ACORN ARTICLE October 26, 2000
New Factors In Wound Healing
“So Doc,
let me see if I got this straight. You’re gonna treat my foot with pig guts and sea
weed?” was how Larry greeted my new treatment regimen for his slow to heal foot
ulceration. I admitted that this amusing characterization was a not entirely false
representation to what I had just told him.
Larry is one of
many people with hard to close wounds. Wounds that refuse to heal are frequently found on
the feet but they can be just about anywhere on the body. Diabetes, poor circulation or
both are common findings. Larry had both. Most wounds heal if the circulation is good and
the wound is kept open and clean.
Treating these
wounds has become an industry onto itself. There are companies that sell many millions of
dollars a year worth of products to get wounds to heal. Those of us on the front lines of
ulcer and wound care are bombarded by new products every month. I explained to Larry some
of the most exciting new products.
Larry’s
wound produces a lot of moisture. Too much moisture is bad so something is needed to
absorb the extra fluid. Who would have guessed that a product made from seaweed would be
the answer. Classified as an alginate, sea weed dressings can absorb many times
their weight in fluids. Even better, the mixture of the alginate and wound fluid creates a
gel that further encourages healing. For many people adding a seaweed dressing creates the
perfect environment to heal a wound. It helped Larry but it was not enough; he needed
growth factors.
Growth factors
are to wounds what Miracle Grow is to roses. It adds just the right ingredients to
encourage the body to heal the wound. Currently there are three sources of growth factors
available.
The first growth factor
commercially available was Procuren, a product developed at a few private wound care
centers from patients’ own blood cells. If you are at a Procuren wound care center a
paste will be made from your own platelets, a cell found in your blood. Procuren contains
about 5 separate growth factors and is daily placed on the wound.
About two years ago the second
growth factor product, Regranex, hit the market. Regranex comes in a little tube (a $300
tube!) and is applied to the wound once a day. With Regranex or Procuren, wounds seem to
heal 10% faster and 10% of otherwise non-healing wounds will now heal. For many people
these products have been a lifesaver.
Three months ago a third
product, Oasis, made its way to the market. Oasis is derived from what the package insert
politely calls porcine gastrointestinal submucosa. To you and me that means the lining of
pig’s intestines. You already read what Larry calls it. The product is processed to
remove all that is pig but leaves a whole “pen” of wound growth factors,
actually many more than the earlier products. It comes as a parchment-like sheet that is
placed on the wound and stays for up to a week at a time. In my practice I have seen the
Oasis product heal several wounds that were not helped with any other methods. This
product goes beyond lifesaver; I call it a sole-saver.
If the Oasis doesn’t
work I might suggest a try with Apligraf which is a living tissue derived from neonatal
foreskins. In a personal e-mail from the manufacturer they assured me that it was from the
foreskin of full term infants who volunteered (actually the parents volunteered) to donate
the base material. Apligraf is an actual
layer of skin about the size of a silver dollar. It has all the properties of skin. If you
cut it with a knife it will heal. Placed on the wound it becomes a skin covering. Special
properties allow it to turn into whatever kind of skin it is supposed to represent. Placed
on the toe it becomes toe skin. Placed on the bottom of the foot it becomes thick bottom
of the foot skin. I had a chance to apply Apligraf at a wound care seminar in Phoenix and
I welcome the addition to my wound care tools.
Larry doesn’t know
about the Apligraf. If he is a little squeamish about “pig guts” I cannot
imagine what he will say when I tell him about baby foreskins. He doesn’t read the
Acorn so do me a favor and don’t give him this, er, little tip.
Dr. Michael Zapf is a Board Certified podiatrist with offices in
Agoura Hills and Thousand Oaks. If you have questions about wound care please call his
office at (818) 707-3668.
