EFFECTS OF PERIPHERAL BLOOD MONONUCLEAR CELLS, ALONE OR IN COMBINATION WITH ACELLULAR DERMAL MATRICES, IN DIABETIC PATIENTS WITH NON HEALING CHRONIC WOUNDS

Background: Diabetic foot ulcers (DFUs) represent a major complication of diabetes mellitus and are associated with impaired wound healing. Original regenerative and immunomodulatory therapies have been proposed to improve healing outcomes. Objective: To evaluate the association between topical monocyte infiltration, dermal substitute application, and their combination with wound healing outcomes in patients with DFUs. Methods: A retrospective case–control study was conducted including patients with DFUs treated at a specialized wound care center. Adult patients with Wagner grade 1–3 DFUs were included. Cases were patients who achieved favorable healing outcomes (complete healing within 16 weeks or ≥50% ulcer area reduction at 12 weeks), while controls showed unfavorable outcomes such as poor or absent healing. Patients were categorized according to treatment received: topical monocyte infiltration, dermal substitute application, combination therapy, or standard care. Multivariate logistic regression was performed to estimate odds ratios (ORs) for healing. Results: A total of 32 patients were included (20 cases, 12 controls). Combination therapy was associated with significantly higher odds of favorable healing compared to standard care (OR 5.9231, 95% CI 0.6281-55.855; p < 0.01). Both monocyte infiltration and dermal substitutes alone were also associated with improved outcomes, though with lower effect sizes. Conclusions: The combined use of topical monocyte infiltration and dermal substitutes may synergistically enhance the healing of diabetic foot ulcers. Prospective randomized studies are warranted to confirm these findings.