Fat grafting for lower extremity ulcers

Elsharkawi, Mohamed
Chronic lower limb ulcerations (CLU) are open sores which fail to heal within 6 weeks. Ulcers affect approximately 49 million people worldwide every year, making them one of the most common health problems globally1 . CLU can cause significant morbidity and mortality with great discomfort and social isolation for patients2 . Moreover, it can lead to increased burdens on the health care systems. Approximately 28$ billion expenditures annually are reported in the United States for the management of chronic leg ulcers3, 4 . Different mechanisms can lead to CLU. Venous ulcers caused by chronic venous dysfunction represent the most reported CLU with a prevalence of more than 70%5 . Sharing the same pathophysiology of arterial insufficiency due to either large vessel disease caused by peripheral arterial disease or small vessel disease caused by prolonged pressure, arterial, and pressure ulcers are the second common CLU with reported prevalence of approximately 10-25%6 . CLU is a complex entity, and its management is not a straightforward process. Despite the current different measures used for management, the outcomes are sometimes disappointing due to prolonged healing times and increased risk of recurrence which is another problem faced by these patients. It can be as high of 70% in venous ulcers and 40% in diabetic foot ulcers at 1 year7, 8. This has urged the clinicians to look for other alternatives and adjuncts to aid the healing process and reduce the recurrence risk. In this chapter, a brief review of the pathophysiology of different lower limb ulcers, clinical evaluation, current available management options including standard measures and commonly used adjuncts with a special emphasis on fat grafting will be performed.
NUI Galway
Publisher DOI
Attribution-NonCommercial-NoDerivs 3.0 Ireland