Terapias regenerativas para feridas complexas do pé diabético: desafio terapêutico
Regenerative therapies for complex diabetic foot wounds: a therapeutic challenge
Vinicius Tadeu Ramos da Silva Grillo; Eduardo Aparecido Romio; Caíque Damasceno Sousa; Gabriel Gomes Ranite; William Rodrigues da Silva; Pedro Luciano Melluci Filho; Francisco José de Oliveira Filho; Matheus Bertanha
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Abstract
Diabetic foot ulcers are a leading cause of morbidity, hospitalization, and nontraumatic lower-extremity amputation in patients with diabetes mellitus. Effective management of these wounds requires a multidisciplinary approach and combined therapies addressing infection control, perfusion optimization, and stimulation of tissue regeneration. This case report describes a patient with a severe infected neuroischemic foot ulcer treated with a sequential integrated strategy: infrapatellar endovascular revascularization, targeted antibiotic therapy, serial debridement, negative pressure wound therapy, application of an ovine-derived extracellular matrix, and autologous grafting of adipose tissue-derived mesenchymal stem cells. The treatment resulted in complete wound healing and limb preservation, with no recurrence after 7 months of follow-up. This case highlights the potential role of advanced regenerative therapies in the management of complex, refractory diabetic foot wounds, expanding therapeutic perspectives in the care of patients with diabetic foot.
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References
1 Duncan BB, Magliano DJ, Boyko EJ. IDF Diabetes Atlas 11th edition 2025: global prevalence and projections for 2050. Nephrol Dial Transplant. 2025;41(1):7-9.
2 Duarte EG Jr, Lopes CF, Gaio DRF, et al. Diretrizes da Sociedade Brasileira de Angiologia e de Cirurgia Vascular sobre o pé diabético 2023. J Vasc Bras. 2024;23:e20230087.
3 Caiafa JS, Castro AA, Fidelis C, Santos VP, Silva ES, Sitrângulo CJ Jr. Atenção integral ao portador de pé diabético. J Vasc Bras. 2011;10(4, suppl. 2):1-32.
4 Ji S, Liu X, Huang J, et al. Consensus on the application of negative pressure wound therapy of diabetic foot wounds. Burns Trauma. 2021;9:b018.
5 Chen P, Vilorio NC, Dhatariya K, et al. Guidelines on interventions to enhance healing of foot ulcers in people with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev. 2024;40(3):e3644.
6 Senneville É, Albalawi Z, van Asten SA, et al. IWGDF/IDSA Guidelines on the Diagnosis and Treatment of Diabetes-related Foot Infections (IWGDF/IDSA 2023). Clin Infect Dis. 2023;79(1):286-286.
7 Raizman R, Hill R, Woo K. Prospective multicenter evaluation of an advanced extracellular matrix for wound management. Adv Skin Wound Care. 2020;33(8):437-44.
8 Camargo PAB, Bertanha M, Moura R, et al. Uso de curativo a vácuo como terapia adjuvante na cicatrização de sítio cirúrgico infectado. J Vasc Bras. 2016;15(4):312-6.
9 Wagner FW Jr. The dysvascular foot: a system for diagnosis and treatment. Foot Ankle. 1981;2(2):64-122.
10 Mills JL, Conte MS, Armstrong DG, et al, and the Society for Vascular Surgery Lower Extremity Guidelines Committee. The society for vascular surgery lower extremity threatened limb classification system: risk stratification based on wound, Ischemia, and foot Infection (WIfI). J Vasc Surg. 2014;59(1):220-34.e1-2.
11 Armstrong DG, Lavery LA, Wu S, Boulton AJM. Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds. Diabetes Care. 2005;28(3):551-4.
12 Wynn M, Freeman S. The efficacy of negative pressure wound therapy for diabetic foot ulcers: a systematised review. J Tissue Viability. 2019;28(3):152-60.
13 Magden GK, Vural C, Bayrak BY, Ozdogan CY, Kenar H. Composite sponges from sheep decellularized small intestinal submucosa for treatment of diabetic wounds. J Biomater Appl. 2021;36(1):113-27.
14 Santos ICRV, Carvalho EF, Souza WV, Albuquerque EC. Factors associated with diabetic foot amputations. J Vasc Bras. 2015;14(1):37-45.
15 Erzinger FL, Polimanti AC, Pinto DM, et al. Diretrizes sobre doença arterial periférica da Sociedade Brasileira de Angiologia e Cirurgia Vascular. J Vasc Bras. 2024;23:e20230059.
16 Chen L, Zhang S, Da J, et al. A systematic review and meta-analysis of efficacy and safety of negative pressure wound therapy in the treatment of diabetic foot ulcer. Ann Palliat Med. 2021;10(10):10830-9.
17 Bosque BA, Dowling SG, May BCH, et al. Ovine Forestomach Matrix in the Surgical Management of Complex Lower-Extremity Soft-Tissue Defects. J Am Podiatr Med Assoc. 2023;113(3).
18 Agostinis C, Spazzapan M, Vuerich R, et al. Differential capability of clinically employed dermal regeneration scaffolds to support vascularization for tissue bioengineering. Biomedicines. 2021;9(10):1458.
19 Bosque BA, Frampton C, Chaffin AE, et al. Retrospective real‐world comparative effectiveness of ovine forestomach matrix and collagen/ORC in the treatment of diabetic foot ulcers. Int Wound J. 2022;19(4):741-53.
20 Bertanha M. Perspectivas de uso de células-tronco em cirurgia vascular. J Vasc Bras. 2016;15(3):173-5.
21 Sun Y, Zhao J, Zhang L, Li Z, Lei S. Effectiveness and safety of stem cell therapy for diabetic foot: a meta-analysis update. Stem Cell Res Ther. 2022;13(1):416.
Submitted date:
04/21/2025
Accepted date:
01/14/2026
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