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.

Healing Diabetic Foot Ulcers

In my practice, I treat a lot of diabetic patients, and I see a lot of diabetic wounds. In this case, the wounds are called diabetic foot ulcers.

When evaluating diabetic foot ulcers, some of the things we look for as foot specialists are signs of infection, size of the wound, lab tests, blood sugar levels, shoes, and circulation of the feet and legs. All of these are important. Also, getting a good history from the patient is very important. We need to know how long the wound has been present, what medications have been given, and if any other treatments have been rendered yet.

As a podiatist, my main goal is to save my patients' feet. So this is a very important topic for me. We need the patient to help us do our job to heal the diabetic foot ulcer. Whether that means staying off of the foot or wearing a special boot, the doctor knows best when it comes to healing the foot ulcer. The longer the ulcer remains open, the higher incidence of infection (whether it be in the soft tissues or in the bone). And once it goes into the bone, that is when amputation occurs.

Dr. Michele Summers Colon, DPM, MS
3503 Lexington Ave.
El Monte, CA 91731
626-442-1223
www.elmontefootdoctor.com

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Please feel free to email me if you have any questions or if you would like to schedule an appointment, or you can visit our website or call our office.
dr.michele.colon@gmail.com

So what exactly is a Diabetic ulcer and why is it so bad?

Those with diabetes and their friends and family members have at one point and time heard the term “diabetic ulcer”. And it is usually followed by “that’s why their foot was amputated”. So what is a diabetic ulcer?

An ulcer is any break in the skin that does not heal in a reasonable amount of time, usually a week to 10 days. This can occur anywhere, not just the feet. But for diabetics, the feet are the most common place for ulcerations to occur. This is due to 2 problems: neuropathy and pressure.

Neuropathy is the loss of sensation that can occur with long term or uncontrolled diabetes. Once you cannot feel things like heat, friction or pain, then any area of pressure can form a callus on the foot. When this callus is present for several days to weeks without being treated, the skin under the callus becomes soft and breaks down, resulting in an ulcer. This is now an all access pass for bacteria to enter the body and cause infection. That infection, if left untreated, can cause loss of part or all of the foot or leg.

I often have patients that tell me they attempted to treat the ulcer for several days to weeks before coming in the office. They applied Neosporin and washed it every day, but it just wasn’t getting better. To treat an ulcer effectively, several things need to occur. First and foremost, stop any infection that may be brewing or already started. No ulcer will heal if it is infected. This is done with topical ointments that are more effective at treating infection than Neosporin and antibiotics. Next, removing any tissue that may be harboring bacteria and also slowing down the healing progress of the ulcer. Lastly, take away the pressure. If an ulcer has constant pressure applied, then good healthy skin cannot grow over it to heal. So using special offloading boots or shoes to reduce the pressure is crucial in treating the wound.

Other factors in treating your ulcer include keeping your sugars in control and eating a well balanced diet. With high sugars, the body has a great deal of trouble healing any wound and it has a harder time fighting off infection. Remember….bacteria loves sugar!!

Once the ulcer is healed, the next step is preventing another one. If you haven’t seen a podiatrist and you are diabetic, now is the best time to have those feet checked for any signs that an ulcer could form. If you have had an ulcer in the past and have not seen your podiatrist in over a year, get on the phone and make an appointment! Prevention is the key to saving your feet!