Peripheral Blood Mononuclear Cells (PB-MNCs) For The Treatment Of Chronic Tissue Dystrophy In A Complex Case Of Lower Limb Reconstruction.

INTRODUCTION: A smoker patient diagnosed with Rhabdomyosarcoma of the anterior tibial muscle of the left leg was reconstructed, after oncological resection, with basic and advanced surgical procedures, always developing wound dehiscence. A local injection of PB-MNCs drove the last reconstructive technique to complete wound healing.

MATERIALS AND METHODS: A 25-year-old active smoker patient was diagnosed with Rhabdomyosarcoma (T2N0M0, stage IIIA) of the anterior tibial muscle of his left leg, treated with neoadjuvant chemo- and radiotherapy (RT). Following oncological demolition, the patient developed wound dehiscence with bone exposure and a perilesional chronic radiodermatitis. After many surgical debridements and reconstructions made by skin grafts and dermal substitutes with poor outcomes, the dehiscence was subsequently treated by covering the exposed bone with a reverse sural fascio-cutaneous flap. At 13 days post-operatively, a new wound dehiscence was observed, without clinical signs of infection. A new split thickness skin graft was performed, and a concentrate of autologous Peripheral Blood Mono Nuclear Cells (PB-MNCs) was injected at level of the flap and in the perilesional skin.

RESULTS: 14 days after PB-MNCs injections, the graft-take was reached as well as improvements in perilesional tissue trophism and, in about 2 months of follow-up, the wound dehiscence sites were completely healed. An improvement of the lesion and perilesional trophism demonstrated the efficacy in neoangiogenesis enhancing vascular supply during chronic wound healing after PB-MNCs injections as a treatment.

CONCLUSIONS: Potential new strategies to improve healing of difficult wounds and radiation injuries are important in the field of plastic surgery, and this seems to be a novel description of PBMNC's. Indeed, PB-MNCs, showed a good efficacy in this cases, but further evidences as for the methods above mentioned, are awaited to best investigate this new therapeutic approach.

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Reconstructive

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