Abstract
Background
The stromal vascular fraction (SVF) of adipose tissue consists of cellular subpopulations with distinct regenerative potential.
Objective
To investigate the regenerative capacities of autologous SVF cells in the treatment of chronic leg ulcers of venous (VLU) and arterial-venous (AVLU) origin.
Methods
Multimorbid ulcer patients received a singular topical treatment with 9-15x106 SVF cells, separated from abdominal lipoaspirates by digestion with collagenase and dispase and applied immediately after isolation. The primary endpoints were the change in wound size 12 weeks after treatment and evaluation of adverse events. Secondary endpoints included the time to complete wound epithelialization and change in pain levels. Postoperative wound treatment modalities and treatment of comorbidities were not intensified compared with preoperative management. Follow-up period was at least 6 months.
Results
Sixteen elderly ulcer patients (7 with VLU, 9 with AVLU) were treated as described. All VLU patients (median ulcer size: 48.25 cm2) and 4 of 9 AVLU patients showed complete epithelialization of the ulcers within 71 to 174 days. In 3 patients with large ulcerations on both legs, ulcerations on the non-treated, contralateral leg also epithelialized. Patients reported a considerable rapid decrease in pain intensity by 2.5 points on average on a visual scale from 1 to 5 within the first two weeks after treatment. The patients were followed-up for 9-44 months (median: 30 months). No severe side effects were observed.
Conclusions
The use of SVF cells presents an effective, minimally invasive option for the treatment of VLU and AVLU even in multimorbid patients. In patients with larger predominantly ischemic AVLU and comorbidities, one-time application of the used amounts of SVF cells was not sufficient in the majority of cases.
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