• 1

    Lobmann R, Pittasch D, Muhlen I, et al: Autologous human keratinocytes cultured on membranes composed of benzyl ester of hyaluronic acid for grafting in nonhealing diabetic foot lesions: a pilot study. .J Diabetes Complications 17::199. ,2003. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Dalla Paola L, Cogo A, Deanesi W, et al: Using hyaluronic acid derivatives and cultured autologous fibroblasts and keratinocytes in a lower limb wound in a patient with diabetes: a case report. .Ostomy Wound Manage 48::46. ,2002. .

    • Search Google Scholar
    • Export Citation
  • 3

    Caravaggi C, De Giglio R, Pritelli C, et al: HYAFF 11-based autologous dermal and epidermal grafts in the treatment of noninfected diabetic plantar and dorsal foot ulcers: a prospective, multicenter, controlled, randomized clinical trial. .Diabetes Care 26::2853. ,2003. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Uccioli L; TissueTech Autograph System Italian Study Group. A clinical investigation on the characteristics and outcomes of treating chronic lower extremity wounds using the tissuetech autograft system. .Int J Low Extrem Wounds 2::140. ,2003. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Cavallini M: Autologous fibroblasts to treat deep and complicated leg ulcers in diabetic patients. .Wound Repair Regen 15::35. ,2007. .

  • 6

    Monami M, Longo R, Desideri CM, et al: The diabetic person beyond a foot ulcer: healing, recurrence, and depressive symptoms. .JAPMA 98::130. ,2008. .

    • Search Google Scholar
    • Export Citation
  • 7

    Monami M, Vivarelli M, Desideri CM, et al: Pulse pressure and prediction of incident foot ulcers in type 2 diabetes. .Diabetes Care 32::897. ,2009. .

  • 8

    Margolis DJ, Allen-Taylor L, Hoffstad O, et al: Diabetic neuropathic foot ulcers: predicting which ones will not heal. .Am J Med 115::627. ,2003. .

  • 9

    Oyibo SO, Jude EB, Tarawneh I, et al: The effects of ulcer size and site, patient’s age, sex and type and duration of diabetes on the outcome of diabetic foot ulcers. .Diabet Med 18::133. ,2001. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Armstrong DG, Lavery LA, Frykberg RG, et al: Validation of a diabetic foot surgery classification. .Int Wound J 3::240. ,2006. .

  • 11

    Folstein MF, Robins LN, Helzer JE: The Mini-Mental State Examination. .Arch Gen Psychiatry 40::812. ,1983. .

  • 12

    Katz S, Akpom CA: 12. Index of ADL. .Med Care 14::116. ,1976. .

  • 13

    Lawton MP, Brody EM: Assessment of older people: self-maintaining and instrumental activities of daily living. .Gerontologist 9::179. ,1969. .

  • 14

    Yesavage JA, Brink TL, Rose TL, et al: Development and validation of a geriatric depression screening scale: a preliminary report. .J Psychiatr Res 17::37. ,1982. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    McHorney CA, Ware JE, Raczek AE: The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. .Med Care 31::247. ,1993. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Mannucci E, Ricca V, Bardini G, et al: Well-being enquiry for diabetics: a new measure of diabetes-related quality of life. .Diabetes Nutr Metab Clin Exp 9::89. ,1996. .

    • Search Google Scholar
    • Export Citation

Autologous Skin Fibroblast and Keratinocyte Grafts in the Treatment of Chronic Foot Ulcers in Aging Type 2 Diabetic Patients

Matteo Monami Unit of Geriatric Medicine, Department of Cardiovascular Medicine, University of Florence and Azienda Ospedaliera Careggi, Florence, Italy.

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Maria Vivarelli Unit of Geriatric Medicine, Department of Cardiovascular Medicine, University of Florence and Azienda Ospedaliera Careggi, Florence, Italy.

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Carla Maria Desideri Unit of Geriatric Medicine, Department of Cardiovascular Medicine, University of Florence and Azienda Ospedaliera Careggi, Florence, Italy.

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Giulio Ippolito Unit of Geriatric Medicine, Department of Cardiovascular Medicine, University of Florence and Azienda Ospedaliera Careggi, Florence, Italy.

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Niccolò Marchionni Unit of Geriatric Medicine, Department of Cardiovascular Medicine, University of Florence and Azienda Ospedaliera Careggi, Florence, Italy.

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Edoardo Mannucci Unit of Geriatric Medicine, Department of Cardiovascular Medicine, University of Florence and Azienda Ospedaliera Careggi, Florence, Italy.

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Background: We assessed the tolerability and efficacy of autologous skin cell grafts in older type 2 diabetic patients with chronic foot ulcers.

Methods: Treatment with Hyalograft 3D and Laserskin Autograft was proposed to a consecutive series of type 2 diabetic patients older than 65 years affected by long-standing (>6 months) foot ulcers with an area greater than 15 cm2. Ulcer healing rates and measurements of ulcer area were determined monthly for 12 months.

Results: Seven patients with 12 ulcers, nine of which received the described treatment, were enrolled. During 12-month follow-up, all of the ulcers healed except one. In the remaining eight ulcers, the median healing time was 21 weeks (interquartile range, 4–29 weeks).

Conclusions: Autologous skin cell grafts are feasible, well tolerated, and apparently effective in the treatment of diabetic ulcers of the lower limbs in advanced age. Age did not seem to moderate healing times. (J Am Podiatr Med Assoc 101(1): 55–58, 2011)

Corresponding author: Matteo Monami, MD, PhD, Geriatric Unit, Department of Critical Care, Ospedale di Careggi, Via delle Oblate, 4 – 50141 Florence, Italy. (E-mail: mmonami@libero.it)