SLR - June 2009 - Olanipekun, Herrick, Aungst
Reference:
Yoshikawa, T., Mitsuno, H., Nonaka, I., Sen, Y., et al. Wound Therapy by Marrow Mesenchymal Cell Transplantation. Plastic and Reconstructive Surgery,121,860-877.
Scientific Literature Reviews
Reviewed by: Olufunmilayo Olanipekun, DPM; Allison Herrick, DPM, David Aungst, DPM
Residency Program: Greater Los Angeles Veteran Affairs/ UCLA-Olive View Medical Center
Podiatric Relevance:
The purpose of this study is to provide insight into if marrow mesenchymal cells may be useful in the treatment of various ulcerations due to the presence of stem cells.
Methods:
This study involved 20 patients with various skin wounds who were followed over a 3 year period. Each patient had 10-20 ml of bone marrow fluid aspirated and cultured from their ilium in a medium which contained either fetal calf or autologous serum. The cultured cells were then placed into artificial dermis made of collagen sponge which was then cut to fit the size of their wound. After several days the silicone membrane was removed and the patients healing process was monitored.
Results:
The patients that received the artificial dermis without cultured marrow mesenchymal cells showed failed results both macroscopically and microscopically within 2 weeks. The patients who received marrow mesenchymal cells which were injected without artificial dermis had similar results with failure at 2 weeks. All of the 20 patients which had failed using other treatments were then treated with the artificial dermis (Pelnac) with implanted cultured marrow mesenchymal cells which revealed positive macroscopic and microscopic changes at 2 weeks. In these wounds, the histologic findings revealed human nonepithelial fibrous tissue and vascular cells thought to be regenerated using the cultured cells. There were 7 patients with lower leg or foot ulcers which were treated with the artificial dermis with implanted cultured cells. Only 2 of the 7 patients with ulcers healed. The other 5 patients showed regeneration of fibrous and fat tissues and healed after receiving a split thickness skin graft. There were 11
patients with infected decubitus ulcers which were treated with the artificial dermis with implanted cultured cells. Of this group, 2 patients died from unrelated events, 4 patients mostly healed, 5 patients healed the ulcer, and there was recurrence in only 2 of the patients after worsening in their nutritional state. Overall, the wounds healed in 18 patients with a duration ranging from 2 weeks to over 2 months after graft placement. There were no adverse reactions due to the graft and it did not exacerbate the skin wound in any of the 20 patients.
Conclusions:
Overall, the marrow mesenchymal cell transplantation facilitated the wound healing process in all 20 patients as opposed to when only the artificial dermis was implanted without the cultured cells. This procedure should be considered due to it being minimally invasive, it’s ability to be performed with local anesthetic, and the lack of damage to healthy skin in comparison to using other existing grafting techniques.