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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2006 August;19(4):253-6
Bioengineered skin grafts after revascularization in the treatment of ischemic ulcers
Russo G. 1, Crippa M. 2, Lorenzi G. 2, Motolese A. 1
1 Operative Unit of Dermatology Alessandro Manzoni Hospital, Lecco, Italy
2 Operative Unit of Vascular Surgery Alessandro Manzoni Hospital, Lecco, Italy
Aim. To verify the role of dermal skin grafts after successful revascularization procedures in the healing of ischemic ulcers of the lower limbs.
Methods. From February 2002 to January 2004 we have treated 7 patients (2 males and 5 females, mean age 74,8 years) suffering from Peripheral Arterial Occlusive Disease (PAOD) with trophic lesions. Six of them were diabetic. Two patients were treated by means of femoro-popliteal by-pass BK, two received a femoro-tibial by-pass, two received a popliteal-dorsal pedal by-pass, (in every case we have used autologous saphein vein) and one patient was treated only with medical therapy with prostaglandine E-11 (PGE-II). Every patient suffered from large ischemic lesions localized at the leg or foot lasting for more than six months associated with rest pain. Four patients presented bacteric sovrainfections of the lesions. Our protocol consists of revascularization, daily debridment and then skin grafting using autologous fibroblasts and keratinocytes seeded on Hyaff-11 an esther of Hyaluronic acid.
Results. In six patients (85,7%) the ulcers completely healed. The time required for healing ranged from 7 days to 34 days (mean 15 days). The only failure occurred in a diabetic patient with a large lesion of the forefoot who received a femoro-popliteal by-pass (BK) and underwent a bacteric infection of the skin graft.
Conclusions. Regenerative dermal skin graft performed following open or endovascular arterial revascularization is a valid method for the treatment of large ischemic trophic lesions in patients with severe peripheral arteriopathy.