# Intradermal Application of Allogenic Wharton’s Jelly Mesenchymal Stem Cells for Chronic Post-Thoracotomy Wound in an Elderly Patient After Coronary Artery Bypass Grafting: Clinical Case with Brief Literature Review

## TL;DR

An elderly man with a long-lasting infected chest wound after heart surgery healed completely after treatment with special stem cells.

## Contribution

Demonstrates successful use of Wharton’s jelly mesenchymal stem cells for chronic, treatment-resistant surgical wounds.

## Key findings

- Intradermal WJ-MSC injections led to complete healing of a four-year-old chronic sternal wound.
- WJ-MSCs modulated the inflammatory environment and stimulated tissue regeneration.
- The treatment was effective even after conservative methods and surgery failed.

## Abstract

Invasive thoracic surgery represents a great post-operative problem—a large and slowly healing surgical wound, often with infectious complications. In elderly people, this may turn out to be a severe chronic state resistant to the common treatment. We describe a clinical case of an elderly man with refractory chronic sternal osteomyelitis and mediastinitis developed after CABG that persisted for four years. As the conservative treatments—wound debridement and antibacterial therapy—were non-effective, the wound was subjected to the intradermal injections, three times in total, by Wharton’s jelly mesenchymal stromal cells. The outcome was the prominent recovery of wound state followed by complete wound healing. Our case demonstrates beneficial effects of WJ-MSCs in treating conservative treatment-resistant infections in the surgical wound, most likely due to modulation of inflammatory environment in the wound.

Background: Chronically non-healing thoracic wounds after cardiac and non-cardiac thoracotomy, including cases when coronary artery bypass grafting (CABG) is performed, represent a great clinical challenge. It is often that a conservative treatment of the wounds does not provide effective regeneration of the damaged tissues. It is especially critical in patients with infected wounds, in patients owning a systemic infection, and in elderly people. Methods: The article presents a case report of successful treatment of a 63-year-old man with refractory chronic osteomyelitis of the sternum and mediastinitis four years after CABG, complicated by COVID-19 at the time of reconstructive surgery. Due to the low effectiveness of conservative treatment methods, a two-stage approach was applied: radical surgical wound debridement followed by infiltration of the wound with allogenic mesenchymal stromal cells (MSCs) of Wharton’s jelly (WJ-MSCs). Results: This double-stage therapy successfully modulated the inflammatory environment and stimulated granulation, facilitating final thoracoplasty and osteosynthesis. The patient achieved complete healing of the sternum, demonstrating benefits of WJ-MSCs in treating conservative treatment-resistant infections in the surgical wound. Conclusions: The advantages of using perinatal mesenchymal stem cells, with WJ-MSCs as a type of this class of MSCs, were demonstrated in treating chronically infected sternal surgical wounds. We also compared their regenerative properties to other stem cell types like bone marrow MSCs.