Transcript

Elizabeth Carradini, DNP, APRN, CWS:

My name is Elizabeth Carradini. I am a certified wound specialist, and I am the lead educator for a mobile-based wound care clinic out of Oklahoma. I have been doing wound care for 5 years, and I absolutely love educating people about wound care. 

My poster is titled, “Chorion Killed the Radio (Necrosis),” and it is effectively about how I used a dehydrated chorion and amnion membrane graft to heal a patient that had radionecrosis. This patient came to me about 3 or 4 months after receiving radiation therapy for squamous cell carcinoma, and she mentioned that the pain was pretty excruciating and the wound just kept getting bigger and bigger. I tried several different modalities including hyperbaric oxygenation therapy, collagen-derived skin substitute grafts, we did collagenase, we did cadexomer iodine, we did pretty much everything you could think of to try and help decrease her pain as well as get that wound smaller, and nothing was really working well for her. Once I introduced the grafting of the chorion and amnion grafts, her pain went away pretty much completely within 2 applications of that and within about 4 or 5 applications of the graft, she was completely healed.

So. the basis behind what really happened is radiation ends up causing an edema almost in blood vessels. And that edema makes the vessels swell so much that other players that are really important to wound healing can't penetrate to get to the wound to help heal it. This  includes things like platelets. Platelets are what start that wound healing cascade. So, without those, we can't really get started there. It also includes cytokines. Cytokines are major in, they lead inflammation, they help out with cell proliferation, epithelial growth, and when cytokines are decreased, we're also going to have a decrease in fibroblasts. And our fibroblasts are really, really important for wound healing, because those are what create collagen, and collagen is really the matrix that kind of helps strengthen the wound. Fibroblasts also contribute to angiogenesis, and angiogenesis is whenever we're forming those new blood vessels that help us get the oxygenation that we need to help heal our wound. So when we have a decrease in platelets, we have a decrease in cytokines, and we have a decrease in fibroblasts, that leads to a wound that is not structurally sound. It has a decrease in oxygenation because of lack of blood flow. And overall it just can be a really difficult thing to try and treat. 

So, the really cool thing about the dehydrated chorion and amnion graft is that the amnion part of it actually contains fibroblasts. And remember those are our guys that help secrete collagen; they help form the matrix, they help form angiogenesis, the new blood vessels that can come help heal the wound, as well as they contribute to epithelial cell migration, which is whenever the wound bed is contracting and healing on itself. The amnion and the chorion layer have a really cool spongy layer between them, and that is just filled with a lot of collagen. I think it's primarily collagen type 3, which is the strong collagen, the structure collagen that really helps us be strong. And then the chorion layer has, I think, 4 or 5 different collagen types in it as well. 

So it's very interesting to see how we can have this patient who's having so much pain and it's really affecting her quality of life, and overall that was really all I cared about. At the end of the day, if I can heal a wound, that's amazing, but I really just want patients to be comfortable and healthy and happy. So I was just mostly happy that I was able to fix her pain, and then closing the wound itself was an even bigger bonus by just kind of lending a hand to the cells that needed a hand to be lent to them. 

So, that's really the thing about wound care, isn't it? Like if you think about it, that's the amazing, wonderful, super exciting thing about wound care is we have all of these amazing products that can help us help the wound become its best self. But the thing is not one size fits all. It really goes back to just how unique we all are as individuals. Because I'm always telling my clinicians, you know, we have to figure out what their body wants. So, like I said, I tried probably 10 different things on her trying to help her out, and ultimately this is the thing that helped her out. I'm not saying that these graphs are one size fits all and they'll help heal everybody with radiation necrosis, but it did help her, and at the end of the day, you know, that was just one life that got changed, and it was really cool to help facilitate that.

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