This document discusses the use of adipose-derived stem cells (ASCs) in treating chronic ulcers. It outlines the normal wound healing process and factors that can impair healing, leading to chronic ulcers. ASC therapy aims to enhance healing by differentiating into various cell types and secreting growth factors. The study evaluated ASC therapy's efficacy on non-healing ulcers through clinical and histological parameters. Fat tissue was processed to extract stem cells, which were injected into ulcers over successive treatments. Ulcers showed improved re-epithelialization, angiogenesis, and collagen deposition after ASC injections and were healed in 2-3 treatments. The conclusion is that ASC therapy is an effective method for treating chronic ulcers when

1. Efficacy of adipose derived
stem cells in management of
chronic ulcers: clinical and
laboratory study
By
Emil Sabry

2. Normal Wound healing
It is an elaborate process
that occurs in distinct,
yet overlapping phases
of well orchestrated
cascade of biological and
molecular processes:
• Hemostasis
• Inflammation
• Proliferation
• Remodeling

3. Abnormal wound healing
•Chronic wounds occur when there is failure of
injured skin to proceed through an orderly and
timely process to produce anatomic and functional
integrity.
•This mostly caused by conditions like DM,
malnutrition, venous insufficiency, ischemia
and/or immunosuppression.

4. Impaired wound healing in DM:
• Impaired cellular
activity
• Impaired
Extracellular matrix
(ECM) synthesis and
deposition
• Impaired growth
factors release
• Impaired
neovascularization

5. Cell therapy
•Despite the huge advances in medical care, chronic
non-healing wounds still represent a challenge in
our practice.
•New therapies are required to optimize wound
healing like cell therapies.
•Cell therapy is defined as a set of strategies to use
living cells as a regenerative therapy to repair,
replace or restore biological function.

6. Stem cells
•The term stem cells refers to a myriad of different
cell types that share two key characteristics: Self-
renewal and the potential for differentiation into
different cell types.
•In 2001, Zuk et al. demonstrated that human fat
obtained from human lipoaspirates contained
multilineage stem cells, which have the potential
to undergo adipogenesis, osteogenesis,
chondrogenesis and myogenesis in vitro and in
vivo.

7. Role of stem cells in chronic wound healing
•Stem cells enhance cutaneous wound healing
through trophic and paracrine activity, providing:
1 - Ability to differentiate into various types of cells.
2 - Biological pump secreting growth factors.
•Resulting in:
- Enhancing growth factors availability for
wound healing.
- Promoting angiogenesis.
- Regulation of inflammatory process.
- Differentiation into target tissue cells.

8. Aims of our work
•Evaluation of the efficacy of ASCs therapy in
treatment of non-healing ulcers(both by clinical &
histological parameters.
•Estimation the amount of stem cells yield of
adipose tissue and the stem cell requirements for
non-healing ulcer in relation to ulcer surface area
by flowcytometry.

9. Methodology
1. Aspiration of fat by standard
liposuction methods.
2. Treatment of fat tissue obtained
enzymatically for freeing cellular
content.
3. Estimation of stem cell yield by
immunophenotypic characters;
CD45, CD31, CD34+, CD105+.
4. Injection of the yielded cellular
contents into the ulcer using
blunt cannulas no. 2.
5. Injection will be for successive
times 20-30 day apart until
healing occurs.

10. Methodology
6. Evaluation of results by:
•Anthropometric measures before and after
injection documented by photography.
•Comparing histologic features in ulcer before and
after injection regarding cellular recruitment,
angiogenesis and restoration of cell appendages.
•Preparation of ulcer for further intervention.
•Overall aesthetic healing results.

11. Histological parameters of assessment:
1. Wound reepithelialization: migration of
keratinocytes, bridging of cells, keratinization
2. Inflammatory cells: absence/ presence
(mild/moderate/marked)
3. Fibroblasts: absence/presence (mild/moderate/marked)
4. New vessels: absence/presence
(mild/moderate/marked)
5. Collagen: absence/presence (mild/moderate/marked)

12. Clinical cases

13. Diabetic ulcer right heel – Healed after 2 injections

14. Diabetic ulcer left forefoot – Healed after 2 injections

15. Trophic ulcer left forefoot – Healed after 2 injections

16. Diabetic ulcer right forefoot – Healed after 2 injections

17. Trophic ulcer right heel – Healed after 2 injections

18. Diabetic ulcer left big toe – Healed after 2 injections

19. Conclusion:
Adipose derived stem cell is an effective
method in treating chronic ulcers
alongside with other lines of treatment
like offloading and optimization of
patient’s general condition

20. Thank you