresh bleeding was observed from the exposed bone. The lesions were then immediately covered with an occlusive dressing, and finally the wound was covered with an epidermal graft of skin harvested from suction blisters. Patients in each group were matched with their counterparts by age, sex, wound size, wound infection and wound duration, to compare the time needed for total skin repair and rates of amputation.

RESULTS

Epidermal grafting significantly accelerated the healing of diabetic foot ulcers (P = 0.042) without exposed bones, with site-specific differentiation. The newly developed combination therapy resulted in the healing of all diabetic ulcers with exposed bones without the occurrence of osteomyelitis or the necessity for amputation (P < 0.0001).

CONCLUSIONS

Our study indicates that early aggressive debridement of diabetic foot ulcers with exposed bones down to a bleeding vascularized base and then grafting epidermal sheets significantly improves healing and reduces the rate of amputation.

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  • Authors+Show Affiliations

    ,

    Department of Dermatology, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita-shi, Osaka 5650871, Japan.

    , , , , , , ,

    Source

    The British journal of dermatology 151:5 2004 Nov pg 1019-28

    MeSH

    Adult
    Aged
    Aged, 80 and over
    Amputation
    Bone Marrow Cells
    Bone and Bones
    Combined Modality Therapy
    Debridement
    Diabetic Foot
    Epidermis
    Female
    Humans
    Male
    Middle Aged
    Occlusive Dressings
    Osteomyelitis
    Suction
    Wound Healing

    Pub Type(s)

    Case Reports
    Clinical Trial
    Controlled Clinical Trial
    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    15541080

    Citation

    Yamaguchi, Y, et al. "Rapid Healing of Intractable Diabetic Foot Ulcers With Exposed Bones Following a Novel Therapy of Exposing Bone Marrow Cells and Then Grafting Epidermal Sheets." The British Journal of Dermatology, vol. 151, no. 5, 2004, pp. 1019-28.
    Yamaguchi Y, Yoshida S, Sumikawa Y, et al. Rapid healing of intractable diabetic foot ulcers with exposed bones following a novel therapy of exposing bone marrow cells and then grafting epidermal sheets. Br J Dermatol. 2004;151(5):1019-28.
    Yamaguchi, Y., Yoshida, S., Sumikawa, Y., Kubo, T., Hosokawa, K., Ozawa, K., ... Itami, S. (2004). Rapid healing of intractable diabetic foot ulcers with exposed bones following a novel therapy of exposing bone marrow cells and then grafting epidermal sheets. The British Journal of Dermatology, 151(5), pp. 1019-28.
    Yamaguchi Y, et al. Rapid Healing of Intractable Diabetic Foot Ulcers With Exposed Bones Following a Novel Therapy of Exposing Bone Marrow Cells and Then Grafting Epidermal Sheets. Br J Dermatol. 2004;151(5):1019-28. PubMed PMID: 15541080.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Rapid healing of intractable diabetic foot ulcers with exposed bones following a novel therapy of exposing bone marrow cells and then grafting epidermal sheets. AU - Yamaguchi,Y, AU - Yoshida,S, AU - Sumikawa,Y, AU - Kubo,T, AU - Hosokawa,K, AU - Ozawa,K, AU - Hearing,V J, AU - Yoshikawa,K, AU - Itami,S, PY - 2004/11/16/pubmed PY - 2005/3/25/medline PY - 2004/11/16/entrez SP - 1019 EP - 28 JF - The British journal of dermatology JO - Br. J. Dermatol. VL - 151 IS - 5 N2 - BACKGROUND: Diabetic foot ulcers with exposed bones commonly result in amputation. OBJECTIVES: To determine whether exposure of bone marrow cells and subsequent grafting of epidermal sheets accelerates healing and reduces the need for amputation. METHODS: Thirty-eight patients with chronic wounds caused by diabetes mellitus were enrolled in this study. Epidermal sheets obtained from suction blisters of each patient were grafted on to diabetic foot ulcers without exposed bones (n = 10) and were compared with the standard treatment of local wound care, debridement with a scalpel when indicated, bed rest and parenteral antibiotics (n = 8). In another group of patients, diabetic wounds with exposed bones were treated either with the standard procedure (n = 9) or with a newly developed experimental procedure (n = 11). In that new procedure, the affected bone was initially exposed by debridement with a scalpel, followed by partial excision with a bone scraper until fresh bleeding was observed from the exposed bone. The lesions were then immediately covered with an occlusive dressing, and finally the wound was covered with an epidermal graft of skin harvested from suction blisters. Patients in each group were matched with their counterparts by age, sex, wound size, wound infection and wound duration, to compare the time needed for total skin repair and rates of amputation. RESULTS: Epidermal grafting significantly accelerated the healing of diabetic foot ulcers (P = 0.042) without exposed bones, with site-specific differentiation. The newly developed combination therapy resulted in the healing of all diabetic ulcers with exposed bones without the occurrence of osteomyelitis or the necessity for amputation (P < 0.0001). CONCLUSIONS: Our study indicates that early aggressive debridement of diabetic foot ulcers with exposed bones down to a bleeding vascularized base and then grafting epidermal sheets significantly improves healing and reduces the rate of amputation. SN - 0007-0963 UR - https://www.unboundmedicine.com/medline/citation/15541080/Rapid_healing_of_intractable_diabetic_foot_ulcers_with_exposed_bones_following_a_novel_therapy_of_exposing_bone_marrow_cells_and_then_grafting_epidermal_sheets_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=0007-0963&amp;date=2004&amp;volume=151&amp;issue=5&amp;spage=1019 DB - PRIME DP - Unbound Medicine ER -