Adipose-derived stem cells for treatment of chronic cutaneous ulcers in patients with critical limb ischemia: a pilot study

Therapeutic approaches based on stem cells have recently been introduced to treat chronic ulcers, with good results. The aim of this study was to evaluate whether the topical application of adipose-derived stem cells (ASCs) with platelet-rich plasma (PRP) for the treatment of ischemic cutaneous ulcers modified the skin perfusion of the treated areas. Perilesional laser Doppler flowmetry (LDF) and transcutaneous oximetry (tcpO(2)) values were recorded for a 3-month period in seven arteriopathic and diabetic patients with ischemic ulcers of the lower limb candidates to amputation, who had been previously treated with single co-administered perilesional and intralesional injections of ASCs+PRP. Significant differences were found between pretreatment (T0) and 3 month post-treatment (T3) values regarding both LDF values (basal mean values: T0 30.7; T3 50.4; declivous mean values: T0 23; T3 38.9;) and tcpO(2) levels (basal mean values: T0 6.7; T3 45.9; declivous mean values: T0 17.6; T3 47.3). According to the values of LDF and TcpO(2), the multidisciplinary treatment of severe ulcers with ACSs+PRP associated or not with revascularization therapy allowed a perilesional improvement of oxygenation and perfusion such to avoid limb amputation, with complete wound healing. Early treatment with ASCs associated or not with reperfusion therapy is an effective treatment even in severe ulcers in advanced stage once treated with amputation of limb.