“We’ve now managed to reduce wound size by 50 per cent in about two weeks. So far, only a few patients have received this treatment,” says Moustafa Elmasry, docent, consultant and plastic surgeon at the Hand and Plastic Surgery Clinic.
The University Hospital and the Burn Centre provide intensive care and treatment of burns. But there is also research into and development of methods for treating chronic wounds using regenerative solutions, where endogenous cells are grown outside the body. A series of techniques is used to treat patients in a completely new way. This method involves taking a small skin sample, a biopsy, from which it is possible, in only a few hours, to isolate a sufficient amount of skin cells to treat a small wound.
“This used to take around 3−4 weeks. Also, together with experienced medical staff, we have developed new ways of applying the skin cells to the open wound, which was a huge challenge,” says Moustafa Elmasry.
Important goalThis research is clinical, which means that it is carried out in close collaboration between the university and the hospital.
Being able to quickly isolate skin cells is an important goal.
“Not only to obtain the necessary amount, but also to reduce patient suffering. A skin transplant is a much larger operation which involves taking a skin graft from another body area. This is a considerably smaller operation.”
Transplantation of skin cells for treatment of chronic wounds. Photo: Ulrik SvedinThe patient, a 67-year-old pensioner, meets us in the clinic at Linköping University Hospital. We have been given permission to take pictures during the surgery.
The wound on his leg would not heal, and just kept getting bigger:
“I don’t wish this on anyone,” he says, touching his shin. “I lost control over the wound. The treatment I got helped a bit, but never fully. You could actually see the bone inside when it was at its worst. I want to help by showing you this. And I hope that others will understand what an ordeal it is to have a wound that doesn’t heal.”
His foot is bandaged and fixated up to his knee joint. Today, his wound is relatively small, about two centimetres. But the last bit has never healed.
And he is not alone. Some 50,000 Swedes suffer from hard-to-heal wounds, among them people with diabetes and multimorbidity who are already impaired. Many of them are elderly and need to have their wounds redressed daily.
“It’s such an extensive suffering. It causes a lot of work for Swedish health care, and consequently high costs for society. So, we would gain a lot if we could help these patients. We don’t cure the cause of the wounds, but we can make a great difference to healing,” says Moustafa Elmasry.
We don’t cure the cause of the wounds,The method complies with the regulations applicable to cellular treatments. These regulations were tightened considerably in the 2010s, following new EU directives. When the research group received major funding in 2019, Linköping University and Region Östergötland joined forces to finance a laboratory for developing a method that would be available to patients as well as compatible with the new regulations.
but we can make a great difference
“With the method we developed, the skin sample, the biopsy, does not leave the operating theatre. This is in compliance with the new regulations, and reduces the risks,” says Ahmed Elserafy, docent and associate professor in the Department of Biomedical and Clinical Sciences at Linköping University.
“This is an operation, instead of a treatment. Using the patient’s own cells there is no risk of mix-ups or contamination in an external lab,” Moustafa Elmasry adds.
Transplantation of skin cells for treatment of chronic wounds. Photo credit Ulrik Svedin
The patient winces when the local anaesthetic is injected around the wound before it is cleaned. But he is awake during the operation and can talk to the nurses and doctors in the room.
They document and measure the wound meticulously, using an application in a digital tablet, which was also developed by researchers and staff at the University Hospital.
Sealed chamberA sealed chamber is then placed around the edges of the wound and filled with the cell fluid.
“It was very difficult to make the liquid stay on the wound. But one of the nurses here knew of this chamber from another type of treatment. It has made a huge difference,” says Moustafa Elmasry.
The patient’s foot is bandaged and fixated again. There was already an improvement after about three weeks, according to Moustafa Elmasry. The treated wound had healed over with new, thin skin.