title: Treatment of pressure ulcers with autologous bone marrow nuclear cells in patients with spinal cord injury.
abstract: BACKGROUND
  Pressure ulcers are especially difficult to treat in patients with spinal cord injury (SCI) and recurrence rates are high. Prompted by encouraging results obtained using bone marrow stem cells to treat several diseases including chronic wounds, this study examines the use of autologous stem cells from bone marrow to promote the healing of pressure ulcers in patients with SCI.
  
  
  OBJECTIVE
  To obtain preliminary data on the use of bone marrow mononuclear cells (BM-MNCs) to treat pressure ulcers in terms of clinical outcome, procedure safety, and treatment time.
  
  
  METHODS
  Twenty-two patients with SCI (19 men, 3 women; mean age 56.41 years) with single type IV pressure ulcers of more than 4 months duration.
  
  
  METHODS
  By minimally invasive surgery, the ulcers were debrided and treated with BM-MNCs obtained by Ficoll density gradient separation of autologous bone marrow aspirates drawn from the iliac crest.
  
  
  RESULTS
  In 19 patients (86.36%), the pressure ulcers treated with BM-MNCs had fully healed after a mean time of 21 days. The number of MNCs isolated was patient dependent, although similar clinical outcomes were observed in each case. Compared to conventional surgical treatment, mean intra-hospital stay was reduced from 85.16 to 43.06 days. Following treatment, 5 minutes of daily wound care was required per patient compared to 20 minutes for conventional surgery. During a mean follow-up of 19 months, none of the resolved ulcers recurred.
  
  
  CONCLUSIONS
  Our data indicate that cell therapy using autologous BM-MNCs could be an option to treat type IV pressure ulcers in patients with SCI, avoiding major surgical intervention.
authors.affiliation: Servicio de Cirugía Plástica, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: J González
authors.initials: JG
authors.lastname: Sarasúa
authors.forename: S Pérez
authors.initials: SP
authors.lastname: López
authors.forename: M Alvarez
authors.initials: MA
authors.lastname: Viejo
authors.forename: M Pérez
authors.initials: MP
authors.lastname: Basterrechea
authors.forename: A Fernández
authors.initials: AF
authors.lastname: Rodríguez
authors.forename: A Ferrero
authors.initials: AF
authors.lastname: Gutiérrez
authors.forename: J García
authors.initials: JG
authors.lastname: Gala
authors.forename: Y Menéndez
authors.initials: YM
authors.lastname: Menéndez
authors.forename: D Escudero
authors.initials: DE
authors.lastname: Augusto
authors.forename: A Pérez
authors.initials: AP
authors.lastname: Arias
authors.forename: J Otero
authors.initials: JO
authors.lastname: Hernández
mesh_terms: D000328:Adult; D000368:Aged; D001854:Bone Marrow Cells / Q000502:physiology*; D016026:Bone Marrow Transplantation / Q000379:methods*; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000209:etiology / Q000601:surgery*; D013119:Spinal Cord Injuries / Q000150:complications; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome