Abstract
Aim
The treatment of foot ulcers with exposed bone is challenging, because of the risk of infection and of difficulties in the development of granulation tissue. A CO2 laser beam could be used to produce discontinuities in periosteum, allowing the exposure of blood containing multipotent stem cells, capable of initiating the healing process. The local application of platelet-rich plasma (PRP) has been proposed as a therapeutic tool for accelerating healing in foot ulcers, including those in patients with diabetes. Aim of the present pilot, proof-of-concept study is the assessment of the therapeutic potential of CO2 laser treatment, either alone or combined with PRP, in the treatment of diabetic foot ulcers with exposed bone.
Methods
We performed a pilot, uncontrolled 3-month observation study on a consecutive series of 9 type two diabetic patients and foot ulcers with exposed bone. A CO2-laser was used for producing nine discontinuities on periosteum for each cm2, by directing the focused laser beam on the bone until bleeding. The procedure was repeated up to 6 times, at a distance of 1 week and ulcers assessed weekly until the end of the study (3 months). In the last 5 of the 14 patients, the treatment described above was associated with PRP.
Results
Of the nine patients treated, four healed, and one more patient developed granulation tissue covering entirely bone surface. Out of the four patients who did not heal, one underwent minor amputation. Among the five patients treated with a combination of CO2 laser and PRP, two healed within 3 months, and two more patients developed granulation tissue covering entirely bone surface; the fifth patient did not show any improvement and underwent amputation.
Conclusions
The present pilot experience represents a novelty in this field showing a possible use of CO2-laser in the treatment of diabetic foot ulcers.
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Author contributions
Matteo Monami and Edoardo Mannucci wrote the manuscript and enrolled patients. Carlo Mirabella and Alesssia Scatena reviewed/edited the manuscript and contributed to the discussion. Stefania Zannoni contributed to the discussion and enrolled patients. Luca Giannoni and Sara Aleffi contributed to discussion, enrolled patients, and reviewed the manuscript. Matteo Monami is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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The authors have no relevant conflict of interest to disclose.
Research involving human participants and/or animals, and Informed consent
Informed consent was obtained from all patients for being included in the study.
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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Monami, M., Mirabella, C., Scatena, A. et al. CO2 laser for the treatment of diabetic foot ulcers with exposed bone. A consecutive series of type 2 diabetic patients. J Endocrinol Invest 40, 819–822 (2017). https://doi.org/10.1007/s40618-017-0642-x
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DOI: https://doi.org/10.1007/s40618-017-0642-x