title: Bio-Engineering tissue and V.A.C. therapy: A new method for the treatment of extensive necrotizing infection in the diabetic foot.
abstract: OBJECTIVE
  The aim of the study is to compare the standard care for progressive necrotizing infection in diabetic foot with a treatment protocol based on the association between autologous fibroblast grafts and vacuum-assisted closure therapy (V.A.C.).
  
  
  METHODS
  A retrospective matched Case-Control study was carried out on 20 patients with diabetic foot infection, 10 treated with the standard care and 10 with our new protocol. Inclusion criteria were: acute diabetic foot necrosis (Wagner III and IV), ulcer size (30 to 80 cm2), tendon and bone exposure. Success in the treatment was evaluated as: percentage of healing at the 20th week, time of healing, deambulation, recurrence and major amputation rate.
  
  
  RESULTS
  A 90% healing rate was observed after 20 weeks in the study group, compared to a 28.6% in the control group. The recurrence rate in the treated areas was 20% in the study group and 100% in the control group. None of the patients in either group required major amputations.
  
  
  CONCLUSIONS
  We achieved very promising results by associating autologous fibroblasts grafts and V.A.C. therapy, in comparison with standard care. V.A.C. therapy seems to improve the growth rate of the fibroblasts, probably by sealing the wound and providing a moist environment following the fibroblast graft. The improved neoangiogenesis of the neo-dermis could explain the reduced recurrence rate of the study group.
  
  
  CONCLUSIONS
  Despite the low number of patients involved and the retrospective nature of the analysis, this study showed a reliable, safe and cost-effective method of treating extensive infection in the diabetic foot.
  
  
  BACKGROUND
  Bio-Engineered Tissue, Diabetic foot, Fibroblast graft, V.A.C.
  
  
  METHODS
authors.forename: Andrea
authors.initials: A
authors.lastname: Armenio
authors.forename: Daniela Anna
authors.initials: DA
authors.lastname: Cutrignelli
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Nardulli
authors.forename: Giulio
authors.initials: G
authors.lastname: Maggio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Memeo
authors.forename: Valerio
authors.initials: V
authors.lastname: De Santis
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giudice
authors.forename: Cosmo Maurizio
authors.initials: CM
authors.lastname: Ressa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D003646:Debridement; D017719:Diabetic Foot / Q000150:complications / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D005260:Female; D005347:Fibroblasts / Q000637:transplantation*; D005528:Foot / Q000098:blood supply; D006801:Humans; D008297:Male; D008875:Middle Aged; D053758:Nanoparticles; D009336:Necrosis; D054843:Negative-Pressure Wound Therapy; D018919:Neovascularization, Physiologic; D012008:Recurrence; D012189:Retrospective Studies; D012834:Silver; D023822:Tissue Engineering; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014945:Wound Healing; D014946:Wound Infection / Q000209:etiology / Q000473:pathology / Q000601:surgery / Q000628:therapy*
chemical_list: D012834:Silver