Monday, March 11, 2013

Stem Cell Therapy Improves Healing in Chronic Wounds

There is so much research right now using stem cells and we are finding so many wonderful applications where they can be beneficial in the foot and ankle.  But none better so far than in healing chronic wounds.

Now the stem cells I’m referring to are not used to grow an ear on a rat or clone a sheep.  These cells are obtained from human placenta immediately after child birth.  Learn more about that process here.  

How are they helping in wound care?  Healing a chronic wound can be challenging at best.  Make it a diabetic ulcer on the bottom of the foot and it can be almost impossible in a less than 6-8 months.  These ulcers are difficult to heal for several aspects.  Pressure from walking causes chronic trauma thus reducing the ability to heal.  The body’s own mechanism of filling a wound is often inefficient due to chronic disease.  Uncontrolled blood sugars add to this.  Bacteria can sit on the wound and may not be causing an infection but will prevent healing.  This list goes on and on.

And up until now we have tried numerous products to improve ulcer healing.  Some would be quickly beneficial.  But in the long term, it always took what seemed like an eternity to heal a diabetic ulcer.  Thanks to scientific research, I am now using live stem cells to close a diabetic ulcer often within 1-3 weeks.  

My approach to wound care is aggressive.  I know that if you have an open wound you are susceptible to infection.  This infection can be limb or life threatening.  So I want to close this ulcer as quickly as possible.  Here’s how I do it:
1st: culture the ulcer to see what bacteria is growing.  Antibiotics either pill form or topically may be started immediately to reduce this growth.
2nd: debride the ulcer.  This means remove all soft tissue that is no longer healthy from the ulcer and get a good bleeding base.  This brings the body’s own healing cells to kick start the process.  If your circulation is impaired, I may not be as aggressive with this step.  Alternatively, I may use a topical cream to slowly debride the ulcer for me.
3rd: offload the ulcer.  I want you in a special boot or shoe and possibly non-weight bearing so that I can take off as much pressure to the ulcer as possible.  
4th:  daily care.  You will be putting some kind of wound product on your ulcer daily followed by a dressing of gauze.  And keep your foot out of shower or bath water.  When you shower, there are several dirty areas between your scalp and your toes.  All of this dirt can end up in your ulcer!

I follow this regimen for 4-6 weeks.  If this does not work, the next step is stem cell therapy combined with a theraskin graft.

This is done in a surgery center setting so that deep debridement of your wound can be performed removing all nonviable tissue.  The stem cells are injected around the edges of the wound and throughout the ulcer base.  This does 2 things:
1.  stimulates growth of skin cells
2.  reduces the bacteria on the ulcer base
Next, I apply a theraskin graft.  This is cadaveric skin that has been donated just like a heart or liver for transplant patients.  But this graft has been treated to remove all living cells so there is no transfer of disease possibility.  This graft acts as an immediate skin covering.

Expect your ulcer to be significantly smaller if not healed within 1-3 weeks depending on size.  During this time, you will need to keep it wrapped with a gauze dressing and wear your boot or shoe at all times.  Minimal pressure to the foot is required otherwise you could injure the graft and stem cells, thus causing the entire thing to fail.

Sounds great, doesn’t it.  Well it is as long as these things are in check:
1.  You are keeping your blood sugar in control.  High sugar means failed graft.
2.  You are compliant with your post op regimen.  Non-compliance means failed graft.
3.  Take prescribed antibiotics as instructed until you are healed.  Too many bacteria means failed graft.
4.  Don’t get it wet.  A wet graft is a failed graft.

If you are dealing with a chronic wound that just won't heal and feel like you have tried everything, call us today.