By: Heide Pearson
At the Multi-Disciplinary Leg Ulcer Clinic (MDLUC) at Halifax’s QEII Health Science's Centre, a small-scale test-and-try of a local wound care technology is having large-scale impacts on the patients participating in the trial.
As a clinical champion, clinical nurse specialist Lindsay Burke has been applying a new type of wound healing product called DermGEN™, made by Nova Scotia-based DeCell Technologies.
"This is a fresh start,” Burke said. “The motivation around being able to offer something different is extraordinary for these patients, especially those dealing with chronic wounds.”
So, what makes this treatment so different?
Unlike skin grafts, DermGEN™ is a wound healing matrix created from donated cadaver skin. The skin has gone through a specific process called decellularization, where donor cells that would cause it to be rejected by a patient’s own antibodies are eliminated. The process also sterilizes the skin and gives it a three-year shelf life, which is much longer than more traditional skin grafts.
"We were always kind of thinking about, ‘How can we fool the body or fight the body?’ And then it changed to: ‘How can we work with the body?’” Dr. Paul Gratzer, one half of the two-person DeCell team, said about the tissue engineering research that led to this innovation.
Gratzer has spent the last 25 years researching how to optimize human tissue to fill a gap he saw in wound care. He saw other, similar products be trialed and fail due to chronic inflammation, scarring, among other issues.
Sean Margueratt is the other half of DeCell Technologies, having started the business with Gratzer after managing the Regional Tissue Bank.
As they honed their product, Margueratt said they listened closely to physicians and feedback from the tissue engineering marketplace. One of the most important things they wanted to ensure was that their product would be consistent for any clinician working with any patient.
"What a frustrating thing for clinician to use the same product on same patient even though there's patient variability, the last thing you need is product variability,” he said.
‘We’re doing something different now’
While DermGEN™ isn’t being widely used yet, the first patients are seeing promising results, with wounds showing progress toward closing in a matter of weeks. This is leading to a significant change in attitude for the MDLUC patients, some of whom have dealt with chronic or recurring ulcers.
“It’s cool to be able to do it with this population because some of them have been part of the MDLUC clinic for longer than I have," Burke said. "And what we’re able to do is say: ‘OK, we’re doing something different now.'"
Some of these patients have had to manage open wounds for years, with traditional methods taking significant time and effort to promote healing. Now, they're healing at an accelerated rate with wounds previously considered chronic, expected to close. Burke said because patients can see change in their ulcer early on, they’re feeling more positive and engaged in their care.
"They're going, 'OK, I'm going to work on offloading again and dig out my walker so that I can reduce the pressure that I'm putting on my limb to try to help it heal,'" she said.
Ronni Bellefontaine, clinical manager, innovation with the Nova Scotia Health Innovation Hub, said Burke’s background as an advanced practice nurse makes her an ideal clinician to champion a new treatment method in her clinic.
“She has that knowledge base and those interactions with community, with physicians and with other clinics around the province so she can really spread the knowledge when the time comes,” Bellefontaine said.
Another aspect of the DermGEN™ solution that’s helping patients feel more engaged is the fact that a portion of the aftercare is being done in peoples’ homes, through the community-based service VON.
Once a patient has reached a stable and predictable stage with their DermGEN™ application, they’re sent home with an information package for their VON nurse, ensuring the ulcer is cared for properly, so the matrix isn't altered.
“I’m big on patient engagement,” Burke said. “Because a lot of wound healing comes down to attitudes and behaviours.”
“We’re kind of setting it up to tell patients: ‘When you go home, you’re the experts because remember, the nurses aren’t going to have seen this before and you will always be the consistent person involved in your wound care.’”
Burke said while the patients participating in the trial are strangers to each other, there’s a sense of community among them, with many often asking how other DermGEN™ recipients are doing.
Meeting a ‘huge unmet need’
Right now, DermGEN™ is being used to treat lower-limb ulcers, but Margueratt said the technology could be applied to other types of tissues.
“We started with skin and we started with diabetic foot ulcers because there’s a huge unmet need,” he said.
There’s already been some exploration about using the technology in other treatment areas.
Burke is hopeful that the more successes they have with DermGEN™, the more MDLUC patients can be transitioned out of the clinic, and no longer even needing community care, allowing more people currently waiting for care to come through her doors.
“Even though it’s been a very small sample, it’s exciting to see what access it can mean, especially for those patients living with chronic wounds,” Burke said.
