By Nelson G. Keller, DPM, FACFAS
Thanks to continuous advancements in skin graft materials, technologies and preservation techniques, more patients with chronic wounds are able to heal – sometimes after many years of suffering.
Wound care has long been a tremendous drain on our national health care system, whether patients are dealing with diabetic, surgical, venous, arterial, traumatic or pressure injuries. Many people experience multiple failed treatments and surgeries, painful and/or dangerous infections, and a high risk of limb amputation.
Yet even large, deep wounds that have lingered for a decade or more can heal, whether in a dedicated wound center or, increasingly, an office setting.
To cite just one example, one of my patients had undergone 18 skin autografts over 20 years after initially injuring his leg in a workplace accident. He fully recovered in 10 months with the help of a TheraSkin allograft, made from human cadaver skin.
TheraSkin is one of a rapidly-expanding list of graft options that aim to provide key growth factors, with some also having antimicrobial and anti-inflammatory properties. Living cells can be carefully preserved via freeze-drying, dehydration or suspension in a fresh state, using a refrigerated tissue culture medium or saline solution.
In addition to working with human cadavers, researchers are crafting three-dimensional extracellular matrixes from amniotic materials, the small intestinal submucosa of pigs, and even the scales of North Atlantic cod, discovered to have similar properties to human skin.
Wound care specialists can pair skin grafts with vacuum-assisted closure – better known as a wound vac – to pull out drainage and create negative pressure to draw the edges of an injury together. Patients with infections benefit from intravenous antibiotics as well.
TheraSkin is made possible by organ donation, although many would-be donors don’t realize that the skin is the body’s largest organ. Teams at LifeNet Health in Virginia Beach can keep 98 percent of cells harvested in split thickness skin grafts alive during the freezing process.
These cryopreserved grafts offer both a native extracellular matrix and all of the biological components necessary to close and replace damaged skin, including growth factors, cytokines, fibroblasts, keratinocytes, and collagen types. Allografts drawn from an umbilical cord or the inner layer of a placenta also contain stem cells that can help inhibit infection.
Wound care specialists benefit from partnering with multiple other physicians caring for patients, including vascular surgeons, endocrinologists, orthopaedists, infectious disease experts, and internal medicine and primary care physicians.
Outside of skin grafts, another effective option for some patients is Multi-wave Locked System (MLS) Laser Therapy. This robotic procedure uses concentrated light energy to relieve pain, reduce inflammation, and promote healing and soft tissue repair without thermal damage.
As wound care centers and in-office facilities continue to expand across the country, our ability to support the body’s own healing process is changing lives for patients of all ages. That success should only keep improving in the future.
Dr. Keller is Board certified in reconstructive foot and ankle surgery and has more than 25 years of wound care experience. He practices at Hampton Roads Orthopaedics Spine & Sports Medicine’s offices in Newport News and Yorktown. hrosm.com