Fat pad augmentation using human adipose allograft yields durable closure in recalcitrant plantar ulcers

Fat pad atrophy or migration leads to high pressure, a key factor in chronic plantar ulcer development. Current standard of care (SOC) only offers temporary pressure relief through off-loading, without addressing underlying fat pad defects.

To assess the intraoperative use of human cryopreserved adipose tissue allograft (hCAT) alongside SOC for patients with chronic recalcitrant plantar ulcers persisting longer than 12 months.

Eight patients with significant comorbidities, including diabetes mellitus, peripheral vascular disease, and chronic kidney disease, were included in this retrospective case series. The average ulcer size was 3.69 cm² (range, 0.14 cm²-20 cm²) with an average duration of 39.6 months (range, 21 months-59 months). Each patient underwent surgical debridement followed by hCAT implantation in the periwound area, followed by SOC. Outcomes included ulcer closure rate, time to closure, ulcer-free duration, and hCAT-related adverse events.

Seven patients (87.5%) achieved complete closure within 2.8 months on average (range, 0.8 months-7.2 months) with a post-closure ulcer-free duration averaging 5.6 months (range, 3.5 months-7.7 months) at the time of data analysis. No hCAT-related adverse events were observed. Patients are still being followed for longer-term outcomes.

These findings support hCAT as an effective adjunct to SOC in the management of chronic recalcitrant plantar ulcers.