title: Rapid healing of intractable diabetic foot ulcers with exposed bones following a novel therapy of exposing bone marrow cells and then grafting epidermal sheets.
abstract: BACKGROUND
  Diabetic foot ulcers with exposed bones commonly result in amputation.
  
  
  OBJECTIVE
  To determine whether exposure of bone marrow cells and subsequent grafting of epidermal sheets accelerates healing and reduces the need for amputation.
  
  
  METHODS
  Thirty-eight patients with chronic wounds caused by diabetes mellitus were enrolled in this study. Epidermal sheets obtained from suction blisters of each patient were grafted on to diabetic foot ulcers without exposed bones (n = 10) and were compared with the standard treatment of local wound care, debridement with a scalpel when indicated, bed rest and parenteral antibiotics (n = 8). In another group of patients, diabetic wounds with exposed bones were treated either with the standard procedure (n = 9) or with a newly developed experimental procedure (n = 11). In that new procedure, the affected bone was initially exposed by debridement with a scalpel, followed by partial excision with a bone scraper until fresh bleeding was observed from the exposed bone. The lesions were then immediately covered with an occlusive dressing, and finally the wound was covered with an epidermal graft of skin harvested from suction blisters. Patients in each group were matched with their counterparts by age, sex, wound size, wound infection and wound duration, to compare the time needed for total skin repair and rates of amputation.
  
  
  RESULTS
  Epidermal grafting significantly accelerated the healing of diabetic foot ulcers (P = 0.042) without exposed bones, with site-specific differentiation. The newly developed combination therapy resulted in the healing of all diabetic ulcers with exposed bones without the occurrence of osteomyelitis or the necessity for amputation (P < 0.0001).
  
  
  CONCLUSIONS
  Our study indicates that early aggressive debridement of diabetic foot ulcers with exposed bones down to a bleeding vascularized base and then grafting epidermal sheets significantly improves healing and reduces the rate of amputation.
authors.affiliation: Department of Dermatology, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita-shi, Osaka 5650871, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Yamaguchi
authors.forename: S
authors.initials: S
authors.lastname: Yoshida
authors.forename: Y
authors.initials: Y
authors.lastname: Sumikawa
authors.forename: T
authors.initials: T
authors.lastname: Kubo
authors.forename: K
authors.initials: K
authors.lastname: Hosokawa
authors.forename: K
authors.initials: K
authors.lastname: Ozawa
authors.forename: V J
authors.initials: VJ
authors.lastname: Hearing
authors.forename: K
authors.initials: K
authors.lastname: Yoshikawa
authors.forename: S
authors.initials: S
authors.lastname: Itami
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001854:Bone Marrow Cells / Q000502:physiology*; D001842:Bone and Bones / Q000473:pathology*; D003131:Combined Modality Therapy; D003646:Debridement; D017719:Diabetic Foot / Q000150:complications / Q000473:pathology / Q000628:therapy*; D004817:Epidermis / Q000637:transplantation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009779:Occlusive Dressings; D010019:Osteomyelitis / Q000150:complications; D013396:Suction; D014945:Wound Healing