Abstract
We have frequently encountered patients with critical limb ischemia demonstrating severely intractable ulcers and gangrene. Such wounds cannot necessarily be healed by standard procedures including skin grafting and flap transfer since adequate blood supply to the grafts cannot be anticipated. In this review, we present our therapeutic strategies for the treatment of ischemic wounds particularly those using regenerative medical approaches. We have performed therapeutic angiogenesis by either autologous bone marrow cells implantation or controlled release of basic fibroblast growth factors using hydrogel injection into ischemic limbs that had no other options for improving the blood supply. In addition to angiogenesis, wound bed preparation was also carried out with the same cells or growth factors in conjunction with collagen sponge matrices. The results of our clinical trial showed that most of the intractable ulcers were healed by wound contraction, spontaneous epithelialization or subsequent skin grafting. These findings suggest that such therapeutic approaches might be considered to contribute to the patients' ambulation and quality of life. Since the incidence of such disorders might increase in the future, this therapeutic approach should play an important role in the preservation of ischemic limbs with severe ulcers.
