Datos preliminares sobre la epitelización con membrana amniótica en ulceras complejas de pie diabético

Résumé

INTRODUCTION The Diabetic Foot is an important complication of Diabetes Mellitus that requires an adequate management and protocolized treatment, to avoid as far as possible minor or major amputations of the lower limbs. In the Wound and Diabetic Foot Unit of the Virgen de la Arrixaca University Clinical Hospital (HCUVA), we treat patients with complex ulcers using advanced therapies for healing-epithelialization, such as the case of Amniotic Membrane Cell Therapy (MA) at the which are attributed analgesic, antimicrobial and anti-inflammatory properties related to its ability to synthesize and release substances that include cytokines and signaling molecules. It is an easy-to-adapt tissue that does not induce rejection with suitable characteristics to treat these ulcers. Our objective was to determine the safety and efficacy in healing-epithelialization by applying MA in the treatment of chronic diabetic foot ulcers. MATERIAL AND METHOD Amniotic membrane cryopreserved was applied to patients with complex diabetic foot ulcers over 8 weeks evolution from May 2014 to November 2017. These patients were included who, after being informed, signed the informed consent. Patients with clinical signs of infection or an active neoplastic process were not included. MA was applied weekly on the wound bed. RESULTS 18 patients between 16 and 82 years old were treated with chronic ulcers, affected by polyneuropathy, macro and diabetic microangiopathy and deformations in the feet. In 17 of them (94%) a reduction in the area of the ulcer was observed with complete epithelization, and in one patient that area was reduced by 75%. The mean time of treatment prior to the application of MA in the patients was 24 months and a half, the average area of the wounds was 10.56 cm2 (0.52 cm2- 42.5 cm2). Regarding the mean time of epithelialization with MA was 145 days (46-392) with a mean of 11.22 membranes applied (4-40). One patient (patient 14) underwent excision of a bone fragment of the fifth metatarsal due to osteomyelitis. CONCLUSION Our results show that treatment with cryopreserved human MA is a safe and effective treatment in patients with complex ulcers in Diabetic Foot, since it has achieved the healing-epithelization of these long-evolving ulcers, in which other previous treatments had failed. Therefore, it is a useful tool that contributes to the evolution towards resolution of these ulcers and can be used safely after the ulcer has clinically stabilized and the signs of infection have been eliminated.