One doctor suggested amputation. Another removed a bone and fashioned a cast that stretched from his toes to his knee. But after many years of pain and frustration, retired stockbroker Philip H. Turner was able to say with some humor yesterday: "This foot's been through a lot."
The bane of Mr. Turner's life has been deep, festering wounds that refuse to heal -- a problem that afflicts an estimated 5 million Americans and leads to half of the amputations performed each year in the United States.
Mr. Turner, a Sykesville resident, has lived with a succession of wounds on his feet, all the result of diabetes. His most recent sore has hobbled him since 1987.
The nickel-sized sore didn't begin to close until he started receiving a combination of treatments at the Greater Baltimore Wound Care Center in Owings Mills about 10 weeks ago. There, a medical team has taken a variety of approaches that includes )) daily applications of a solution made from an extract of his own blood.
To make the solution, a nurse drew about two ounces of blood, then laboratory personnel put the blood through a mechanical process that extracted five growth factors. These factors, carried by blood platelets, circulate through the body to promote healing of injured tissues. But sometimes, in chronically ill patients, they don't reach the extremities in sufficient quantities.
"In essence, we're just beefing up the body's ability to heal wounds," said Dr. Victor Tritto, a podiatrist working at the center. The solution, which carries the trade name Procuren, is simply a liquid containing a concentrate of the patient's growth factors.
The growth factors are responsible for different phases of healing, such as the growth of capillaries and skin cells. But Dr. Tritto was quick to add that Procuren is simply one part of wound management: the rest involves infection control, the removal of dead tissue around a wound and -- sometimes -- surgery to restore blood flow to an area.
"We don't want anyone to get the idea that it is a magic potion," Dr. Tritto said of Procuren.
The Wound Care Center, affiliated with the Greater Baltimore Medical Center, is one of 30 clinics that operate under a franchise arrangement with Curative Technologies Inc. of Setauket, N.Y.
Since the Owings Mills center opened in July, the clinic has treated 120 patients, 25 of whom are receiving the growth factors. Six of those patients have seen their wounds heal, while the remaining 19 have wounds that are healing for the first time, according to Mary Hilton, registered nurse and project director.
With the combined treatments, the average healing time for a chronic wound is eight to 12 weeks, Ms. Hilton said. That may be a long time, but chronic wounds can persist for decades.
Half of all chronic wounds are complications of diabetes, she said, while about a quarter result from circulatory problems that either deprive the extremities of a proper blood supply or cause blood to pool. Persistent skin ulcers also plague the bedridden or people who use wheelchairs at "pressure points," such as the buttocks, back and legs.
Yesterday, Mr. Turner said he was greatly relieved with his progress and glad to put some old remedies behind him.
"Two years ago," he said, "I was wearing a cast up to my knee. When they took it off, my foot was just as bad as it was before."