The cell based dressing with living allogenic keratinocytes in the treatment of foot ulcers: a case study  Yalcin Bayram, Mustafa Deveci, Nejat Imirzalioglu, Yasemin Soysal, Mustafa Sengezer  British Journal of Plastic Surgery  Volume 58, Issue 7, Pages 988-996 (October 2005) DOI: 10.1016/j.bjps.2005.04.031 Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 1 The appearance of cytoline 1™ under stereomicroscope. Please note its porous structure which facilitates to adherence of cultured cells onto both the surface and porous area. British Journal of Plastic Surgery 2005 58, 988-996DOI: (10.1016/j.bjps.2005.04.031) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 2 The procedure of cell loading onto the microcarrier was made in the course of passage. Two cubic centimetre cell suspension and microcarriers was incubated together in the 2cm culture flask. British Journal of Plastic Surgery 2005 58, 988-996DOI: (10.1016/j.bjps.2005.04.031) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 3 (A) Following surgical debridement and irrigation with saline solution, keratinocyte loaded microcarriers are applied onto the wounds with a single layer. (B) Vaseline soaked gauze was fitted over the microcarriers. British Journal of Plastic Surgery 2005 58, 988-996DOI: (10.1016/j.bjps.2005.04.031) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 4 (A) Photomicrograph of adhered keratinocytes onto a microcarrier under light microscope (×100). (B) The keratinocytes are seen in groups or single cell on the porous surface of the microcarrier under scanning electron microscope (×10 000, SEM). British Journal of Plastic Surgery 2005 58, 988-996DOI: (10.1016/j.bjps.2005.04.031) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 5 The appearance of the wound following serial debridement on the heel area of a diabetic patient (A). The application of keratinocyte loaded microcarriers is seen (B). The appearance of the wound on 15th day of the interactive treatment, please note the significant contraction and epithelisation (C). The wound was completely healed at the 24th day of the treatment (D). British Journal of Plastic Surgery 2005 58, 988-996DOI: (10.1016/j.bjps.2005.04.031) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 6 The appearance of the wound on the left heel area of a diabetic patient, the wound was score was 6 since, purulent discharge, pseudomembrane formation and minimal granulation formation without epithelisation and contraction (A). The appearance of the wound at the 30th day the treatment with interactive dressing is seen (B). British Journal of Plastic Surgery 2005 58, 988-996DOI: (10.1016/j.bjps.2005.04.031) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 7 The appearance of the wound on the right malleolar area of a diabetic patient following serial debridement of both soft tissue and bone (A). The appearance of the wound at the 21st day the treatment with interactive dressing is seen (B). British Journal of Plastic Surgery 2005 58, 988-996DOI: (10.1016/j.bjps.2005.04.031) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 8 The appearance of the wound on the tip of the left great toe of a diabetic patient on admission (A). Serial debridement of the necrotic tissues was performed prior to the application of keratinocyte loaded microcarriers (B). The appearance of the wound on 15th day of the interactive treatment, please note the indentations of the microcarriers on the surface of the wound (C). The wound was completely healed at the 30th day of the treatment (D). British Journal of Plastic Surgery 2005 58, 988-996DOI: (10.1016/j.bjps.2005.04.031) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 9 Graph shows the mean value of wound dimensions measured at certain intervals. When compared the wound contractions to the initial wound areas, the differences at time points other than 6th day were statistically significant in the treatment group. However, the difference was statistically significant at the only 30th day in the control group. Bars indicate means±SEM. *p<0.001. British Journal of Plastic Surgery 2005 58, 988-996DOI: (10.1016/j.bjps.2005.04.031) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 10 Graph shows the mean scoring values at certain time points. In the treatment group, wound condition was better and it is statistically significant when compared to the control group. Bars indicate means±SEM. *p<0.001. British Journal of Plastic Surgery 2005 58, 988-996DOI: (10.1016/j.bjps.2005.04.031) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions