Cryopreserved adipose tissue (CAT) for biological offloading of recalcitrant foot ulcers (FUs)

Introduction:  Recalcitrant foot ulcers are increasing in prevalence and often exhaust conventional conservative measures. The risk of a diabetic with a foot ulceration to proceed to an amputation is between 14% and 24%. Mortality after diabetes-related amputation exceeds 70% at 5 years. (1)   This case study presents outcomes for patients who received an implantation of CAT with the purpose of creating a protective tissue layer and providing biological offloading of a recalcitrant FUs.Methods:Cryopreserved adipose tissue was injected adjacent to the wound borders to provide in vivo offloading of the wound bed. In these cases of recalcitrant ulceration there was a significant amount of scar tissue that was well adhered to underlying structures. This required creating a tissue plane either through the wound bed or a small stab incision to inject the allograft into the peri-wound area. Once complete injection Patients range in age from 45-80 years old with wounds that have been in various stages of healing for a minimum of 1 year. Traditional offloading and wound care has been continued in all patients with the area of the CAT injection being offloaded with felt for 1-3 weeks post operatively. Clinically the graft is palpable at the sites of injection and is firm to the touch without any displacement noted. sites are sealed with skin glue and a dry sterile dressing was applied. Results:The CAT was present at the sites of implantation in patients postoperatively at the time of writing. There were no re-ulcerations with significant reduction of peri-wound callus formation. There were no CAT-related complication. Long-term follow-up is ongoing.Discussion: CAT is an allograft which retains the structure of native tissue that provides cushioning and structural support. It is designed to be used for supplemental support and reinforcement in underlying adipose tissue defects or damage; as such, CAT may be a valuable tool in the management of recalcitrant FUs. CAT has to this point maintained structural support at the sites of implantation. Additional follow-up will be required to further evaluate CAT durability.References:1. Liao X, Li SH, El Akkawi MM, Fu XB, Liu HW, Huang YS. Surgical amputation for patients with diabetic foot ulcers: A Chinese expert panel consensus treatment guide. Front Surg. 2022 Nov 8;9:1003339. doi: 10.3389/fsurg.2022.1003339. PMID: 36425891; PMCID: PMC9679004.