Abstract:
Juan, a 45 year-old electrician,suffered a 30,000 volt shock when his left arm contacted a high tension power line. The current travelled down the back of his left leg and exited via a 12cmx10cm wound on the dorsal aspect of his left foot leaving the underlying structures exposed. He subsequently fell from the platform and spent 2 months in the hospital.
Three months after his injury, Juan’s foot ulcer had not closed and he opted to undergo an autologous Stromal Vascular Fraction stem cell procedure. . Four weeks after the first procedure, the ulcer showed significant (70%) closure with clear new growth visible circumferentially around the ulcer. An activated PRP Procedure was then performed to further stimulate the cell division. Two weeks later, Juan was walking in shoes and underwent a final stem cell procedure.
Over a period of 5 weeks, the ulcer closed and the patient attained a new lease on life, recovering the ability to look after himself, and perform his daily activities. It is expected that he will return to work shortly.
Introduction:
History of Present Illness: 45 y/o electrician sustaining a 35,000 volt shock and subsequent fall from a platform on 9/3/17, requiring 2 months of hospitalization. The exit wound left a 10cmx7cm ulcer on the dorsal aspect of his left foot with underlying structures exposed. On December 12, 2017, the patient was evaluated for stem cell therapy. At the first evaluation the wound exhibited only minimal closure leaving the patient in danger of gangrenous necrosis.
Physical Exam: On exam there is a 12cmx10cm ulcer on the dorsal aspect of his left foot and significant scarring on the posterior of his left thigh. He is unable to place any weight on the affected foot and walks with a crutch. He expresses significant concern about his future.
Treatment Plan: Stromal Vascular Fraction (SVF) autologous stem cell transplantation with activated Platelet Rich Plasma (PRP) to be injected into the wound and intravenously followed by 21day re-evaluation.
On December 13, 2017, the SVF procedure was performed. The patient was sedated with midazolam, morphine, and propofol and 100cc of adipose tissue was extracted from his right flank. The mesenchymal stem cells were separated with collagenase and programmed with immunologically privileged nucleotides for bone, muscle, skin, and tendon. The stem cells were then mixed with activated PRP drawn from the patient prior to sedation and injected directly into the borders and center of the ulcer. An IV Infusion was also given. The wound was cleansed with chlorhexidine, covered with a hydrogel containing collagen and hyaluronic acid, and wrapped with a bandage
On January 14, 2018 the patient had his first follow up appointment and significant closure of the ulcer was observed. The size of the wound was reduced by 70% leaving a 4cm x 3cm ulcer with no underlying structures exposed.
On Feb 4, 2018, the patient had his second follow up appointment and the wound was observed to be 2cm x 1cm. The patient was ambulatory and able to wear shoes. A final Bone Marrow Aspirate Concentrate (BMAC) stem cell procedure was performed. A 50cc of bone marrow was extracted from his right ilium, activated with the same nucleotides as the first procedure, and injected into the wound as well as intravenously.
Discussion:
Autologous stem cell transplantation gave this patient the chance at a full recovery; a chance he would not have had without the stem cell transplantation. The level of healing achieved with stem cell treatement prevented the possibility of gangrenous necrosis and the potential loss of his limb. The patient is now ambulatory and able to return to his daily activities.
Conclusion:
Mesenchymal stem cell procedures, both SVF and BMAC, offer the significant potential for healing when no other options exist. We have demonstrated their efficacy in wound closure in this patient.
Table:
Top Left: Patient’s wound 1 month post SVF Procedure
Top Right: Patient’s wound immediately following PRP
