Complete Closure of Chronic Ankle Ulcerations in the Presence of Lymphedema with Use of Adipose Stem Cell Injectable Allograft

Introduction: Chronic heel ulcerations present substantial challenges to wound healing, particularly in patients with lymphedema. Lymphede- ma results in impaired lymphatic drainage, chronic inflammation, and tissue breakdown, complicating the healing process. This case report investigates the use of adipose stem cell injectable allograft as an ad- vanced therapy to achieve complete wound closure in a paraplegic patient suffering with bilateral chronic posterior ankle ulcers further complicated by lymphedema and fat pad atrophy. Methods: The patient initially presented with bilateral posterior heel wounds for two years that were treated using antimicrobial dress- ings, bilayered wound matrix, compression therapy, and offloading devices. These treatments failed. As a result, advanced management was introduced by sharp wide excisional debridement with application of adipose-derived stem cell injectable allograft, thereby promot- ing optimal healing conditions. Concurrently, lymphedema therapy was controlled with use of compression pumps and compression garments. Results: Complete closure of bilateral ulcers following the application of adipose stem cell allografts occurred in 9 months. Effective swell- ing control, achieved through compression pumps and compression garments, proved essential in maintaining the healing progression and preventing the recurrence of ulcers. There has been no recurrence of ulceration for one year. Discussion: This case illustrates the potential of adipose stem cell injectable allografts as a transformative treatment for complex wounds associated with lymphedema. It highlights that a combination of ad- vanced wound care strategies and diligent edema management can result in successful healing outcomes, even in patients with significant comor- bidities. Further research is necessary to explore the broader applicability of this innovative approach, which could lead to enhanced protocols and outcomes in managing challenging wound care cases.