MORRIS – Minooka resident Jim Prosise recently received an allograft – a skin patch from a donor. The patch saved his foot.
In April, Prosise was working outside. When he picked up a railroad tie to move a few feet, a splinter lodged in his finger, and Prosise instinctively dropped the tie, which fell directly on his foot.
The deep bruise escalated into a nasty wound that grew in size and depth, eventually turning into months of pain and immobility.
Challenges – and a solution
Rezin Orthopedics and Sports Medicine foot and ankle surgeon Dr. Kyle Pearson said when he saw Prosise, the wound was about a half-dollar in size and progressing in severity because of Prosise’s Type 2 diabetes, diagnosed the year before at age 66.
Diabetes can damage blood vessels, reducing blood flow that is critical for healing, Pearson said. With such wounds, Pearson said he checks for proper blood flow, treats infection and ensures the injured area is not rubbing or pressing on a shoe.
“Usually at four weeks, the wound should be about 50 percent in size from what it was at its worst,” Pearson said. “At the four-week mark, if what we’re doing isn’t working well, a skin allograft becomes a viable option.”
Pearson recommended Prosise get an allograft after his response to treatment had plateaued. Prosise never had heard of the procedure.
“When he told me about the graft, I thought it would be skin from another part of my body,” Prosise said.
An allograft is a piece of skin from a donor, but it doesn’t have to match in tissue type, as a donated kidney or liver does.
“You don’t have to do antigen tests,” Pearson said, “or blood-type crosses.”
In fact, according to Pearson, it’s expected that the body rejects the graft – but that’s good. In fact, the rejection of the upper layer of skin is part of the process.
“It [the body] grabs all the important nutrients it needs, such as proteins and growth factors and collagen,” Pearson said. “The rest is sloughed off without causing an autoimmune response in a negative way.”
The use of allografts has increased over the past couple decades, Pearson said, because of better research and a greater need.
“It’s another tool to assist with healing wounds in a timely manner,” Pearson said, “before infection sets in, which can lead to amputation and morbidity and mortality.”
Pearson worked with several different types of allografts during his residency and found the best success with the one he currently uses. Other allografts include those made on a mesh from tissue cultures and others made with placenta stem cells.
Pearson said an autograft, where skin is taken from a patient’s own body, is a procedure used on other skin conditions, but not with patients who have diabetes or who are immunocompromised.
“When you use an autograft on a diabetic patient,” Pearson said, “there is the fear of creating another wound to treat the first wound. Using an allograft from a donor gets away from that.”
Pearson receives the allograft on dry ice immediately before its placement. He first cleans out his patient’s wound, removing any dead tissue in a procedure called debriding that prepares the wound bed to healthy tissue that will accept the graft.
The allograft is cut to the exact dimensions of the wound, then placed on top of the wound and secured with sutures or Steri-Strips. A special dressing is placed on top to keep the tissue moist and protected.
“The cells in the graft remain living for up to two weeks,” Pearson said.
Pearson gave Prosise three allografts, one after the other, and his wound finally began healing.
“He seemed pleased between grafts,” Prosise said of Pearson, “and he said things were progressing well. I could see that the wound was closing up.”
Prosise said he has some residual swelling when he is on his feet too much. He’s looking forward to walking around his neighborhood again with his wife, spending more active time with his grandchildren and doing more volunteer work with his church.
Gerri Greenwall of Newark also was healed with allografts. The damage to her foot, however, was much more severe than Prosise’s. Greenwall, who also has diabetes, said she had developed cellulitis in her leg that had gone to her foot and caused a large sore.
She sought medical care, but the wound grew, and she ended up in the emergency room.
“Two doctors wanted to cut my leg off halfway up to my knee,” Greenwall said. “Dr. Pearson thankfully came in and said he thought he could save my foot.”
After several months of surgery, treatment and allografts, Greenwall’s foot was saved.
Today, she is recovering from additional bone surgery on her foot, a byproduct of the infection, with another surgery on schedule, but the allografts did what they were intended to do, and Pearson is optimistic about the eventual outcome.