The tip of Gary Cunningham’s foot was rotting, black and seeping, like a horrifying prop from a zombie movie.
Two doctors at two different area hospitals told the 68-year-old Portage County man they would almost certainly need to amputate his leg from the knee down because 63 years of diabetes had ruined his circulation, robbing the foot of the blood and oxygen it needed to heal after he stubbed his toe and ripped off a nail.
“‘It’s only a leg,’ one of the doctors told me,” Cunningham said. “I should have kicked him with my good leg.”
Cunningham, facing amputation, is exactly who Akron General Health System aimed to lure in 2014 when — before it merged with Cleveland Clinic — it opened a Wound Healing and Limb Preservation Center in Green and expanded services on its main campus.
Saving a limb often means saving a life, said Dr. Windy Cole, associate medical director of the wound care center.
More than half of patients who have a leg amputated die within five years, she said, because it often limits their ability to function. Lack of mobility can worsen pre-existing conditions like diabetes or increase the risk of pneumonia.
Diabetes is to blame in 60 percent of non-traumatic lower limb amputations in adults, according to the American Diabetes Association. In 2010, the most recent data available, there were 73,000 such amputations in the United States.
Peripheral Artery Disease, or PAD, accounts for many of the rest. Smoking, high blood pressure, diabetes and other factors can cause PAD, which causes poor blood flow.
About 29 million Americans have diabetes; another 8 million have peripheral artery disease. That makes wound care big business. Some analysts say it could be worth more than $18 billion in the U.S. by 2019.
Cole was trained as a podiatrist but started moving into wound care about five or six years ago, Now it’s all she does.
She’s pulled safety pins, thumb tacks, toothpicks and all sorts of other sharp items out of patients’ feet.
She’s treated people with third-degree burns on their soles after walking barefoot across hot pavement in the summer.
And one particularly unlucky man lost his fourth and fifth toes to his dog when he fell asleep. The dog wasn’t being malicious, Cole said. It was doing what dogs do — licking a wound.
Many of those people had no idea they were injured because diabetes, peripheral artery disease or a combination had zapped their ability to feel sensation in their feet.
“I used to say I did ‘wound care,’ and people would ask what that sub-specialty was,” Cole said. “Now it’s a growing field with so much new technology. It’s really rewarding.”
Akron General has long had podiatrists, plastic surgeons, orthopedic surgeons, vascular surgeons, primary-care physicians, infectious disease experts and dermatologists. But in the fall of 2014, the hospital began contracting with Massachusetts-based SerenaGroup, which has contracts with about 25 hospitals nationwide. The wound healing specialty group brought expertise in management, billing and revenue. But the contract also meant new research and technology.
“Akron has started growing into becoming a powerhouse in wound care,” said Dr. Thomas Serena, a vascular surgeon who started SerenaGroup.
Besides helping with wound care at Cleveland Clinic Akron General, SerenaGroup has opened a research lab at the Northeast Ohio Medical University in Rootstown and is working with the University of Akron and others on research.
“When you pull a Band-Aid off and it hurts? That’s one of the things we’d like to change for all wounds. We’re trying to come up with a product to reduce pain when changing dressings,” he said. Another product in the works would deliver oxygen to wounds, which could speed healing, Serena said.
SerenaGroup also brought a new fluorescence angiography machine called Luna to the hospital. After patients are injected with dye, the Luna lights up areas where blood flow is moving normally. Parts of the anatomy without blood flow remain dark.
The Luna is the first major technology breakthrough in foot care in decades, Cole said. For 30 years, podiatrists have depended on a scale that rates wounds from one (superficial ulcer) to five (extensive gangrene) based on observation.
Doctors largely have depended on the scale to determine how to provide care, including whether to amputate.
The Luna lets doctors see if a patient has the blood flow needed to heal.
What can that mean for patients?
“I’ve still got my leg,” Cunningham said last week, as he and his wife were stripping wallpaper off their kitchen walls in Diamond, an unincorporated area in Palmyra Township.
Cunningham, who will turn 69 this month, has had diabetes since he was 5 years old. But he never had foot trouble until stubbing his toe on an elliptical exercise machine at Christmas time in 2014. That soon led to a toe amputation and gangrene. Two doctors at two area hospitals suggested amputation.
He saw Cole for a third opinion. Using the Luna — which Cunningham said looks like a giant Shop-Vac — Cole saw hope.
Blood wasn’t moving through Cunningham’s other toes, she recalled, but most of his foot had blood flow, so she thought she could save his leg and foot.
Cole amputated the rest of Cunningham’s toes, cleaned up a part of the bottom of his foot that had turned black and then started hyperbaric oxygen therapy. For 40 days, two hours at a time, Cunningham sat in a clear, plastic, pressurized tube being bombarded with 100 percent oxygen, which Cole said both speeds healing and battles bacteria.
At the end of that treatment, Cole used the Luna again to measure the blood flow in what was left of Cunningham’s foot. This time, she said, the whole screen lit up, showing profuse blood flow everywhere.
Cole then used sterilized cadaver skin — purchased from a lab in Virginia — to close the wounds.
Last week, Cunningham said all was healed but the tiniest sliver next to where his big toe had been. Even without toes, he said he’s getting around fine.
“I don’t think I’d limp at all if I didn’t have arthritis in my knee,” he said.
Cunningham, a retired forklift salesman, said he and his wife know he could face more problems in the future because his lifelong diabetes has done damage.
“But I don’t even think about that now,” he said. “I’m thinking about today and what God has planned.”
Amanda Garrett can be reached at 330-996-3725 or agarrett@thebeaconjournal.com.