Effectiveness of the combined therapy in the treatment of chronic non-healing wounds in patients with autoimmune diseases.

Abstract

Autoimmune diseases are systemic conditions that can have negative effects on wound healing. The objective of the present study was to investigate the efficacy of combining bone marrow-derived mesenchymal stem cells (BM-MSCs), acellular dermal matrix (ADM), split-thickness skin graft (STSG), and negative-pressure wound therapy (NPWT) for treating patients with autoimmune diseases and chronic non-healing wounds. Thirty-four patients with autoimmune diseases and non-healing chronic wounds of the lower extremities between 2012 and 2023 were included in the study. Among these, 18 patients had Behçet's disease, 8 patients had polyarteritis nodosa, and 8 patients had systemic lupus erythematosus. All patients underwent split-thickness skin grafting in external centers. The wounds were debrided, and BM-MSCs concentrate was injected into the wound base. A suitable ADM was applied to the wound. STSG were adapted onto the ADM. The grafts were closed with NPWT. Patients were followed-up for an average of 1.2 years. No necrosis was observed at the wound sites of the post-operative patients. During long-term follow-up, no wounds were observed at the same sites. Although autoimmune diseases fall within the scope of rheumatology, the treatment of chronic non-healing wounds that accompany such diseases requires a multidisciplinary approach. We demonstrated that the combined use of BM-MSCs, ADM, STSG, and NPWT presents an effective approach in the healing of these types of wounds.