Friday, August 06, 1999
New technique speeds healing
Coating bones, wounds with patient's own blood platelets hastens recovery
BY SUE MacDONALD
The Cincinnati Enquirer
A gel-like substance created from the patient's platelets is applied to a piece of bone from his hip. It will be grafted to repair a neck vertebra.
(Yoni Pozner photo)
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Sometimes doctors have to launch all-out tactical and technical measures to help the human body recover.
Sometimes all they have to do is sit back and let nature do its thing. That's why orthopedic surgeon Dr. Bret Ferree likes a new technique that stimulates bones and wounds to heal faster after surgery.
Instead of relying on powerful drugs or synthetic medical devices, Dr. Ferree uses a concentrated thickened form of the patient's own blood platelets, mixed with calcium and naturally occurring clotting substances, to coat bones and wounds just before closing an incision.
The idea is to jump-start and localize the natural chemicals, hormones, enzymes and other substances that the body produces to grow new skin, bones and tissue.
The process for isolating the platelets is called plateletphoresis.
The hope is that focusing the body's natural clotting and growth factors where they're needed will speed the healing process and allow patients to get out of the hospital and back into action sooner.
So far, Dr. Ferree, a back and spine specialist with Wellington Orthopaedic and Sports Medicine, likes what he sees.
“There's a lot of interest, in orthopedics in particular, in looking at the body's ability to heal bones,” Dr. Ferree says. “I think the way many of us would like to go in medicine is to concentrate on the body's ability to heal itself. With this procedure, patient's aren't getting anything that they don't already have.”
Dr. Ferree has used the new technique on about 40 patients in the last 6 months, and some have been able to go home one day after surgery, compared with hospital stays of 2-3 days without the technique.
Moreover, X-rays are showing that the bone seems to heal quicker, sometimes forming new and more bone tissue in a matter of weeks instead of several months, he says.
The technique has broad applications, he points out. It can be used to control bleeding during surgery on blood vessels or cancerous tumors, speed the growth of bone into artificial joints after hip or knee replacement surgery and treat a variety of skin problems, including bedsores, diabetic ulcers or wounds, burns and skin grafts.
“I have a feeling more and more people will be using it to stimulate healing,” he says.
Surgery is always a last resort for disc or spine problems, Dr. Ferree says, but when other treatments fail, surgeons sometimes have to fuse discs or use bone grafts to replace or repair vertebrae and discs that are fractured, cracked or worn out. Bone grafts are usually taken from the patient's hip, rich in marrow that produces blood cells.
The secret to plateletphoresis lies in platelets, the smallest blood cells. Their job is to help the blood clot.
Whenever tissue is injured, or when a blood vessel is cut or broken, platelets rush to the site, releasing a variety of chemicals that clump together and create tiny mesh-like fibers, trapping other cells that plug the injury and stop bleeding. Once bleeding is stopped, platelets continue to release a variety of chemicals that encourage growth of new bones, blood vessels and tissue.
Plateletphoresis involves removing platelets from the patient's own blood just before surgery and mixing them with calcium and thrombin in a wide-tipped syringe.
Calcium is a primary mineral in bone, and thrombin is a naturally occuring clotting material produced by platelets. The mixture creates a cloudy, Jell-O-like substance that's squeezed through the syringe onto the bone or wound at the end of surgery.
“It's the last thing we put into the wound before we close the incision,” Dr. Ferree says.
The procedure uses existing operating-room equipment, common blood donor procedures and the patient's own blood, so it adds only about$200-$300 to the cost of the operation. The collection and processing of blood adds about 30 minutes to surgery.
Without this procedure, doctors' other options for stimulating bone growth include using platelets from a blood donor — which carries a risk of infection — and recombinant DNA products, which are expensive and not easy to obtain, Dr. Ferree says.
With plateletphoresis, “we can multiply the healing factors several-fold. You can take a substance like this, combine it withthe body's natural scaffolding material and help patients heal much quicker.”
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