ST. LOUIS - Walter Knoll is probably best known as being St. Louis’ florist of choice. His family business, Walter Knoll Florists, has been passed down from generations and is a Gateway City institution. However, when an accident irreparably severed half of his thumb tip off, the possibility of struggling to create flower arrangements was not his first fear.
“My biggest concern was I play piano and I really thought my piano playing days were over,” says Knoll. “After a few days it had turned black and personally it was really a low spot because I thought I would have to lose the whole thumb.”
Knoll’s thumb was cut down the middle while woodworking. The circular saw blade on the biscuit joiner he was using slipped and destroyed the outside half of his thumb tip including portions of the bone.
Over the years, two of Knoll’s colleagues had been to Saint Louis University Hospital’s emergency department with trauma injuries and based on their positive experiences, he drove himself to the SLU Hospital ED. The injury was stabilized but Knoll thought his thumb would never be the same. He had returned home wondering if he should move forward with having the injured thumb amputated when he got call from Bruce Kraemer, MD, chief of plastic surgery at Saint Louis University Hospital and a SLUCare physician.
“Dr. Kraemer said plastics had a new option and I took him up on his offer,” says Knoll.
That option is amazing to those Dr. Kraemer has helped using a product produced from certain layers of a pig’s bladder. In its powdered form, the substance looks at first glance like grated parmesan cheese.
“Unlike other dressing materials, you put regenerative matrix powder generously on the wound and then layer it up every day or so that with time and as you keep applying more product, the body’s tissues grow into it as it regenerates,” says Dr. Kraemer.
By applying the compound to a wound like Knoll’s every other day for several weeks, the tissue actually regenerates over time as it fills in the area of tissue loss. The skin tissue on the fingertip even gets the ridges of a fingerprint back.
“By taking specific layers of the pig’s bladder that has collagen – one of the building blocks of the body – and growth factors that promote healing and block scarring,” says Dr. Kraemer, “The results are very promising and can achieve a result that is better what standard operative procedures can provide a patient.”
Over the past two years, Dr. Kraemer has used regenerative compounds on several patients who have presented with devastating traumatic injuries to the Saint Louis University Hospital emergency department. A surgeon from an area hospital who crushed his foot … an area truck driver who severed three fingers in an accident … a person who cut a portion of their arm in a fall. In each case, the compounds not only grew back the tissue, but blocked harmful scarring that would usually occur.
Ordinarily after an injury like Knoll’s, the human body’s first inclination is to scar the injury as it “heals” the injury. This usually leads to a firm retracted scar which isn’t always durable and painless. Providing a more normal environment for the body to “regenerate and heal” allows the body to better restore itself.
Things work differently when this compound is applied. Called an extracellular matrix, it’s a component of body tissue that provides the scaffold for supporting the body's regenerating healing cells. Applied to a wound, it doesn’t trigger an immune response. Instead, it slows scarring and promotes cell growth to repair damage and allow a healthier tissue to appear which is more normal in appearance and function.
“It helps with both the scarring and healing at the same time,” says Dr. Kraemer.
It shows so much promise, the United States government is keeping a close eye on medical progress using the extracellular matrix materials. The hope is large for thousands of veterans – including those of the Iraq and Afghanistan wars – many of whom face significant loss of tissues from their arms or legs. Many physicians predict this compound could be an alternative to standard amputation procedures in the future.
“While the war injuries are terrible, locally we have some pretty significant injuries as well that come through the emergency department doors,” says Dr. Kraemer. “Using these compounds offers a lot of hope for patients who we otherwise would struggle to help.”
In the case of Knoll, he’s still a few weeks away from a total recovery, but the early results have been amazing. Preserving the painless length of his thumb for piano playing was very important to him and Dr. Kraemer’s work allowed him to preserve the thumb’s length without any sacrifices.
“I still have some pain and occasionally wear a rubber finger cap when I play the piano and don’t have all the strength I used to have, but I should be back in another three or four months,” says Knoll.
Moving forward, Dr. Kramer is interested in seeing how the compound helps patients in other ways. There are some researchers around the world who see a day that this approach may replace prosthetics for some patients.
“We’re far from that,” says Dr. Kraemer. “But this is very exciting.”
About Saint Louis University Hospital Saint Louis University Hospital is a 356-licensed bed quaternary/tertiary referral center located in the heart of the city of St. Louis. Approximately 75 percent of patients are drawn from a 150-mile radius. Through affiliation as the teaching hospital for Saint Louis University, the hospital provides patients and their families with an environment of medical innovation. Working in this endeavor are the hospital’s medical staff partners, SLUCare, the physicians of Saint Louis University. The hospital admits more than 17,000 patients annually, performs more than 200 organ transplants a year and is a Level I Trauma Center that treats more than 2,000 major trauma cases a year. For more information, please visit www.sluhospital.com.
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