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Case Study
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Use of bilayered cell therapy in the treatment of diabetic foot wounds with exposed bone Rosemay Michel, DPM, Shelli Brewington, DPM, Javier La Fontaine, DPM, University of Texas Health Science Center, San Antonio, TX Problem: To recommend Bilayered Cell Therapy (BLCT)* as a viable option of expeditious healing of wounds with bone exposure The importance of timely resolution of wounds in patients with Diabetes and other immunocompromising conditions is widely cited in literature. Surgical wounds are of concern due to the significant risk of spread of infection to resultant exposed soft tissue and/or bone, which may necessitate eventual amputation. A majority of surgical wounds in the diabetic foot present with exposed bone, which must be closely monitored with planned timely closure to prevent a more proximal level of amputation Controversies exist among surgeons regarding timing of closure of open amputations or pedal surgical wounds. Absolute certainty of absence of infection is imperative prior to closure. However, due to patient related factors, such as vascular status and level of immunosuppression, these wounds often exhibit delayed healing and require adjunctive means for closure. Options include skin grafting, biological therapy and human skin equivalents We report a case of a patient who underwent a partial 1st ray amputation secondary to an infected neuroischemic pedal ulceration with resultant exposed 1st metatarsal stump. The wound was treated with BLCT*, which resulted in complete resolution without occurrence of soft tissue infection, osteomyelitis, or need for proximal amputation Conclusion: BCLT* is a viable option for closure of diabetic foot wounds with exposed bone * BLCT: Apligraf¨, Organogenesis, Inc., Canton, MA Singh N, Armstrong D, Lipsky B. Preventing foot ulcers in patients with diabetes. JAMA. 2005; 293:217Ð228 Lipsky BA, Berendt, AR, Deery, HG, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004;39(7):885Ð910. Yamaguchi Y, Yoshida S, Sumikawa Y, et al. Rapid healing of intractable diabetic foot ulcers with exposed bones folliwng a novel therapy of exposing bone marrow cells and then grafting epidermal sheets. Br J Dermatol. 2004;151(5):1019Ð1028 Shen JT, Falanga V. Innovative therapies in wound healing. J Cutan Med Surg. 2003;7:217Ð224 Brem H, Balledux J, Bloom T, Kerstein M, Hollier L. Healing of diabetic foot ulcers and pressure ulcers with human skin equivalent. Arch Surg. 2000;135:627Ð634. |
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