Placenta tissue saved Ron Williams’ leg from being amputated below the knee.
Williams, a 64-year-old Toronto screenwriter, was packing for a move in March 2020 when a wine glass shattered on the floor.
As a longtime diabetic with neuropathy, Williams says he didn’t feel a tiny shard pierce his skin.
Several weeks later, his foot was swelling and hurt a lot — the small piece of glass had created a deep wound that got infected.
“It started rotting and decaying," he says, grimacing at the memory.
He was bedridden for six months and treated at Sinai Health’s Hennick Bridgepoint Hospital, but the wound did not heal.
He says that if the infection persisted, his leg would have had to be amputated.
But around February 2021, a nurse asked if he wanted to try a treatment that involved a donated placenta through a new wound-care program that was being launched at Mount Sinai.
“I had nothing to lose,” Williams says.
A placenta's amnion, also known as amniotic membrane – a thin inner layer of tissue that once surrounded an embryo — was applied to his foot.
When a wound's healing process hits a roadblock and won’t close, the amniotic membrane recruits stem cells to migrate and proliferate in the affected area. It blocks pain, reduces inflammation and prevents scarring, explains Balram Sukhu, director of Mount Sinai Allograft Technologies (MSAT).
The graft is placed on the wound, dressed and left undisturbed. A week later it's replaced with new tissue, and repeated until the wound heals.
Although amniotic membrane was first documented as a wound healing treatment over 100 years ago, it wasn't widely used out of fear of disease transmission. Now that there's well-established protocols for tissue banks, health providers say the membrane’s regenerative properties are a game-changer for severe wounds and burns. Yet a lack of awareness paired with the co-ordination required to collect placentas from delivery rooms, bring them to tissue banks and then ship them out to wound treatment centres has held back the treatment from becoming more widely available.
At Toronto's Mount Sinai, there’s a labour floor, a tissue bank, and a nearby rehabilitation facility, which made it an ideal place to launch the amniotic membrane program that has since provided treatment to at least 80 patients, all of which resulted in wound closures, Sukhu says. Williams was one of the first recipients.
The process begins with a pregnant woman who is having an elective C-section, since it's a more sterile environment than other types of birth.
Rebecca Lewis-Zarkos, who donated her placenta after delivering her daughter at Sinai in October, said the process was simple: a 20-minute phone call about her health history, a blood sample and a consent form.
“There’s nothing I need it for,” Lewis-Zarkos says about the organ, which in utero supplies the fetus with respiration, nutrition and immunity, but would have just gone to biological waste after birth.
“I think it's just a really good feeling that you've hopefully helped somebody else through a difficult time. Something that my body no longer needs, my baby no longer needs, is going on to help somebody else.”
Here's how the process works: after a caesarean delivery, the placenta is placed in a sterile bag and brought down to the basement tissue bank.
The organ can be kept in the fridge for a couple days as it awaits processing.
Sometimes it's processed right away — on a November afternoon, Sukhu unpacks a placenta from a plastic bag in a Coleman’s cooler box, just a couple hours after one donor delivered.
On a mini operating table in his lab, Sukhu cuts out the amniotic sac, spreading it flat on a metal tray. He takes samples to test the tissue for infection. Then, with tweezers, he peels the amniotic membrane from the sac’s outer layer of tissue, like separating pieces of Saran Wrap stuck together.
After a series of sterile washes, he packs what looks like a deflated jelly fish into a tube and places it in a deep freezer, where it waits for a nurse to fetch it for a patient in need.
Maria Becerra is one of the nurses who puts grafts like this one to use on the wound floor. “The process is quite simple," she says, explaining how she places the amniotic membrane directly on the wound and dresses it once a week until it closes. "It's not painful. It's nothing really invasive for the patient.”
“The way I like to think about amnion is that it's food for the wound. That's how I kind of like explaining it. It gives balance to the micro environment of the wound to help accelerate the healing process,” she says.
Becerra was Williams’ nurse. She was amazed to see his wound heal week-to-week.
Images Sinai shared with The Canadian Press of Williams’ wound show a dramatic evolution. Within a week, the deep open gash that once spanned from his heel to the middle of his foot healed almost 60 per cent. Within five weeks, it closed.
“I couldn’t believe it. I still can’t believe it,” Williams says. He removes his sock to show his naked foot. Barely a scar remains.
At Sinai, Sukhu says all the pieces were already in place for this collaboration, with the birthing centre and tissue bank under one roof.
But not all institutions have this foundation and resources.
Sukhu says there is potential for MSAT to scale up its volume and ship amnion to other hospitals, and even collect donated placenta from other birthing centres if needed. They've done this on a small scale, he says, sending tissue to at least three other Ontario hospitals for wound treatment and saw “excellent outcomes."
“The hope is that it will move to others, not just in this hospital, (but) to other patients in other hospitals and wound care clinics and so on,” says Sukhu.
Dr. Marc Jeschke, medical director of the burn program at Hamilton Health Sciences, says he studied applying amnion to severe burns 20 years ago. But he says it still hasn't become widely used, in part, because of the process required to produce it.
"The idea is great. It's a fantastic product. How to put it out to the population, particularly for burns or trauma — it's a challenge," he says.
Sukhu also thinks the treatment hasn't become more widely used because many clinicians still don't know it exists.
There’s two hospitals in Edmonton with placenta donation programs that started back in 2003, which now ship surplus amniotic membranes to hospitals in British Columbia, Saskatchewan, and Quebec. Last year, they processed 23 amniotic membranes, Alberta Health Services says.
For ocular surgeons, the Eye Bank of Canada processes placentas from Michael Garron Hospital to treat macular hole reconstruction and recurrent ulcers, reaching up to 200 patients across Ontario a year.
“When you look at it, it’s not anything out of the ordinary. It’s tissue that would have gone in basically the waste,” says Sukhu.
“So what are we waiting for?”
This report by The Canadian Press was first published Dec. 12, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
Hannah Alberga, The Canadian Press
