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CRYO - AND GLYCEROLATE-PRESERVED ALLOGRAFTS IN THE TREATMENT OF CHRONIC NON-HEALING LEG ULCERS

G. Mosti*, V. Mattaliano*, M.L. Iabichella*, P. Piperni*, R. Polignano**

* Angiology Dpt. - Barbantini Hospital – Lucca (Italy) ** Angiology Dpt. –Camerata Hospital, ASL 10 – Florence (Italy).

Chronic leg ulcers are often effectively treated using compression therapy and appropriate dressings. However there are many ulcers that are very difficult to treat, especially with mixed, vasculitic and arterial aetiology. Patients with non-healing or with extensive leg ulcers have been candidates for skin grafting for some years. Cultured skin grafts have been also used, particularly viable keratynocytes on a Hyaluronic acid matrix, but this treatment is very expensive. Recently, the development of skin bank services have permitted to use a cryo- or glycerolate-preserved allogenic skin grafts with good results as for the wound size reduction and also the decrease of pain.

Aim of the study.
The Authors relate their experience on the treatment with cryo- and glycerolate-preserved allogenic grafts in 26 patient with chronic non-healing leg ulcers.

Material and methods.
We treated 26 Patients, aged 38-84 (70+6 years), 8 males and 18 females with different aetiologies: 10 venous, 6 arterial, 3 mixed, 2 vasculitic, 1 neuropatic and 4 not classified ulcers. The dimension of the ulcers varied from 20 to 800 cm2; depth from 1 to 5 cm.; the duration varied from 8 months to 6 years; all ulcers were unresponsive to previous local treatments and to bandages, were very painful and needed daily dressings. The material applied was a cryo-preserved (-80C°) skin graft in 20 cases (cadaveric allograft in 18 cases and taken from a living donor in 2 cases); a glycerolate-preserved skin in the other 6 cases.

Results.
In 21 patients we observed a quick disappearance of pain, within a few hours after applying the skin graft; in 3 patients we observed a considerable reduction of pain within a few days; in only 2 cases the result was unchanged (both arterial ulcers). The secretion decreased sensibly allowing a reduction in the frequency of dressings. The healing time of the ulcer decreased drastically, although we rarely observed a proper merging of the skin graft in the ulcer. No infections occurred.

Conclusions
The cases we treated allow us to evaluate the effects of this kind of skin grafts, particularly in promoting granulation and a quick reduction of ulcer size. They were effective in non-healing ulcers and improved patients’ quality of life, reducing exudate and pain, especially in those patients in which a peridural anaestesia was not possible. Finally the treatment was safe and not expensive (the skin cost was about 50 € cent/cm2).