Combined Regenerative Approach for a Complex Lower Extremity Wound

A Case Report

Pedro Salomão Piccinini, MD; Mariana Rodrigues de Sousa Rebelato; Marwan Masri; Carlos Oscar Uebel, MD, PhD; Rubem Lang Stümpfle, MD; Milton Paulo de Oliveira, MD


Wounds. 2021;33(5):E34-E38. 

In This Article

Abstract and Introduction


More than 400 million patients worldwide are affected by diabetes; over their lifetime, at least 25% will develop foot ulcers that often result in high rates of nonhealing wounds and amputation. The authors present the case of a 43-year-old female patient with multiple comorbidities who presented with a large (8 cm x 4 cm), noninfected, hindfoot plantar ulcer that extended down to the bone and calcaneus. Over 2 weeks, the patient was successfully treated using a combination of an acellular dermal matrix, nanofat grafting, and negative pressure wound therapy, lessening the effects of the ulcer on the patient's quality of life and achieving limb salvage. Utilizing the regenerative procedures described herein may improve patient care and decrease costs.


A diabetic foot ulcer (DFU) is a multifactorial complication affecting patients with diabetes mellitus (DM). These ulcers have a lifetime prevalence of 25% in this population and represent a major cause of hospitalization.[1–4] Diabetic foot ulcers also generate an economic burden on the health care system and severely impact patient quality of life.[5,6] Standard of care (SOC) consists of management of comorbidities, evaluation of vascular status and debridement, and provision of daily dressings, pressure offloading, and infection control. However, a majority of DFUs do not heal completely, and some lead to infection and amputation.[3,7] Newer wound therapies have been shown to offer better alternatives by promoting angiogenesis to accelerate healing.[4–6] In this context, the authors present the case of a patient with multiple comorbidities who presented with a chronic nonhealing plantar wound; while multiple prior treatments failed, the wound was successfully treated with nanofat grafting, negative pressure wound therapy (NPWT), and an acellular dermal matrix (ADM).