29-08-2017, 10:00 AM
Traditionally, the treatment for severe second-degree burns is to add insult to injury: cut a strip of skin from another site in the same patient in order to graft it over the burn. The process works, but causes more pain for the burn victim and doubles the area that needs healing. Now a relatively new technology has the potential to heal burns in a way that is much less invasive than skin grafts. With just a small skin biopsy and a kit already done, surgeons can create a suspension of the basal cells of the skin - the stem cells of the epidermis - and spray the solution directly on the burn with results comparable to those of the grafts Of skin.
The cell spray is intended to treat severe second degree burns, in which the two upper layers of the skin are damaged, but the subcutaneous tissue is left intact. Third-degree burns, which are more severe, still require a skin graft. The aerosol, already approved for use in some countries, has gained interest from the United States Army, whose Institute of Armed Forces Regenerative Medicine is funding an essay, scheduled to begin before the end of this year, of more than 100 patients .
The technology, developed by the Australian surgeon Fiona Wood, is based on cells, such as skin progenitor cells and color-transmitting melanocytes, which concentrate on the junction between the two upper layers of the skin. With a small step-by-step kit called ReCell, surgeons can harvest, process and apply these cells to treat a burn as large as 50 square inches. The kit, marketed by Avita Medical, a UK-based regenerative medicine company, is a tiny independent laboratory about the size and shape of a large box of sunglasses.
After removing a small sample of skin near the site of the burn (the closer the biopsy is, the better for accurate color and texture matching), the surgeon places it in the tiny incubator of the kit along with an enzyme solution. The enzyme clears the critical cells at the dermal-epidermal junction of the skin and the surgeon collects them by scraping them from the epidermal and dermal layers and suspending them in solution. The resulting mixture is then sprayed onto the wound, repopulating the combustion site with basal cells from the biopsy site.
"Currently, treating any burn that requires a skin graft is the same technology we used to use 30 years ago," says James Holmes, a surgeon and medical director of the Burn Center at Baptist Medical Center at Wake Forest University. Current practice with larger burns requires grafts from the donor's skin that are anywhere in a room to the full size of the burn area. ReCell requires only as much as four square centimeters. "This allows you to take a very small skin biopsy and process it on the operating room table using a fully prepackaged device," says Holmes. "You are able to cover an area that is 80 times the size of your biopsy."
Holmes is the lead investigator in an upcoming multicenter study that will compare skin grafts and ReCell. Patients in the trial will act as their own controls: If a burn victim has a second degree burn severe enough so that surgeons can be treated by skin grafting, half the burn will be treated that way, while The other half will be treated with the cellular aerosol.
Not everyone agrees that second degree burns require grafts or other treatments to heal. "Most burns heal without a skin graft. They mostly heal with a band-aid," says Robert Sheridan, a surgeon at the Shriners Burn Institute at Massachusetts General Hospital in Boston. "There is a long history of [patient-derived] autologous products for the treatment of burns and all suffer from high costs or neutral results." The next study in the United States will not compare ReCell with any treatment, so it is unlikely that this problem resolved soon.
As a complete replacement for skin grafts, ReCell only works against serious second-degree burns: deeper third-degree burns have destroyed the skin layer that the ReCell solution could repopulate. However, the aerosol may be useful in treating more severe burns in conjunction with other approaches, as well as for the treatment of existing scars. Wood, director of the burn unit at Royal Perth Hospital, uses ReCell in a process called scar remodeling, in which the cellular aerosol helps to repopulate scarred skin with melanocytes to fit more closely with the patient's original skin tone . It also uses it in combination with other treatments, such as Integra skin growth scaffold, to reduce scarring and improve healing time.
"I use this technology in combination with all other traditional technologies, and I can improve the outcome and speed of healing," says Wood, who is also co-founder of the McCombs Foundation, a nonprofit research organization Burns and scarring. Royal Perth Hospital once had a long waiting list of patients for reconstructive surgery to correct the deep scars that accompanied third degree burns. Now, he says, there is no waiting list. "Our rebuilding rates are going down because people do not need it. Because we are doing more at the beginning, they do not need the secondary work of the scar."
The cell spray is intended to treat severe second degree burns, in which the two upper layers of the skin are damaged, but the subcutaneous tissue is left intact. Third-degree burns, which are more severe, still require a skin graft. The aerosol, already approved for use in some countries, has gained interest from the United States Army, whose Institute of Armed Forces Regenerative Medicine is funding an essay, scheduled to begin before the end of this year, of more than 100 patients .
The technology, developed by the Australian surgeon Fiona Wood, is based on cells, such as skin progenitor cells and color-transmitting melanocytes, which concentrate on the junction between the two upper layers of the skin. With a small step-by-step kit called ReCell, surgeons can harvest, process and apply these cells to treat a burn as large as 50 square inches. The kit, marketed by Avita Medical, a UK-based regenerative medicine company, is a tiny independent laboratory about the size and shape of a large box of sunglasses.
After removing a small sample of skin near the site of the burn (the closer the biopsy is, the better for accurate color and texture matching), the surgeon places it in the tiny incubator of the kit along with an enzyme solution. The enzyme clears the critical cells at the dermal-epidermal junction of the skin and the surgeon collects them by scraping them from the epidermal and dermal layers and suspending them in solution. The resulting mixture is then sprayed onto the wound, repopulating the combustion site with basal cells from the biopsy site.
"Currently, treating any burn that requires a skin graft is the same technology we used to use 30 years ago," says James Holmes, a surgeon and medical director of the Burn Center at Baptist Medical Center at Wake Forest University. Current practice with larger burns requires grafts from the donor's skin that are anywhere in a room to the full size of the burn area. ReCell requires only as much as four square centimeters. "This allows you to take a very small skin biopsy and process it on the operating room table using a fully prepackaged device," says Holmes. "You are able to cover an area that is 80 times the size of your biopsy."
Holmes is the lead investigator in an upcoming multicenter study that will compare skin grafts and ReCell. Patients in the trial will act as their own controls: If a burn victim has a second degree burn severe enough so that surgeons can be treated by skin grafting, half the burn will be treated that way, while The other half will be treated with the cellular aerosol.
Not everyone agrees that second degree burns require grafts or other treatments to heal. "Most burns heal without a skin graft. They mostly heal with a band-aid," says Robert Sheridan, a surgeon at the Shriners Burn Institute at Massachusetts General Hospital in Boston. "There is a long history of [patient-derived] autologous products for the treatment of burns and all suffer from high costs or neutral results." The next study in the United States will not compare ReCell with any treatment, so it is unlikely that this problem resolved soon.
As a complete replacement for skin grafts, ReCell only works against serious second-degree burns: deeper third-degree burns have destroyed the skin layer that the ReCell solution could repopulate. However, the aerosol may be useful in treating more severe burns in conjunction with other approaches, as well as for the treatment of existing scars. Wood, director of the burn unit at Royal Perth Hospital, uses ReCell in a process called scar remodeling, in which the cellular aerosol helps to repopulate scarred skin with melanocytes to fit more closely with the patient's original skin tone . It also uses it in combination with other treatments, such as Integra skin growth scaffold, to reduce scarring and improve healing time.
"I use this technology in combination with all other traditional technologies, and I can improve the outcome and speed of healing," says Wood, who is also co-founder of the McCombs Foundation, a nonprofit research organization Burns and scarring. Royal Perth Hospital once had a long waiting list of patients for reconstructive surgery to correct the deep scars that accompanied third degree burns. Now, he says, there is no waiting list. "Our rebuilding rates are going down because people do not need it. Because we are doing more at the beginning, they do not need the secondary work of the scar."