Alum uses cutting-edge stem cell treatment to restore man’s leg
Bobby Rice never expected that cutting his foot could reshape his entire life.
The Dalton, Georgia, carpet layer was walking trash to the dumpster outside his apartment when he stepped on broken glass. Rice felt no pain and because of his profession, was used to dealing with scratches and cuts. He bandaged his foot and didn’t think any more of it.
At least he tried not to.
But the glass had created a hole in his foot that constantly drained, ruining his socks. Rice was still not in any pain, so he decided to use a remedy that he had success with many times before. He superglued the wound shut.
The draining ceased, but the real problems were just beginning, as the wound quickly became infected. The infection began traveling up through Rice’s foot, ankle, and eventually lower leg. His leg began to swell and change color from shades of blue and green to patches of black. Yet it was still easy for Rice to ignore since he wasn’t in any pain.
Eventually fevers of 104 degrees, nausea, and shaky limbs accompanied Rice’s discolored flesh. His nausea was so severe that he went more than 21 days holding down nothing except Sprite. Finally, after blacking out on the floor in his apartment, Rice knew that something was very wrong. He called a cab and was taken to the hospital.
Doctors examined Rice and quickly identified the problem. Rice’s leg had become infected with necrotizing fasciitis, more commonly known as flesh-eating bacteria. An undiagnosed diabetic, Rice also suffered from diabetic neuropathy, which had destroyed the nerves in his legs and explained why he couldn’t feel what should have been a painful injury.
The decision for the physician examining Rice’s leg was clear: amputate.
“I didn’t want to lose my leg,” Rice said. “I asked to see someone who didn’t want to cut my leg off.”
Given the severity of Rice’s situation, Dr. Spence Misner ’73 was called in. Misner, who had been practicing foot and ankle pathology for more than 30 years, specialized in limb salvage, treating high-risk patients with critical wounds on the verge of losing a leg.
If Rice was hoping for a different answer from Misner, he would be disappointed. Misner initially came to the same conclusion as other physicians. Rice would lose his leg.
“The usual standard for treating a flesh-eating infection is immediate amputation,” said Misner, a 1973 psychology alum. “You would rather lose a leg than lose a life.”
Misner knew that in taking Rice’s leg, he would also be taking his livelihood. The doctor brought Rice into surgery twice, each time cutting away more infected flesh. By the time he finished, barely anything aside from tendon, bone, and an open wound remained from 6 inches above Rice’s ankle to his toes. Weeks of advanced wound care yielded little progress. Despite Misner’s skill, the situation was beginning to look hopeless.
Fortunately, Misner had a breakthrough. One of the sales representatives that he was acquainted with mentioned a company he worked with, Osiris Therapeutics, that developed several stem cell products. Misner called the company and explained Rice’s situation. Osiris agreed to donate anything that Misner needed, however, a stem cell tissue transplant on this level had not been attempted.
“I told Bobby he had a choice,” Misner said. “We can either amputate your leg, or we can try a procedure that has never been done. If it works, you have a leg. If it doesn’t work, you are not out anything.”
Rice agreed to give it a try.
With Misner agreeing to donate his time, and Osiris agreeing to donate nonembryonic stem cell products Grafix and Ovation, Misner prepared to begin the treatment. When the first of the stem cell products arrived, Misner took them to the -75 Fahrenheit cold storage at the hospital, where he opened the container to inspect what he would be working with.
What Misner found were 2×2 tissue squares half the thickness of Saran wrap that contained stem cells, connective tissue, growth factors, and skin growing cells. What he didn’t find were recommended procedures for administering the stem cell treatment.
“I called the company because no protocol was included,” Misner said. “Osiris responded that the reason we are giving these to you is there is no protocol. However, being in wound care I had extensive experience in using biologic skin. This was similar.”
The tissue transplant was a slow, tedious process. The squares, which thawed slowly, were peeled off of their backing and placed directly on what was left of Rice’s leg using microscopic forceps.
“It sounds simple, but it can be a difficult substance to work with,” Misner said. “It is similar to Saran wrap in that it balls up. But it is 10 times harder to work with because you can’t throw it away since each square is expensive.” Each is valued at approximately $2,000.
Related article: Stem cells: From controversy to optimism
Covering a wound as large as Rice’s required 10 or more squares. With the treatment being repeated every three weeks for more than six months, the cost for the stem cell products alone quickly rose above $250,000, making the products donated by Osiris a significant investment—especially when considering that the case was unprecedented and Rice lacked health insurance.
“Osiris is at the forefront of significant breakthrough medicine,” said Osiris Therapeutics Chief Operating Officer Lode Debrabandere. “As a result, the most catastrophic medical cases are brought to us. When you have people who can’t afford the products, you can put your money better into donating products than into marketing and advertising. Our products need to be used. That is more important.”
The investment Misner and Osiris made in Rice’s foot slowly began to yield results. Between December 2011 and May 2012 the stem cells regenerated tendon, ligament, fat, bone, and skin.
“Stem cells have been used before to regenerate these components individually—but they have never been used in complex care,” Misner said, “never to address all of these tissue parts at one time.”
An additional surprise came during a later treatment session when a nurse tickled Rice’s foot. Rice jerked his foot slightly and exclaimed that it tickled. The words passed without notice, until Rice realized the significance of the moment.
Feeling had returned to his leg. The stem cells were regenerating his long-damaged nerves. In time, after more than 10 treatment sessions over six months, Rice’s leg was almost completely healed.
“Bobby is walking again,” Misner said. “I did have to amputate fifth toe and fifth metatarsal, so he doesn’t have a completely normal foot. But if he wants to go for a walk, he can. If he wants to work, he can work. He has a leg with a very minimal disability.”
Rice is also pleased with the outcome of the treatment.
“Dr. Misner is a great doctor. Without him I wouldn’t be here right now. He isn’t just a doctor to me—he’s a friend.”
Moving forward, Misner will be sharing his findings with the medical community. He has already received requests worldwide for findings on his procedure, as well as several requests from patients with similar precarious conditions. Misner is eager to see the work continue, but knows it will take more than him to find the future of stem cells in limb salvage.
“The work has to be replicated, it has to be improved on,” Misner said. “We have to change the mindset that if you have necrotizing fasciitis, you amputate to save the life. Now we can move from amputation to limb salvage.”
Photos: See how Misner transformed Rice’s foot from a limb riddled with gangrene and flesh-eating bacteria to a new, healthy appendage. WARNING: The gallery contains graphic images that may be unsettling to some viewers.