WATERBURY -- Waterbury Hospital physicians have been using a new treatment for deep, chronic wounds in patients -- their own skin.
The new procedure, called autologous cell therapy, uses a small amount of a patient's own skin to generate a spray-on suspension of activated skin cells that slowly restore the skin's outer layer, or epidermis, essentially covering the wound with the patient's own new skin cells.
"Scientific knowledge has increased tremendously since I was in residency, when the choice was whether to use a wet dressing or a dry dressing," said Dr. David Knight, surgeon and co-director of Waterbury Hospital's Wound Center, which opened in 2019. "We know much more about the molecular process of wound biology than we did then."
Knight was a resident in 1981.
The new process involves removing a small piece of the patient's skin -- about a 1-centimeter-by-1-centimeter square -- with a Dermablade. That skin is then placed into an enzyme that breaks it down to its cellular components. Those components are then transferred to a syringe which a doctor then "sprays" over the patient's wound.
"One square centimeter of skin will cover 80 square centimeter of wound," Knight said.
Dr. Peter Ferrante, a podiatrist and co-director of the Wound Center, said, "You are spraying this on a noninfected wound so a big advantage we see is you're letting your body and the skin take over."
Program Director Briana Saucier, a nurse, said, "One patient saw a 50% decrease in the size of her wound. This is not a procedure that anybody has to go to the (operating room) for."
"We don't actually heal wounds," Knight noted. "Your body heals wounds. We just set up the conditions so it can."
Ferrante says nearly all of the wounds he treats are diabetic ulcers, the numbers of which are growing as the obesity crisis and cases of type 2 diabetes increase in the country, especially in minority groups. Between 2012 and 2022, the number of Americans with type 2 diabetes increased by 20%, according to a study by the University of Georgia.
The disease also is accelerating among the young. In young adults, type 2 diabetes prevalence increased by 95% between 2001 and 2017 in the U.S., according to a study by the American Hospital Association. Certain populations, particularly African-Americans, have been disproportionately affected.
However, other patients with traumatic wounds such as dog bites, accidents, knife injuries or pressure ulcers (bed sores) can benefit, doctors say. People require wound care for various reasons, primarily when wounds don't heal properly or show signs of infection, potentially leading to complications or loss of a limb. Wound specialists create individualized care plans to promote healing and improve quality of life, especially for those with chronic wounds like diabetic foot, pressure or venous stasis ulcers.
The procedure is becoming a valuable alternative or addition to split-thickness skin grafting, in which surgeons remove a larger portion of a patient's epidermis (top) and dermis (middle) layer, about as thick as an apple skin, typically from the thigh. That skin is then introduced into a machine that puts mesh-like holes into it, allowing it to stretch over a larger area and letting the wound drain. Patients sometimes complain that the graft hurts more than the wound, Knight said.
A wound is a universe of its own. Once skin is broken, it is as if a door to the body's inner dynamics has been opened, exposing it to bacterial colonies and igniting the self-preserving instinct that, for a superficial wound, allows platelets and a protein called fibrin to knit over and close up the wound into what most of us call a scab.
But deep wounds - -- many of them caused by diabetes or trauma -- often try to heal in a way that retards, rather than accelerates, wound healing, doctors say. These require particularized wound treatment, often including the scraping away or debridement of dead, infected or damaged tissue; skin grafts or the use of a hyperbaric chamber to deliver a high concentration of oxygen to the bloodstream, which reduces infection, stimulates the growth of new blood vessels, reduces inflammation and fights infection.
"The body has to heal you. We don't have anything so special that we can sprinkle all over you and make the wound go away," said Dr. Peter Jacoby, medical director of the Saint Mary's Hospital Wound Center in Waterbury, which just celebrated its 20th anniversary. "But the body very often will say, 'let's go after the wound.' But if it's a deep wound, the body may not be able to heal it all that quickly. The body is letting the dead cellular products form in the wound. All those dead products could lead to infection. So we want to get rid of those dead cellular products, debride (scrape out) the wound and get the wound back to a healthy bleeding bed so that we can then put in products and let the body do its work."
Knight said, "The natural tendency is to heal, but for certain people that turns out to be very different. For diabetics it is very different. A diabetic with ulcers on their feet is likely to progress to amputation of toes, parts of the foot and then the leg. Knight said he had a 20-year-old patient who has had continued amputation of toes and finally, by 31, his foot and leg, due to diabetes.
"Diabetes is not just a medical problem, it's a social problem," he said. "People aren't taking care of themselves because they don't have money to take care of themselves. They can't afford insulin and they get ulcers. Diabetes is an epidemic. You have a life-threatening illness. The problem is good food that's really good for you is expensive."
Because diabetics often suffer from neuropathy, many cannot feel the bottom of their feet or know they have a cut or wound. Knight recommends the daily use of a hand mirror to check both feet.