Burn
units are some of the most devastating places for a caregiver
to work. Patients, many of whom are young children, are
often in excruciating pain and doctors have precious little
time to get the situation under control. Now, surgeons
at the Queen Victoria Hospital in East Grinstead, UK have
gotten the go-ahead to evaluate an innovative approach
to burn treatment dubbed "spray-on skin."
Surgeons at the hospital have been
using the technique on burn victims for about five years
now. Pilot studies previously conducted on 12 patients
have shown promise, but this is the first controlled
trial of the procedure, which will also evaluate the
cost-effectiveness of the approach. So how do you get
skin in a can? The reality is a little more complex,
but basically, an aerosol head is attached to a syringe
containing a solution of suspended skin cells. All it
takes after that is a little squeeze of the needle.
Dr Baljit Dheansa, Burns Consultant
and Plastic Surgeon at the Queen Victoria Hospital,
understands the concerns of critics who've been clamouring
for more rigorous clinical testing before this technique
becomes standard practice. "We need more convincing
evidence and that is why we are doing this trial," says
Dr Dheansa. "I think [the procedure] will be an important
tool in the surgeon's treatment box." During the course
of the study, 24 patients with severe burns and 50 children
between 12 and 36 months with scalds will be treated
with the spray-on cell technique. "All adults with large
burns in our centre are eligible," he adds.
FASTER
MEANS BETTER
Depending on the severity of the burns and the proportion
of the body that is affected, surgeons can face several
obstacles when it comes to treatment. Treating a severe
burn is a race against the clock: without the protective
layer the skin provides, the body is left helplessly
exposed to infection and vital fluids are free to seep
out. So it's essential to cover up the affected area
as quickly as possible. The traditional treatment involves
a graft: the patient's own skin is harvested from a
donor site and stretched over the exposed region. Of
course, the amount of skin that can be removed to produce
a graft is finite: if a large portion of the body has
been burned, sufficient donor sites may not be available.
The innovative spray-on technique
addresses these limitations. "Healing seems to be quicker,
we need fewer operations and use relatively less skin
graft," explains Dr Dheansa. Skin cells are cultured
in massive numbers in the lab prior to their application
to the wound. "We get much larger numbers of cells from
a 2x2 cm graft," he says.
DOLLARS
AND CENTS
The second goal of the trial is to assess the cost-effectiveness
of this hi-tech procedure. Since the cell culture process
requires specialized equipment and staff, spray on skin
treatment can drive up costs significantly. But Dr Dheansa
warns we have to look at the bigger picture. "The cost
of growing these cells is about the cost of two days
in intensive care, and burn patients may spend weeks
[there]," he says. "The treatment may actually reduce
this and therefore be very cost-effective."
The "spray-on" cell technique was
pioneered by Dr Fiona Wood, head of the Burn Unit at
the Royal Perth Hospital in Western Australia. Dr Wood
has been using the technique with positive results since
1995, but she and her innovation were propelled into
the limelight under the most ghastly of circumstances.
In October 2002, victims of the terrorist attack in
Bali were sent to her hospital for treatment. All but
three of the 28 patients who were sent to Dr Wood's
unit survived.
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