01 · The Patient
A 59-year-old male came to our attention with a complex ulcerative lesion on the right lower limb, associated with diabetic lipoid necrobiosis and diabetic arteriopathy.
The patient was already clinically fragile. His medical history included poorly controlled type I diabetes, ischemic heart disease with previous coronary angioplasty, and severe chronic pre-dialysis renal failure. He was also allergic to Ciprofloxacin and Ceftriaxone.
From a pharmacological standpoint, he was taking insulin, valsartan, bisoprolol, esomeprazole, Luvion, torasemide, amlodipine, cardioaspirin, doxazosin, allopurinol, Cholecomb, sodium bicarbonate, clopidogrel and Binocrit.
The lesion had been present for several months and had already been treated according to the gold standard approach without any meaningful clinical response.
02 · The Wound
At first presentation on 20 May 2025, the lesion was located on the right lower limb. It showed a necrotic central area with clear signs of inflammation.
The wound measured 0.86 cm² and was painful, with an NRS score of 6. Although relatively limited in size, the lesion was clinically significant because it combined two difficult biological contexts: diabetic lipoid necrobiosis and diabetic arteriopathy.
This dual nature made the case particularly complex. The inflammatory component was sustained by the underlying necrobiosis, while the vascular component reduced the tissue’s ability to progress toward healing.
03 · Prior treatment history
Before regenerative therapy was considered, the patient had been treated according to the standard therapeutic approach for diabetic lipoid necrobiosis.
The gold standard treatment included corticosteroid-based therapy and optimization of glycemic control. Despite six months of this approach, the lesion remained substantially unresponsive.
On 16 July 2025, after ongoing standard care, the lesion had only marginally reduced to 0.76 cm² and remained painful, with an NRS score of 5. Standard treatment was therefore continued.
By 17 October 2025, however, the clinical course confirmed stagnation. The lesion had increased to 1.06 cm² and pain was still present, with an NRS score of 4. At this point, the lack of response to standard care made it necessary to consider an alternative therapeutic strategy.
04 · Decision and protocol
Given the failure of standard treatment and the dual nature of the lesion — diabetic lipoid necrobiosis and diabetic arteriopathy — the decision was made to proceed with PBMNC therapy using E-PRP and CGF in combination.
The objective was to act on both components of the wound: to support local vascular restoration and to modulate the inflammatory environment that was preventing progression toward healing.
The procedure was performed using the High Q Cell® All-In-One system, which allows the simultaneous preparation of E-PRP and CGF from autologous blood.
The E-PRP was injected into the lesion and the surrounding area, while the CGF patch was applied directly over the wound bed to provide a sustained biological stimulus.
05 · Clinical response
The first combined E-PRP and CGF application was performed on 17 October 2025. No complications were reported.
At reassessment on 28 October 2025, only eleven days after the first treatment, the lesion area measured 1.15 cm². Although the surface area had not yet decreased, the clinical signs had changed significantly: pain was virtually absent, with an NRS score of 0, and inflammation appeared almost completely resolved.
This early change was clinically relevant because it suggested that the treatment had rapidly modified the biological behavior of the wound, even before final closure occurred.
On 27 November 2025, a second application of PRP and CGF was performed under sedation using the same procedural approach.
06 · Outcome and follow-up
On 9 December 2025, less than two months after the first PBMNC treatment and eleven days after the second application, the lesion appeared resolved.
Because of the complete clinical response, no further treatments were considered necessary.
The result was particularly relevant because it followed several months of therapeutic stagnation under standard care. After only two combined E-PRP and CGF applications, the lesion moved from a non-responsive inflammatory state to complete resolution.
The documented progression showed a clear contrast between the prolonged pre-treatment stagnation and the rapid acceleration of healing after PBMNC therapy.
07 · Discussion
This case illustrates the potential role of combined E-PRP and CGF treatment in a difficult ulcerative lesion associated with diabetic lipoid necrobiosis.
The case was particularly interesting because the wound was not simply a chronic ulcer. It was the result of a combined pathological condition: an inflammatory dermatological disease resistant to standard therapy, superimposed on diabetic arteriopathy and systemic fragility.
The rapid disappearance of pain and inflammation after the first treatment suggests a strong biological effect beyond simple wound coverage. The subsequent closure after the second application supports the hypothesis of a synergistic action between injectable E-PRP and CGF patch therapy.
E-PRP provided a concentrated autologous cellular and growth factor stimulus through intra- and perilesional injection, while the CGF patch acted as a dense fibrin matrix capable of supporting a sustained regenerative effect over time.
The key clinical message is that, in selected non-responsive cases, combined PBMNC therapy may offer a regenerative option when standard treatment has failed to produce meaningful progress.
This treatment does not replace diagnosis, glycemic control, vascular assessment or standard wound care. Rather, it may represent a complementary option in complex lesions where inflammation, impaired perfusion and chronicity coexist.