3rd Degree Burns and Deep 2nd Degree Burns need to be covered almost immediately, and the options at present are:
Autograft: Where a thin strip of epidermis, including just a tad of dermis, is taken from the patient's own body, using a Dermatome, then is often put through a Meshing device which allows the graft more flexibility and stretching. This is called a 'Split Skin Graft', and serves the purpose of covering the wound, keeping infection out, and healing the area.
Disadvantages: Patients with a burn percentage of greater than 60% of Body Surface Area do not have enough unharmed skin to crop. The resultant Split Skin Graft also lacks the functions of full thickness skin such as, the ability to sweat, lack of feeling, ability to regenerate and the growth of hair.
Allograft: Where Split Skin is taken from another Donor, including a cadaver within 18 hours of death. These grafts can re-vascularize once adhered to the wound and achieve an environmental 'seal' of the burn wound. When peeled off, the underlying surface is granulated and heals up with minimal scarring.
Disadvantages: Are rejected within 7 to 14 days. Cultured Skin Sheets take about 30 days to be made from a skin biopsy from the patient, so some other temporary covering would need to be applied.
Xenograft (pigskin): provides the same level of protection from infection as allograft, so pigskin is often embedded with salts of antimicrobial agents to increase its bacteriostatic potential. Pigskin is cheaper and more available than allograft. It's recommended uses include protective coverage of partial-thickness wounds, and should be changed every 3-4 days to prevent infection.
Disadvantages: Degenerates within 3 to 4 days.
Artificial Skin dressings: Provide wound protection, increase the rate of wound healing, and reduce patient discomfort. Very careful application is essential. When used to cover clean partial-thickness wounds, the dressing detaches as healing occurs underneath.
Biobrane© is a synthetic, membrane with an outer silicone layer bonded to an inner collagen nylon matrix. Its elasticity and transparency allows easy drape ability, fuller range of movement and easy wound inspection.
Disadvantages: The major problems with Biobrane© in treating burns are its expense and its lack of inherent antimicrobial properties. Wound infections are not uncommon.
So, what about the Future?
An Australian, Dr Fiona Woods, head of the Royal Perth Hospital Burns Department, and scientist Marie Stoner, used the newly invented US technology of Cultured Skin to save a patient with 90% burns, then moved from growing sheets of skin, which takes about 3 weeks, to producing sprayable skin cells within 5 days, and gained worldwide acclaim.
Technology moved on, and using the Skin Cell Suspension, Spray Guns have been developed, and almost unbelievably, a Skin Cell Printer is being trialled, where the patients wounds are charted by a Laser, then the Skin Cell Suspension sprayed accurately onto the wound.
Also, by adding Stem Cells to the normal Skin Cells the possibility of the Stem Cells converting to the useful cells such as melanin, nerve, hair follicles, sweat glands and the dermis, would eventually produce a normal skin.
Australian Scientists are working towards growing a Live Full Thickness Skin from a patient's biopsy.
Since my extensive 3rd Degree Burn 30 year ago there have not been many developments apart from Dr. Fiona Woods Skin Cell Suspension. They used Silver Sulfadiazine on me then and they still use it today.
I believe that Dr. Woods has shown the way of the future, and that further developments of her technique will eventually produce a "Full Thickness Skin Graft", the 'Holy Grail' of the Burns Surgeons.
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