Mesenchymal Stem Cells and Regenerative Therapy with Bilateral Gracilis Flaps for Perineal Reconstruction of a Wound Infection in the Setting of Anal Squamous Cell Carcinoma

Abstract

Many patients are affected by HIV/AIDS, and these conditions are highly prevalent worldwide. Patients with HIV/AIDS can experience debilitating wound infections that often require flap reconstruction and become challenging for surgeons to treat. In the past 5 years, mesenchymal stem cells have been tested and used as regenerative therapy to promote the growth of tissues throughout the body because of their ability to successfully promote cellular mitogenesis. To the authors’ knowledge, the use of mesenchymal stem cell grafting following necrosis of a myocutaneous gracilis flap (as part of perineal wound reconstruction) has never been reported in the literature. In addition, the use of mesenchymal stem cells and regenerative medicine combined in the setting of squamous cell carcinoma of the anus with prior radiation (along with comorbid AIDS) has not been previously documented. In this report, the authors outline the case of a 60-year-old patient who had a recipient bed (perineum) complication from prior radiation therapy. Complicating the clinical picture, the patient also developed a Pseudomonal organ space infection of the pelvis leading to the failure of a vertical rectus abdominis myocutaneous flap and myocutaneous gracilis flaps. As a result, the patient underwent serial operative debridements for source control, with the application of mesenchymal stem cells, fetal bovine dermis, porcine urinary bladder xenograft, and other regenerative medicine products, achieving a highly successful clinical outcome. A procedural description for future use and replication of this method is provided.

Application of Stem Cells Shows Antiinflammatory Effect in an Irradiated Random Pattern Flap Model

“…Irradiation therapy delivers lethal doses of radiation to areas of malignancy to destroy cancer cells. As a consequence, the surrounding healthy cells are also exposed to lethal doses of radiation [ 2 , 3 ]. A negative side effect is the development of radiodermatitis with erythema, ulceration and pain, followed by chronic soft tissue atrophy, alopecia and stiffness [ 2 ].…”

“…A negative side effect is the development of radiodermatitis with erythema, ulceration and pain, followed by chronic soft tissue atrophy, alopecia and stiffness [ 2 ]. Radiation-induced damage and inflammation often lead to chronic radiation-induced fibrosis within 4 to 12 months following therapy and may continue for years [ 2 , 3 ].…”

“…Therefore, application of stem cells might be a possible solution. Topical application of a mixture of different stem cells such umbilical cord mesenchymal stem cells and other regenerative medicine products in a patient with an irradiated perineal wound after anal squamous cell cancer and flap failure resulted in wound healing after 79 days [ 3 ]. Application of conditioned mesenchymal stroma cells in severe local radiation injuries accelerated wound healing [ 4 , 5 ].…”