Traditional skin grafts can require anesthesia in an operating room, leaving the patient in lots of pain and creating unsightly scars. They also can take a lengthy time to heal.
A new skin grafting procedure is alleviating most of those concerns for many patients.
Nena Lundgreen is one of these patients. She is a graduate student at BYU, studying biology. She enjoys the outdoors and was rock climbing in Rock Canyon in April when she was seriously injured. Lundgreen lost two toes and half of two other toes on her left foot and was restricted in her activities.
After the amputations, she was being treated for wound care for a couple of months to help her foot heal.
"The wound on the top of my foot was open, and was closing very slowly," she said. "I had been invited to go on a trip on a houseboat to Lake Powell. I had gotten to where I could move around a bit and I wanted to go. But the doctors said I needed a skin graft." That was to keep water out of the wound.
Lundgreen found out that Utah Valley Regional Medical Center was one of a few hospitals in the state with a new piece of equipment that allows a new type of skin graft with fewer aftereffects.
"I ended up choosing to do that," she said. "It doesn't leave big permanent scarring. I have enough nasty scars now."
"They said it would take about the same healing time, but there was no anesthesia. It wasn't painful and there was no scarring," she said. "It really was great. It didn't hurt at all."
Dr. Marc Robins, who performed the skin graft for Lundgreen, said not everybody would have that pain-free experience, although the pain is usually less than with a traditional skin graft. He said he was pleased with the new technology.
"The exciting thing is that it avoids a surgical procedure," he said. "It is relatively painless. It is a quick and easy office procedure now to do an effective skin graft."
To say that Lundgreen is pleased is an understatement.
"I am pretty happy with it," she said. "It worked as well but did not have the pain, hassle and scarring. I have had enough pain and scarring. I definitely would recommend it to anyone who is a candidate. It is easier."
Missing a good portion of the toes on one foot has called a stop to her rock climbing, but other activities are continuing.
"I am back to snowboarding, longboarding and surfing," she said.
Robins explained how the grafting takes place. It starts with an implement which looks similar to a cheese grater. It is placed on the donor site, often the patient's inner thigh.
There is a window on the device so the doctor can see what is happening as small blisters are raised. A piece of medical tape is placed on the skin and a thin layer of skin is then sliced off, then placed on the wounded area. The blister-like pieces are spread out, giving multiple points of contact to provide a framework for healing.
"It is like a bridging network to get new cells to grow across," Robins said.
The donor site? "It is about the equivalent of a sunburn or a slapped thigh," he said. "The difference is the thickness of the skin removed."
"It gets as good results as the split tissue skin graft," Robins said. "There is less pain, especially at the donor site. There are no infections at the donor site, but it still stimulates that last layer of healing."
The grafting usually begins quickly.
"We sometimes see results starting within a week," Robins said. "It reduces the healing time."
Since UVRMC began using CelluTome in June, they have done about 23 procedures, Robins said. He has personally done about 16 of those.
"It basically just came out in June," he said. "We were one of the first hospitals to get it. They keep developing newer devices. This makes much smaller blisters."
Not all wounds are right for the procedure. Some will heal normally and do not need the grafting. Others are over bone or tendon and it does not work on those areas, as there needs to be a "wound bed" prepared.
Robins said he learned how to do the procedure at a workshop provided by the company which manufactures the implement.
"It was so easy to do," he said. "It is a very quick learning curve."