What is regenerative medicine?
Regenerative medicine, in its most simplest definition, is using bioengineered products to accelerate the body's healing potential. In wound care, this refers to placental based tissues to heal wounds. The placenta is a magical piece of material containing loads of stem cells ideal for healing. After all, it nourishes and builds a baby for nine months.
The reason I love wound care of the lower extremity is that there are many components to understanding why a wound may not heal. The lower extremity is different from other body parts because of our dependency with weightbearing and walking for activities of daily living. The biomechanics of the lower extremity is complicated (have you ever tried to not walk on one foot for a day?) It's not so easy and yet this is what is required to heal a foot ulcer.
When do I employ regenerative medicine in my practice?
To be honest, I am a firm believer of following basic principles of wound care so I tend to avoid most sales reps until I absolutely need them. My medical and surgical background allows me to dig around in my medical toolbox to solve wound problems. Many times, wounds can be healed by utilizing the following protocol that I just made up in these 2 seconds, pnuemonic OPENMIC:
- Off-loading the pressure point (a biomechanical evaluation to determine source of pressure ie equinus, other foot deformities)
- Patience (wound healing takes time, but you don't want an acute wound to crossover to a chronic state by waiting too long)
- Edema control (probably the most underrated part of the puzzle, but critical to control, swelling impedes nutrients from getting to the wound and healing it)
- Nutrition and medical management (in diabetics --> control of blood glucose; obesity --> protein intake, etc)
- Maintaining a balanced moist wound bed (if it's dry, wet it; if it's wet, dry it --> FYI "wet-to-dry" dressing is not adequate)
- Infection control (if present treat it appropriately prior to use of any grafts)
- Circulation status (is there enough blood to heal? If not, refer to appropriate vascular interventionalist quickly)
If after a month, the wound does not improve in size and appearance (or the wound is grossly large in a compromised host), I escalate the treatment plan to using allografts that is rich in stem cells. The stem cells recruit the body's own cells to potentiate healing. Time is of essence so I employ this technique as soon as insurances approve of its use.
Here's an example of a very sweet patient of mine who was close to having her leg amputated:
The back of the heel poses the biggest challenge because it is a constant pressure point. I have found that being aggressive with these wounds using regenerative medicine to be highly beneficial on top of the OPENMIC principles of wound care. For patients unable or unwilling to undergo flap reconstruction for immediate wound coverage, this is a really nice option to get patients to heal and ultimately prevent major lower extremity amputation.