Regenerative Surgery: Use of Fat Grafting Combined with Platelet-Rich Plasma for Chronic Lower-Extremity Ulcers

The authors present their experience with reconstructive surgery of the lower extremity for chronic ulcers, evaluating the effects related to the use of a platelet-rich plasma combined with fat tissue. A total of 20 patients, 25 to 50 years of age (median age, 40 years), have been managed with platelet gel in the Plastic and Reconstructive Surgery Department at the Tor Vergata, University of Rome. The patients were affected by both lower-extremity chronic ulcers and vascular disease. The authors observed that 16 of 20 chronic lower-extremity ulcers reepithelialized during an average of 9.7 weeks, with platelet releasate suspended on a collagen base (platelet-derived wound-healing factor), compared with 2 of 10 similar wounds treated with medication based on hyaluronic acid and collagen. Collectively, these data provide evidence for the clinical use of platelet technology in the healing of both soft and hard tissue wounds. Currently, plastic surgery with autogenous fat grafts can be performed for stabilization of chronic lower-extremity ulcers. The objective of this study was, through the presentation of clinical cases, to suggest a therapeutic plan formed by two sequential treatments: acquisition of platelet gel from a small volume of blood (9-18 ml) followed by the Coleman technique for reconstructing the three-dimensional projection and superficial density of tissues. The results proved the efficacy of combining these two treatments, and the satisfaction of the patients confirmed the quality of the results.