title: CO2laser for the treatment of diabetic foot ulcers with exposed bone. A consecutive series of type 2 diabetic patients.
abstract: OBJECTIVE
  The treatment of foot ulcers with exposed bone is challenging, because of the risk of infection and of difficulties in the development of granulation tissue. A CO2laser beam could be used to produce discontinuities in periosteum, allowing the exposure of blood containing multipotent stem cells, capable of initiating the healing process. The local application of platelet-rich plasma (PRP) has been proposed as a therapeutic tool for accelerating healing in foot ulcers, including those in patients with diabetes. Aim of the present pilot, proof-of-concept study is the assessment of the therapeutic potential of CO2laser treatment, either alone or combined with PRP, in the treatment of diabetic foot ulcers with exposed bone.
  
  
  METHODS
  We performed a pilot, uncontrolled 3-month observation study on a consecutive series of 9 type two diabetic patients and foot ulcers with exposed bone. A CO2-laser was used for producing nine discontinuities on periosteum for each cm2, by directing the focused laser beam on the bone until bleeding. The procedure was repeated up to 6 times, at a distance of 1 week and ulcers assessed weekly until the end of the study (3 months). In the last 5 of the 14 patients, the treatment described above was associated with PRP.
  
  
  RESULTS
  Of the nine patients treated, four healed, and one more patient developed granulation tissue covering entirely bone surface. Out of the four patients who did not heal, one underwent minor amputation. Among the five patients treated with a combination of CO2laser and PRP, two healed within 3 months, and two more patients developed granulation tissue covering entirely bone surface; the fifth patient did not show any improvement and underwent amputation.
  
  
  CONCLUSIONS
  The present pilot experience represents a novelty in this field showing a possible use of CO2-laser in the treatment of diabetic foot ulcers.
authors.affiliation: Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, SOD Diabetologia - AOU Careggi, Via delle Oblate n. 4, 50141, Florence, Italy. matteo.monami@unifi.it.
authors.forename: M
authors.initials: M
authors.lastname: Monami
authors.affiliation: Immunohematology and Transfusion Medicine, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Mirabella
authors.affiliation: Diabetology Unit, Ospedale San Donato Arezzo, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Scatena
authors.affiliation: Geriatric Medicine, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Nreu
authors.affiliation: Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, SOD Diabetologia - AOU Careggi, Via delle Oblate n. 4, 50141, Florence, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Zannoni
authors.affiliation: Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, SOD Diabetologia - AOU Careggi, Via delle Oblate n. 4, 50141, Florence, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Aleffi
authors.affiliation: Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, SOD Diabetologia - AOU Careggi, Via delle Oblate n. 4, 50141, Florence, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Giannoni
authors.affiliation: Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, SOD Diabetologia - AOU Careggi, Via delle Oblate n. 4, 50141, Florence, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Mannucci
mesh_terms: D000368:Aged; D001842:Bone and Bones / Q000473:pathology / Q000528:radiation effects*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D017719:Diabetic Foot / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D010865:Pilot Projects; D014945:Wound Healing / Q000528:radiation effects*
keywords: Bone healing; Laser ablation; Lasers CO2; Wound healing impaired; Wound healing in diabetes