Pediatric plastic surgeon Rick Redett is able to achieve good outcomes because most burn patients have plenty of unburned skin on their body that can be used for skin grafts. But what if a child has severe burns over his entire body, leaving no healthy skin?
“The biggest challenge in treating severe burns is replacing like tissue with like tissue,” says Redett. “We don’t have easy solutions for big burns.”
Redett was recently faced with such a challenge in treating a Baltimore 3-year-old with burns over 92 percent of her body. Cadaveric skin alone could close her wounds and protect her body, but only temporarily as the body usually rejects cadaveric skin within 14 days. And without a skin covering, burn patients are extremely vulnerable to life-threatening inflammation, infections, bleeding and drops in temperature.
Right away, though, Redett knew of a possible solution. It would be a highly technical and meticulous process involving multiple operations, but he could culture the patient’s own skin cells to grow new skin, and then apply it to her body. First Redett took postage-stamp size skin biopsies of the child and sent them to Genzyme Corporation in Cambridge, MA, where, over the course of about 10 days, they were co-cultured with mouse cells to form cultured epidermal skin grafts about the size of playing cards. Because these grafts, called Epicel®, are grown from a patient’s own skin cells, they are not rejected by the patient’s immune system. The grafts were then delivered to Redett, who in two operations transplanted the cultured skin, patch by patch, onto the patient’s body. Redett performs the procedure in quick, 2 ½ hour stages to minimize blood loss and hypothermia. To reduce the risk of infections, both the new skin and the wound dressings covering it are soaked in antibiotics.
Typically, follow-up grafting procedures are necessary because only up to 75 percent of cultured skin grafts are accepted by the body. But the child, Redett says, has taken the new grafts “amazingly well.” He adds, however, that because there’s no dermis in the cultured skin, it’s thinner and more fragile than natural skin. That makes it more prone to contracting and a scarred appearance.