Fat grafting and skin grafting for the treatment of non-ischaemic ulcers in the lower extremity

Introduction:
Standard surgical treatment for non-ischaemic ulcers in the lower extremity often fails and its results become unpredictable. We present and evaluate the fat grafting technique that we use for the treatment of these wounds, to which we add a skin graft and negative pressure therapy.

Material and methods:
This is a prospective case-control study of 46 patients with venous and vasculitic ulcers in the lower extremity. Thirteen patients were submitted to this surgical technique, and 33 were treated conservatively. We analysed the results of complete wound closure and size reduction. We compared these groups according to the presence of risk factors, and analysed the individual influence of each treatment and risk factors in the final result.

Results:
In the surgery group, we achieved size reduction in 83.3% of the ulcers, and complete closure in 58.3% of them, in a mean time of 13.43 weeks. Surgical treatment managed to heal completely 100% of ulcers with an initial size of < 20 cm², but only 25% of those ≥ 20 cm² (p = 0.016). None of the included variables had a significant individual prognostic value in the final result. However, ulcers with complete closure had smaller mean size, regardless of the treatment (p = 0.076).

Conclusions:
The effectiveness of the therapy may be dependent on the size of the ulcer. Fat grafting is an easy and safe procedure for the treatment of non-ischaemic chronic wounds in the lower extremity, but we cannot declare that this technique is more effective than conservative treatment for the healing of this type of wound.