[ BACKGROUND ] Recent experimental studies have shown that bone marrow derived cells take part in postnatal neovascularivation in wound healing. Although the pathogenesis of chronic leg ulcer has not been elucidated, disorder of topical angiogenesis derived from circulating endothelial progenitor cells may be a conceivable mechanisms of disrupted wound bed neovascularization.

[ PURPOSE ] We tried to induce topical angiogenesis for regeneration of non-healing chronic leg ulcers by transplantation of autologous bone marrow.

[ PATIENTS and METHOD ] We selected three patients affected with longstanding chronic leg ulcer resistant to treatment. In all patients, ulcers had been present at least 1.5 year (mean: 6.5 years) despite clinical treatment with various topical agents and wound dressings. One of three patients had a history of repeated skin grafting but ulcer remained. Autologous bone marrow was aspirated from iliac crest, diluted with heparinized saline, and collagen sponge (TERUDERMIS, Terumo, Japan) was soaked in. Immediately after surgical debridement of wound bed, bone marrow-impreganated collagen sponge (BMiCS) was applied topically. Splited thickness meshed skin was grafted secondary.

[ RESULT ] In all patients, the treatments led to rapid formation of well-vascularized granulation tissue within 2 weeks. Meshed skin was grafted 2 to 4 weeks after BMiCS graft and all took well. No recurrence of leg ulcer on the grafted skin hadbeen observed over 10 months except small lesion in one patient at where only collagen sponge was applied.

[ CONCLUSION ] We suggest that transplantation of autologous BMiCS could represent a novel therapeutic angiogenesis tool for the treatment of recalcitrant ulcers.
View Synopsis (.doc format, 22.0 kb)