Injection of Stromal Vascular Fraction Plus Platelet-Rich Plasma in a Non-Healing Decubitus Ulcer

Abstract

Non-healing decubitus ulcers can be challenging to treat and may often progress to other life-threatening complications. Significant tissue damage is present in stage 3/4 wounds and treatment options can be limited or present additional risks. Applications of regenerative medicine and stem cell therapy are rapidly expanding in particular in the field of non-healing wounds. Adipose tissue is a rich source of autologous stem cells which can be easily isolated in an outpatient visit. The population of cells collected from fat after the adipocytes (fat cells) are removed via centrifugation is called stromal vascular fraction (SVF) and contains mesenchymal/adipose stem cells, fibroblasts, pericytes, endothelial/progenitor cells and more. Adipose tissue is collected under local anesthesia via cannula and SVF is separated via centrifugation after enzyme digestion. In addition, peripheral blood can be centrifuged to collect platelet-rich plasma (PRP) which contains a mixture of cytokines/growth factors. Here we present a first in man case study of a single injection of SVF and PRP into a chronic non-healing stage 3 ulcer in a patient with an incomplete spinal cord injury. After removing approximately 60 mL of fat tissue, the SVF was isolated and resuspended in approximately 5 mL of PRP for local administration in the non-healing wound. The wound was monitored and tracked with imaging and the patient was tracked for quality of life parameters as well as safety (adverse events). No complications or other safety events were reported either during the procedure or in the months following the procedure. The patient reported reduction of pain consistent with wound healing and a willingness to repeat therapies if required. The healing stage 3 pressure injury showed clear re-epithelialization. Based on this case study, a feasible treatment plan to promote healing for stage 3 and 4 decubitus ulcers could be a single injection of SVF plus PRP. J Med Cases. 2018;9(10):323-327 doi: https://doi.org/10.14740/jmc3128w