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.

Podiatrists Save Diabetic Feet...It's Just What We Do

I had an experience yesterday that almost moved me to tears. In December I wrote about a gentleman who was incredibly close to losing his leg, if not his life (Here's the original post). Within a short time frame of days, he went from having a "minor" ulcer treated to a major infection of the foot which ended up with him losing two toes, but has retained the functional foot. Before the first operation, I had a conversation with the infectious disease physician caring for him who was insistent that my surgery was futile and he needed an amputation above his knee to save him. The patient and I discussed this and agreed that we wanted to try anyway.

During the first operation, I experienced an infected foot like I'd never seen before, even in my training. It was very apparent that the surgery didn't get rid of the infection like it should have. A few days later, another surgery with a toe amputated. The following week a third surgery with a second toe amputated. Then the miracle...

His fever dropped to normal, all the color came back into his face, his appetite returned. He looked healthy. He made a commitment to his wife, me, and most importantly, himself, to take this horrible time in the hospital and take charge of his diabetes. He did everything right to lower his blood sugar to normal levels. We sent him for Hyberbaric oxygen treatments which helped the residual minor infection to resolve and started to promote healing. As he was discharged, we put a negative pressure "VAC" dressing on his foot to further promote healing.

Our initial hope was to get the wound to the point that we could use a skin graft to close it. Yesterday, that changed. He is doing everything right, including being vigilant about controlling his diabetes. The bottom of his foot is close to healing on its own...without a skin graft! This is ideal, since that would make the skin much thicker and would minimize the risk of breaking open again. Thinking where we were just a few short months ago, I'm staggered to think that soon he'll be back to wearing shoes and even back to work with two functioning feet.

Good thing we decided not to take the easy way out by amputating the leg, don't you think?