Posted by Ellen on February 01, 2001 at 13:43:11:
Created skin saves limbs
Bioengineering develops way to heal wounds
By Charles Etlinger
The Idaho Statesman
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Kim Hughes / The Idaho Statesman
Anna Christensen laughs with nurse Kathryn Earhart during a recent checkup at Elks Rehabilitation Hospital. Christensen had a leg wound that wouldn't heal because of her diabetes, and several doctors told her that her leg would have to be amputated. But Dr. Margaret Doucette used a bioengineered skin graft made from human and beef tissue to heal the wound.
After Anna Christensen knocked over a chair onto her foot while vacuuming in her Nampa home a year ago, she came close to losing her leg to amputation.
The 72-year-old retired dry-cleaning shop owner developed a sore that wouldn't heal, as is common with diabetics like herself who have poor blood circulation.
Several months after she suffered the injury, doctors told Christensen that her leg would have to be amputated just below the knee because of spreading infection and tissue loss.
But now, her wound has nearly fully healed with the help of a bioengineered skin graft.
"It's a wonderful thing," she said. "I could be sitting here with no leg."
Christensen is able to drive -- and visit her husband, Edward, who is in a nursing home with Alzheimer's disease -- thanks to Dr. Margaret Doucette, the Idaho Elks Rehabilitation Hospital and a product called Apligraf.
Doucette has applied the grafts to the feet or legs about 40 diabetic patients.
So far, none have lost their limbs, as about 65,000 American diabetics do each year.
Apligraf is a 3-inch-diameter disk of parchment-like material made from human and beef cells.
The human cells are foreskins from babies circumcised at Beth Israel Hospital in Boston, said Theresa Mazzaro, a specialist in Vancouver, Wash., with Apligraf's marketing company, Novartis Pharmaceuticals Corp.
With bovine collagen -- a protein from beef soft tissue -- the human cells are grown in the laboratory of Organogenesis Inc., which developed Apligraf.
The baby cells are used because they are robust.
"It creates this human skin equivalent," Mazzaro said.
The Apligraf disk is laid over the wound and covered with a dressing.
Unlike a surgical procedure, the patient doesn't have to be sedated.
The Apligraf provides a scaffold for the patient's skin to grow and stimulates healing from the edges.
After three or four weeks, there are no Apligraf cells in the wound, Mazzaro said.
While other doctors in Southern Idaho are trying Apligrafs, which also can be used for other kinds of wounds, Doucette "pretty much has a monopoly because of her expertise," Mazzaro said.
An osteopathic physician, Doucette is the medical director of the Elks Wound Care Clinic, where the bioengineered grafts are applied.
She works with what she calls several good physical therapists and nurse specialists at the Elks and at St. Luke's and Saint Alphonsus hospitals.
She also is chief of physical medicine and rehabilitation at the Boise Veterans Affairs Medical Center.
The Apligraf was approved for use on diabetic foot ulcers by the U.S. Food and Drug Administration last June.
The agency had approved the Apligraf for venous leg ulcers -- painful, ugly ulcers -- two years earlier, and Doucette treats those cases also at the Elks.
With diabetics, regular skin grafting is normally the only option, Doucette said.
But the skin isn't a very good source for healing, and taking if from another part of the patient's body creates yet another wound.
Bioengineered grafts cost about $1,000, much less than skin grafts, and, of course, amputations.
"The field of wound healing is in its infancy," she said. "Five years ago, we couldn't offer this."
Doucette will discuss her experiences with her patients, including Christensen, at a Novartis conference in Orlando, Fla., in February.
Christensen had two Apligrafs, the first in August and a second in November, because a small area of tendons was still exposed.
She goes to the Elks twice a month to have the wound checked.
"She's kind of a firecracker in her own way," Doucette said. "She always razzes us and asks if she is ready to go dancing. She's just a delight."
Apligraf
Contact Charles at 377-6334 or cetlinger@boise.gannett.com