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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2005 June;12(2):61-4
Open and endovascular revascularization combined with regenerative dermal skin graft in the treatment of ischemic ulcers
Lorenzi G. 1, Crippa M. 1, Rossi G. 1, Ferrari S. 1, Terzi A. 1, Motolese A. 2
1 Operative Unit of Vascular Surgery Alessandro Manzoni Hospital, Lecco, Italy
2 Operative Unit of Dermatology Alessandro Manzoni Hospital, Lecco, Italy
Aim. The aim of the study is 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 bypass (below the knee), 2 received a femoro-tibial bypass, 2 received a popliteal-dorsal pedal bypass, (in every case we have used autologous saphein vein) and 1 patient was treated only with medical therapy with prostaglandin E-11 (PGE-2). Every patient suffered from large ischemic lesions localized at the leg or foot lasting for more than 6 months associated with rest pain. Four patients presented bacteric sovrainfections of the lesions. Our protocol consists of revascularization, daily debridement and then skin grafting using autologous fibroblasts and keratinocytes seeded on Hyaff-11 an esther of hyaluronic acid.
Results. In 6 patients (85.7%) the ulcers completely healed.
The only failure occurred in a diabetic patient with a large lesion of the forefoot who received a femoro-popliteal bypass (below the knee)) and underwent a bacteric infection of the skin graft.
Conclusion. 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.