Healing Problem Wounds with State-of-the-Art Wound Care Therapies

MemorialCare Health System Excellence in Healthcare Presents Weekly Dose of Wellness Here's your host, Deborah Howell.

Deborah Howell (Host): Hello there, welcome to the show. You are listening to Weekly Dose of Wellness Brought to you by MemorialCare Health System. I'm Deborah Howell. Today our guest is Dr. Robert Kingston, Medical Director of the Center for Advanced Wound Healing at Saddleback Memorial. Dr. Kingston trained in surgery at Long Beach Memorial Medical Center and served as an attending physician in the emergency department of Saddleback Memorial for 30 years. He helped plan and develop the Center for Advanced Wound Healing at Saddleback Memorial and has served as medical director for five years. Welcome, Dr. Kingston.

Robert Kingston, MD: Thank you.

Deborah Howell (Host): What are the primary causes of non-healing wounds?

Robert Kingston, MD: Well, there are many, but diabetes puts one at risk for that. Having been treated with radiation, usually for a cancer, will put you at risk for it. Poor circulation is certainly one factor. Also, on the other side, leaky veins will do it if your legs are swollen. Pressure injuries where you have pressure in one area all the time. And unfortunately, as you get older, they're more likely to develop more chronic type wounds.

Deborah Howell (Host): Sure. Just age in and of itself, right?

Robert Kingston, MD: Yep.

Deborah Howell (Host): Okay. We're like cars. You know, when we get old, things start breaking down. What are the early warning signs of a non-healing wound that patients should be aware of?

Robert Kingston, MD: Just the fact that it is, you know, you're doing your usual things and it's not responding. Perhaps you've gone to your doctor and he gives you a cream or something, and it just doesn't respond like it used to. That may be the signal that it's becoming a chronic wound. And chronic wounds have a whole different chemistry pattern than acute wounds do. So when you were 12 and you had an injury, that pretty much followed the acute pattern. But for these other various reasons, sometimes they fall into a chronic pattern. And one way to understand it is just that the wounds forget what to do, and they get caught up doing and saying the same old thing, which doesn't get it done.

Deborah Howell (Host): Okay. So what happens if patients ignore the warning signs or if symptoms are not addressed at all?

Robert Kingston, MD: Well, the wound gets worse, it gets deeper, and it gets harder to clear up. So usually if you get to these, the earlier you can get to them, the more likely you can heal them in a quicker time period rather than it taking sometimes forever.

Deborah Howell (Host): Okay. What are some of the treatment options?

Robert Kingston, MD: So the first thing to do is to specify exactly why the wound is chronic. So you have to go through a series of exams, and once you know exactly why it's being chronic, then you can trigger treatments, but sometimes just keeping pressure off it. If you have a wound on the sole of your foot, going on some type of thing where you're not putting weight in your foot is helpful. Breeding the wound helps. So taking away the old part of the wound helps because what you're doing is taking away old cells that have just failed. So we're made up of 10 trillion cells, and sometimes we have to address the whole person holistically, and sometimes we're addressing cells right in the area and specifying a treatment for them. And sometimes we just have to remove those cells because they just don't have the wherewithal to do the healing job, and we can get down to younger cells. Sometimes we do other things like put compression on the leg to keep fluid out. We'll use a type of vacuum on the leg to keep the area dry and to encourage protein growth. Sometimes we'll use what can be thought of as artificial skin grafts that have a lot of factors that the skin can respond to or help it heal. And then sometimes hyperbaric therapy will be the treatment that makes a difference.

Deborah Howell (Host): Yeah, I've been meaning to ask, what is hyperbaric oxygen or HBO therapy? We've been hearing a lot about it.

Robert Kingston, MD: Yeah, HBO therapy is therapy of applying larger doses of oxygen and applying them under pressure so that the tissues get more oxygenated. So in a lot of these wounds, when you think of arterial wounds, diabetic wounds, sometimes even pressure wounds, they are starved for blood supply and oxygen. So, being able to load the blood with higher levels of oxygen means that that can get delivered to the wound site. So, that helps the cells divide and grow. It helps the white cells fight infection and has a number of effects like that that we find help heal chronic wounds.

Deborah Howell (Host): Yes, and how do you prevent recurrence of these type of wounds?

Robert Kingston, MD: The way you can prevent recurrence is to pay meticulous attention to the area. So, if you've had a pressure wound, it's to make sure that you're not putting undue pressure, like sleeping in one place for a long time. Also, making sure that the blood supply is adequate and keeping it adequate. And keeping the skin at a certain moisture so it's not overly moist or overly dry. And keeping excess fluid out of the tissues. So we spend a lot of our time with patients teaching them how they're going to take care of this when they get discharged.

Deborah Howell (Host): Okay, sounds good. I've seen a little machine at some place. I can't remember where it was. It was sort of something that they moved around the exterior of the wound. Do you know anything about this type of machine?

Robert Kingston, MD: Moved around the exterior of the wound?

Deborah Howell (Host): Yeah, and they said it helped seal the wound in some way at the very tip of the exterior of the wound.

Robert Kingston, MD: Well, you may be speaking about negative pressure wound therapy, so when we do vac therapy, we actually put a dressing around all edges of the wound and seal it in. And then we attach a suction device to that. And so any excess fluids get drawn away and pulled away so that the moisture level in the wound stays right. Because that really helps it heal a lot. And it also promotes the growth of protein tissues, which is the superstructure for anything that's going to form. So it's very necessary.

Deborah Howell (Host): Okay. And anything going on with stem cell in terms of healing wounds?

Robert Kingston, MD: At an experimental level, we kind of get close to stem cells because we use very small and kind of energetic types of cells called fibroblasts. And these are actually grown in a lab in tissue culture and, you know, if you can assign ages to the cells in your body, these are like young, robust teenagers ready to go. They're filled with growth factors, filled with activity, and these cells will actually communicate with the other cells in your body. So we're interested in the ones that are around the wound. So these cells start to communicate, and it encourages your own cells to then start to get more metabolically active, to divide, and to start moving in to fill the wound area.

Deborah Howell (Host): Sounds good.

Robert Kingston, MD: So we're kind of close. The actual stem cell research is going on and will make a difference. But right now, we actually grow a lot of our tissue cultures.

Deborah Howell (Host): Okay, good. And crossing our fingers for even more developments in the future with stem cells. Dr. Kingston, thank you so much for your time today. It's been very, very enlightening. One last question. Where can listeners go for more information?

Robert Kingston, MD: They can call the clinic. So that's (949) 452-3309. They can go on the MemorialCare website, which is memorialcare.org/woundhealing.

Deborah Howell (Host): Okay, so once again, that's memorialcare.org/woundhealing or (949) 452-3309. Dr. Kingston, thank you so much for your time today.

Robert Kingston, MD: Thanks, Deborah. It's a pleasure.

Deborah Howell (Host): To find out more about wound care or to listen to a podcast of the show, please visit memorialcare.org. That's memorialcare.org. And join us again next time as we explore another weekly dose of wellness brought to you by MemorialCare Health System. I'm Deborah Howell. Have yourself a terrific day.