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Autologous fat grafting combined with negative pressure wound therapy in severe diabetic foot ulcer: a case study

01 April 2021

Abstract

Objective:

Hard-to-heal wounds are a surgical challenge, and diabetic foot ulcers (DFUs) are one of the most common and severe varieties. Previous studies have shown that autologous fat grafting (AFG) and negative pressure wound therapy (NPWT) have the potential to promote wound healing. This case study describes how these two methods together helped in the healing of a serious DFU.

Case history:

A 65-year-old female patient had a severe DFU on her right foot, with a 30-year history of disease and renal failure. By the time symptoms were evident, regular dressing changes and antibiotic treatment were inadequate. She received surgical debridement, AFG and NPWT. Finally, as the granulation tissue covered the full wound bed, the wound was closed by split-thickness skin grafting. One month later, the DFU was fully healed with no recurrences.

Conclusion:

The application of AFG or components of adipose tissue to treat hard-to-heal wounds has been researched at both the molecular level and in clinic. In this case, we have proved the curative effect of jointly using AFG and NPWT.

Diabetic foot ulcer (DFU) is one of the most challenging complications in patients with diabetes and it has a lifetime incidence of 15–25%.1 Impaired diabetic wound healing has become an important cause of non-traumatic lower-limb amputation worldwide, and it progresses to major amputation in 14–24% of patients.2 These intractable and refractory wounds pose a challenge in plastic surgery. The main goal of the specialist is to accelerate wound closure and lower the amputation rate to improve patients’ outcomes. The purpose of this article is to describe a new clinical practice in a patient with a severe DFU classified as grade IIID (in accordance with the University of Texas Diabetic Wound Classification)3 by applying autologous fat grafting (AFG) and negative pressure wound therapy (NPWT).

A 65-year-old female patient, with a history of diabetes and renal failure, was admitted to our department with a right DFU and fever. Several months previously, the treatment she received in the local hospital had involved washing, dressing changes and antibiotic treatment to prevent the wound from progressing. The treatment was unsuccessful and her second toe was removed. Amputation of the foot had been suggested, but the patient always refused it.

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