At 76, Rod Hartwick knows all there is to know about horses. For nearly 36 years, he was the best-known equine veterinarian in New Orleans—and he continued that career success in Chesapeake, Va. Hartwick is also a pioneer in the use of the CO2 laser in animal surgery. But his innovative work took a dark turn in 2002. One of his patients—a large horse—fell on him during a laser procedure.
Hartwick survived, but the crushing impact damaged his back and weakened his health. A few months later, he toppled from a ladder while cleaning his home’s gutters. His wrist tendons tore; his Achilles heel ripped. Hartwick underwent surgery to repair both tendons.
That’s when things turned darker still. The mythological tale of Achilles’ heel being the warrior’s weakest point has a core of truth. Hartwick notes, "The Achilles tendon is the weakest area of the human body—and the hardest to heal. Within a month mine became badly infected. I ended up firing my first surgeon and hiring another."
The replacement surgeon opened Hartwick back up. He removed the infected tissue. So far, so good. But the gaping wound refused to heal. Instead of skin, there was an open—and odorous—gulley, several inches wide and deep, and filled with scar tissue. That tissue soon became infected again.
Over the next three years, Hartwick went from doctor to doctor. Following the advice of vascular specialists and other physicians, he endured a skin graft procedure. He tried hyperbaric oxygen therapy to saturate the unhealed tissue with additional oxygen. No matter what he tried, the open sore remained.
"The doctors kept messing with me," says Hartwick in his sonorous Louisiana drawl. "But none of them could figure out how to close this thing up." After three years of futile efforts, he needed a walker to get around and was forced to close his beloved practice. Like his body, Hartwick’s spirit was wounded, too.
What went wrong? The doctors still don’t know. A million things can go wrong after an injury; that the healing process usually goes right is an under-appreciated miracle.
The human body is good at healing itself—so good that most of us take it for granted. But healing is a complex biochemical dance. Normally, cells multiply by division. A cell splits, creating two new cells, which divide again. The process continues in a geometric progression of healing. The proliferating cells send out growth factors, triggering the creation of new blood vessels. A collagen matrix—the substrate of skin—comes together. Gradually, new skin forms. These steps take place in an orderly progression, dependent on a complex set of requirements every step of the way. Usually, the dance goes flawlessly.
Occasionally, there’s a misstep, and a wound becomes chronic. Diabetes is usually the culprit, although vascular disease, surgical complications and other conditions can also be to blame. Whatever the cause, approximately 3 to 5 million Americans suffer from non-healing wounds.
In Sarasota, Doctors Hospital of Sarasota’s Wound Center makes treating stubborn wounds a specialty. This innovative facility, which opened in 1994, clocks in more than 2,000 patient visits each year.
Headed up by vascular surgeon Dr. Steven Silverman, the center’s multi-specialty team includes vascular surgeons,
podiatrists and a host of physician assistants and registered nurses who specialize in the healing of wounds.
"The buck stops here," says Silverman. "We treat people who can’t be helped elsewhere."
Silverman explains that the suffering inflicted by a non-healing wound goes far beyond the pain and discomfort of the wound itself. Patients can lose mobility, sliding into a relentless physical and emotional deterioration.
According to Silverman, 98 percent of the patients who complete his out-patient program are discharged with their wounds healed. Some treatments employ biologics and wound agents to enhance different phases of wound physiology. Other procedures deal with underlying arterial and venous disorders. Some patients benefit from surgery to repair and reconstruct damaged bones and ligaments. The program usually combines a variety of treatments.
Over the past few years, the center has added a new technology to its wound-fighting arsenal—a procedure called Dermagraft. And that is the treatment that turned things around for Rod Hartwick.
By 2004, Hartwick had been reduced to the point of near immobility. After the first set of operations in 2002, he had closed his practice and, with his wife, Norma, moved to Punta Gorda to be near their son. In 2004, Hurricane Charley struck. It trashed Hartwick’s new home and, as he put it, "made me mad as hell." With the help of pain medication and pumped on Prednisone, he spent the next few months repairing his house. His renewed fighting spirit also inspired him and his wife to make another move—to Sarasota, which they had visited and liked.
A friend had told Hartwick about a Sarasota doctor who worked miracles with chronic wounds. But Hartwick had heard such promises before, and they’d turned out to be empty. In 2005, shortly after they’d moved to town, he called Doctors Hospital, expecting more of the same.
"I spoke to a nurse and asked if Silverman had any testicles," he says, laughing now at the memory. "I was so sick of all the doctors who told me I was on my own. None of them had any balls. I wanted to know if Silverman did."
The nurse might have been put off by Hartwick’s question. But instead she set up an appointment for him to meet Silverman. They met and, in Hartwick’s words, Silverman looked at his wound and said, "Ah, hell, that’s nothing. We can fix that."
First, the team vacuumed out Hartwick’s wound. For the next two months, Hartwick "wore" a small machine, or VAC, that continuously drained infectious material, scar tissue and other fluids from the wound area. The device seals the wound with a foam dressing and applies negative pressure to the wound bed with a tube that’s threaded through the dressing.
Dermagraft came next. In clinical terms, Dermagraft is a bioengineered tissue product manufactured from human fibroblast cells derived from neonatal foreskin tissue. When used on a wound area, Dermagraft helps restore the dermal bed, allowing the patient’s wound to heal.
In layman’s terms? It’s artificial skin that helps human skin regenerate.
Dermagraft’s greatest success has been in the arena of diabetic foot ulcers, a major health challenge worldwide. According to the company’s internal studies, 30 percent of diabetic foot ulcers treated with Dermagraft achieved complete wound closure within 12 weeks of treatment.
Because Dermagraft is stored at -75°C, it must first be thawed, rinsed and then cut exactly to fit into the wound bed. The Wound Center has one of the area’s few in-house cryogenic freezers capable of storing Dermagraft.
After the wound is completely cleaned, the surgeon applies the Dermagraft. He also protects the wound with dressings and pressure-relieving footgear. This procedure is performed weekly for two to three months.
Bottom line? Dermagraft worked for Rod Hartwick. Today, aside from some rheumatoid arthritis and other complications from the original accident, he’s got his moxie back.
"After all I went through, I just got plain lucky to meet up with Dr. Silverman and the Doctors Hospital team," says Hartwick. "He’s aggressive, and that’s what I needed to beat this."
"Dermagraft significantly improved Rod’s situation," says Silverman. "We’re using it more and more with chronic wounds. By providing critical growth factors for healing, Dermagraft is cutting-edge technology for wound healing."
For more information, contact The Wound Center at Doctors Hospital of Sarasota, (941) 342-4460.
An estimated 3 to 5 million Americans have suffered from a non-healing wound.
Every year, more than $15 billion is spent treating chronic wounds. Each year, the figure grows steadily, rising by 15 percent annually as an aging population develops more chronic diseases associated with non-healing wounds.
More than 60 percent of nontraumatic lower-limb amputations occur in people with diabetes.
In 2004, about 71,000 nontraumatic lower-limb amputations were performed in people with diabetes.
After 12 weeks of treatment, 30 percent of diabetic foot ulcers treated with Dermagraft plus conventional therapy achieved complete wound closure vs. 18 percent treated with conventional therapy alone.
Sources: Thomas Hospital, Johns Hopkins Wound Center, National Diabetes Information Clearinghouse and www.dermagraft.com