There are three levels of burns:
- First-degree burns affect only the outer layer of the skin. They cause pain, redness, and swelling.
- Second-degree (partial thickness) burns affect both the outer and underlying layer of skin. They cause pain, redness, swelling, and blistering.
- Third-degree (full thickness) burns extend into deeper tissues. They cause white or blackened, charred skin that may be numb.
Technology for burn victimsSpecialized medical equipment is crucial to the recovery of burn victims:
- Electric Beds: - Patients can manipulate their own bed position and are more independent.
- Specialist Microscopes: - Plastic surgeons can perform micro-vascular surgery.
- Mobilise Stretcher: - Easy transfer of patient to and from bed with minimal patient movement and a built-in scale for weighing and immobilized patient.
- Patient Controlled Analgesic Pumps: - Patients can manage their own pain by pushing a button which releases medication.
Artificial skinBurned, dead skin must be replaced with something that does everything the old skin did: regulate temperature, keep in fluids and keep out invaders like bacteria.
One option is to move a thin layer of healthy skin from elsewhere on the body to cover the burn. But if more than 50 percent of the body is burned, there obviously isn't enough healthy skin. Skin from cadavers can help temporarily, but after a few weeks will be rejected by the body's immune system.Artificial skin nurtures the body's own skin cells, sometimes even deceiving them as they struggle to grow and replace burned tissue. The technology is promising, but doctors warn it's costly and not always completely effective.
Spray-on cells to treat severe burnsA team at Queen Victoria Hospital in East Grinstead, West Sussex, has used the technique to treat several patients - including a man with 90% burns.
The latest study examines whether the cells go on to become a fully functioning part of the skin. The technique was first pioneered in Perth, Western Australia, and used on some patients - including victims of the Bali bombing - but has never been fully evaluated. It can cover a much bigger areas and do it much more quickly. The East Grinstead team have embraced the technology, and used it to treat several patients with severe and extensive burns.
The current method of treating burns victims is to take samples of skin from unaffected areas, and put them through a meshing machine.
The mesher's platform will accommodate almost any size and irregular shape of skin graft. No lubrication is required and the design allows easy access for cleaning, which makes it virtually maintenance free and autoclavable.
This expands the tissue, creating a string vest pattern of connected patches of skin surrounded by large holes.
Slow method: The technique can be used to cover big patches of tissue where the skin has been completely burned away. However, it is slow, and not always effective.
New techniqueThe East Grinstead team are using a new technique that has the potential to be much more useful. The treatment helped heal severe burns on an elderly patient's legs.
Mr Phil Gilbert, a consultant plastic surgeon who specialises in burns said: "It can cover a much bigger areas and do it much more quickly."In pilot studies we also get the impression that wounds heal noticeably quicker with less scarring."
A healthy skin sample is taken from the patient, and split in the laboratory to separate out the surface cells, known as keratinocytes. These cells are then cultured for two to three weeks, and made up into a suspension.At the same time other skin cell tissue from the patient is put through a different type of meshing machine, known as a meek mesher. Instead of creating a string vest pattern of tissue, this machine cuts the skin sample into tiny little squares.
Tissue combinationThe cultured cells are then sprayed on to the small pieces of tissue and combine to create new skin for the patient. Mr Gilbert said the technique had been used to treat a man who suffered 90% burns. Initially his burns were shaved off, and he was covered in sterile skin which had been harvested from bodies and kept frozen in storage. Doctors were only able to take skin samples for culture from small areas of one leg unaffected by burns. "We would have struggled to keep him alive using the standard methods," he said. "These have been used to treat people with very extensive burns, but these have nearly always been children." His skin is far from normal - it is thin, and has no hair follicles, sweat or oil glands. But it has begun to settle down, and take on a more natural pale colour.
Strict regulations on the storage of skin, introduced in the wake of concerns over CJD, mean that it is very expensive to culture cells in this way. "People want to know why they should spend x thousand pounds on a patient, so the stronger the evidence we can produce that is worthwhile the better," he said.
John Sandham IEng MIET MIHEEM