01 · The Patient
An 86-year-old woman was referred to our care with recurrent ulcers on the left lower limb that had been present for more than ten years.
The ulcers appeared spontaneously and were associated with burning pain, especially in the late afternoon and at night. The lesions visible at presentation had been open for approximately 26 months.
The patient was clinically fragile and had multiple comorbidities. She was class 2 obese, had type II diabetes and severe osteoporosis, and suffered from deep vein thrombosis, polyarthrosis with polyarthralgia, glaucoma, hypertension, dyslipidemia and hypertensive heart disease with episodes of decompensation, which had led to two hospital admissions for pulmonary edema. She had also suffered a stroke with left-side damage.
Her surgical history included left saphenectomy and cholecystectomy. Daily pharmacological therapy included omeprazole, allopurinol, cardioaspirin, ramipril with hydrochlorothiazide, lecardipine HCl, bisoprolol, empagliflozin, vitamin D and bisphosphonates. She also used naloxone HCl and ibuprofen as needed for pain control.
02 · The Wound
At presentation on December 29, 2022, the lesions involved the left lower limb and had a total area of 9.64 cm².
Pain was very high, with an NRS score of 8. The clinical pattern was characterized by recurrent ulceration, spontaneous onset and burning pain, suggesting an inflammatory vascular component rather than a simple chronic wound.
The patient also reported several allergies, including simvastatin, paracetamol, amoxicillin-clavulanate and various topical remedies such as ozonated oils. She wore K1 compression stockings almost constantly, except during periods when open ulcers made their use intolerable because of pain.
The combination of chronic recurrence, severe pain and systemic frailty made the wound difficult to manage using standard strategies.
03 · Prior treatment history
When the patient first came to our care, pain management was initiated and her general treatment plan was reviewed.
An arteriovenous Doppler ultrasound showed sequelae of right-sided deep vein thrombosis, as well as multiple atherosclerotic lesions that were not hemodynamically significant. A biopsy of the lesions was performed and finally led to a diagnosis of vasculitis.
The patient was treated with silver sulfadiazine for P. aeruginosa colonization. Hospital admission was also scheduled for bioengineering treatment and further investigations. Colonic pathologies and neoplastic comorbidities were ruled out.
Corticosteroid therapy was excluded because of the patient’s severe osteoporosis. Rheumatology consultation also ruled out the need for further systemic therapies.
Between November 2022 and September 2023, the patient was admitted three times for bioengineered tissue grafts and underwent ten sessions of hyperbaric oxygen therapy, which she subsequently discontinued because of increased pain.
04 · Decision and protocol
In November 2023, the patient entered a drop-out period after being admitted for heart failure and treated at another center, where treatment was suspended. She returned in May 2024 with the lesion worsened, as expected.
In September 2024, after 22 months of standard treatment without conclusive results, treatment with mononuclear cells was proposed.
The patient was informed that data in the literature for this specific indication were not yet fully established. She accepted the proposed treatment, and a course of two applications was scheduled, spaced approximately one and a half months apart.
The treatment plan involved infiltrative E-PRP together with CGF membrane application, using the High Q Cell® All-In-One procedural kit.
The rationale was to support local healing through both the injectable action of E-PRP and the sustained biological support of the CGF fibrin matrix.
05 · Clinical response
On September 23, 2024, immediately before treatment, the lesion area measured 3.22 cm² and pain was still significant, with an NRS score of 5.
On the same day, the patient underwent infiltrative E-PRP grafting and CGF membrane application using the High Q Cell® All-In-One procedural kit. The postoperative course was uneventful.
Pain control improved rapidly. Within two weeks of treatment, the previously significant pain was brought under control.
The clinical response exceeded expectations. By the time the patient was readmitted for the second scheduled application, the lesion had already resolved.
06 · Outcome and follow-up
On November 8, 2024, forty-six days after the first E-PRP and CGF application, the lesion appeared resolved and was completely pain-free, with an NRS score of 0.
Because there was no longer any need to cover the lesion with a CGF membrane, the second planned treatment was modified. Only E-PRP was injected, with the objective of stabilizing the scar.
At a routine follow-up in March 2026 for an unrelated condition, the scar was still holding very well. The patient had remained disease-free for sixteen months, a stability she had not experienced for years.
The outcome was therefore clinically meaningful not only because the lesion resolved quickly, but also because the result remained stable over time.
07 · Discussion
This case illustrates the possible role of PBMNC-based regenerative treatment in persistent vasculitic lesions when standard approaches are limited by frailty, comorbidities or intolerance.
The case was particularly relevant because the patient had a long history of recurrent ulcers and the visible lesions had remained open for more than two years. Standard strategies, including bioengineered grafts and hyperbaric oxygen therapy, had failed to provide stable resolution. Corticosteroid therapy was not feasible because of severe osteoporosis, and systemic options were limited by the patient’s overall fragility.
After a single E-PRP and CGF application, the lesion resolved in just over forty days and pain disappeared completely. This rapid response after such a long non-healing period suggests a meaningful biological effect on the inflammatory and reparative environment of the wound.
The treatment should not be interpreted as a replacement for proper diagnosis or standard systemic management of vasculitis. Rather, it may represent a local, minimally invasive regenerative option in selected fragile patients where conventional treatment has failed or cannot be safely pursued.
The absence of recurrence at long-term follow-up further strengthens the clinical relevance of this case and suggests that local stabilization of the tissue environment may be as important as wound closure itself.