Clinical characteristics of stem cell application in the surgical management of post-traumatic and trophic skin defects. Literature review

Abstract

Chronic post-traumatic and trophic skin defects present a significant clinical challenge, particularly in the context of ischemia, infection, diabetic angiopathy and neuropathy, or severe traumatic injuries. Conventional treatments such as debridement, skin grafts, and local or free flaps often fail to achieve durable healing, thereby increasing interest in regenerative technologies. Mesenchymal stem cells (MSCs), particularly those derived from bone marrow and adipose tissue (ADSCs), exert significant paracrine, angiogenic, and immunomodulatory effects. These properties enhance the wound microenvironment and augment the efficacy of standard surgical interventions. Clinical studies and meta-analyses indicate that autologous MSC therapy accelerates healing of diabetic, venous, arterial, and mixed ulcers, decreases the risk of amputation, and improves tissue perfusion. In reconstructive surgery for post-traumatic defects, ADSC/SVF-assisted lipofilling and nanofat technologies are widely utilized. These approaches promote scar tissue remodeling, improve tissue elasticity, reduce contractures, and optimize conditions for subsequent flap reconstruction. Furthermore, cellular or cell-matrix constructs (MSCs combined with scaffolds) have the potential to manage complex soft-tissue defects with bone exposure, thereby reducing the need for extensive reconstructive procedures. Despite these promising outcomes, current evidence is limited by small sample sizes, methodological heterogeneity, the absence of standardized dosing protocols, and a lack of large multicenter randomized controlled trials. Furthermore, although no significant risks have been reported in existing studies, the issue of long-term oncological safety warrants continued monitoring. Emerging strategies include cell-free approaches such as exosomes and MSC secretions. Additionally, the integration of cellular technologies with 3D-printed and bioengineered matrices, as well as the development of standardized surgical algorithms that leverage MSCs to enhance the efficacy of conventional reconstructive techniques, are being explored.