Surgeries, to sites with impaired wound healing capability, often face difficulties. The application of regenerative medicine may provide a breakthrough in dealing with the challenge. The authors have reported a simple, low-cost technique to concentrate bone marrow cells and platelets. The product is called "bone marrow-derived platelet-rich plasma : bm-PRP". When surgeries were performed at sites with impaired wound healing (caused by irradiation, chronic ischemia, long-term administration of steroids), bm-PRP was injected into wound beds and edges. In bm-PRP injected, nucleated cells were concentrated approximately seven-fold to bone marrow aspirate and platelets were three-folds. An aberage of 13.5 × 10⁷ nucleated cells were transplanted per surgery. Wound closure was obtained within three weeks in all patients. No adverse events were encountered in bone marrow harvest or in injection of bm-PRP. Without large-scale facilities, bm-PRP can be prepared in a short period of time at a relatively low cost. Through our experience, we propose supplementation of bm-PRP in performing surgery at sites with impaired wound healing.

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Artificial dermis enables the wound coverage to induce thinner, pliable and more favorable reconstruction. Simultaneous use with growth factor and cells are leading to better quality of artificial wound healing. In intractable and chronic radiation injured wounds, autologous adipose-derived stem (regenerative) cells successfully heal the wound for more than 2 years, which previously treated with artificial dermis with skin grafting, local or free flap transfers but recurred within 1 year post-operatively. The adipose-derived stem cells in culture demonstrate high and consistent cell proliferation, saturation density and colony-formign capacity. Additionally, the cells are highly inducible in differentiation to the adipose cells by a real-time BODIPYassay.
In a ShcC deficient mouse model, the artificial dermis alone failed to heal by 6 days post-operatively and the artificial wound healing in ShcC-deficient model with treatment of adipose-derived stem cells led to the almost equal wound healing with the control wild littermate animals.
The combined use of adipose-derived stem (regenerative) cells with the artificial dermis is effective in chronic wound healing such as radiation injuries and nerve-deficient conditions.

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The development of Integra, a permanent dermal replacement matrix, provides an important alternative to the traditional reconstructive choices. The efficacy of Integra has been clinically evaluated upon its application in 2 cases presenting with extensive burns and 13 cases presenting with deep wounds exposing bones or tendons. In all cases presenting with extensive burns and in 13 cases presenting with deep wounds exposing bones or tendons, the neodermis became biointegrated with vascular ingrowth from the wound bed 2 - 3 weeks after treatment with Integra, and the graft take was excellent. Postoperative contracture of the grafted skin was minimal and the texture was excellent in the thin split thickness skin graft cases. In conclusion, Integra proved very safe and useful for achieving good derma-like tissue in cases of extensive burns and deep wounds exposing bone or tendons.

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I present three advanced methods for negative-pressure wound therapy ; combined use with artificial dermis, combined use with the shoelace technique, and the application to skin grafts.
In combined use with artificial dermis, the formation of good dermis-like granulation tissue was obtained by the early phase of invasion of fibroblasts and vascular endothelial cells into the collagen layer of the artificial dermis.
In addition, it has advantage, such as prevention of the loss or displacement of artificial dermis, control of infection of artificial dermis, and augmentation of the soft tissue.
In combined use with the shoelace technique, the size of ulcer was reduced horizontally by the shoelace technique, and the depths of the ulcer and pocket were reduced by negative-pressure wound therapy.
In the application to skin grafts, by its use together with a self-adhesive polyethylene mesh, there was no displacement of skin graft fixation, which could thus be performed easily ; it also reduced the operative time.

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The rate of SSI is high in cases of acute diffuse peritonitis due to lower gastrointestinal perforation. Since April 2011, we have been performing NPWT in order to achieve delayed primary closure instead of primary closure, as was previously applied in our hospital. Twenty-three patients who had undergone surgery in our hospital between April 2009 and March 2012 were divided into groups of NPWT (group A) and primary closure (group B). There were no cases of superficial SSI in group A (0%) and seven cases in group B (43.8%). The average length of stay in hospital of the patients in group A was 28.0 days, while it was 46.2 days in group B. Group B had a propensity toward a longer stay. A comparison between group A and group B who had undergone reopening of wound due to SSI revealed a significant difference (p=0.04) in terms of the days until wound healing. The average number of days for group A was 24, compared with 56 for group B. Management of wound with NPWT was more effective than that of SSI after primary closure. Thus, we can report that this treatment was highly effective.

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