In the United States, 1.1 million people seek medical attention for burns every year, according to the American Burn Association. Third-degree burns, which extend to the deepest of the skin's layers, require immediate care to prevent infection and dangerous fluid loss that can lead to shock. A quarter-century ago, NIH-funded burn surgeons determined that badly burned skin should be removed as quickly as possible (rather than letting it slough off over time), followed by immediate and permanent replacement of the lost skin. This seemingly simple idea ultimately became standard practice for treating major burn injuries and led to the development of what is now an artificial skin system called Integra� Dermal Regeneration Template�. After removing the damaged skin, surgeons blanket a burn wound with a covering like Integra�, then apply a skin graft on top of this biomaterial to coax the growth of new skin to close the wound. While ideally surgeons obtain skin grafts from the burned patient, in the case of severe burns covering 80 to 90 percent of the body surface, there is not enough remaining skin to use for this purpose.
Now, Dr. Steven T. Boyce at the University of Cincinnati and the Cincinnati Shriner's Burns Hospital has succeeded in growing skin cells from a burned patient and adding them to a polymer sheet to create living skin grafts in the laboratory. In an effort to permanently close burn wounds, Boyce and his coworkers placed the laboratory-grown skin grafts on top of Integra� and bathed everything with a nutritious mix of growth factors and antibiotics to help prod the growth of new blood vessels and control infection. The researchers tested this technique on three children who had been badly burned in fires. The results were promising, showing that the new method offers an advantage over other currently available technologies, such as using non-living epidermal substitutes that cannot as accurately restore the structure and function of native skin. In each test case, the patient's new skin was a lighter color than before, but it had returned to its original softness, smoothness, and strength--with minimal scarring.
The new method may improve the treatment of severely burned patients who have lost more than half of their skin to third-degree burns, because the availability of skin for grafting the burn wounds of these patients is often limiting to recovery. This approach to wound treatment may also decrease treatment costs and hospitalization times associated with the treatment of severe burns, though more studies are needed to formally test these predictions. Finally, the method succeeded in regaining much of the cosmetic appearance of the burn-damaged skin of these young patients--a crucial element in helping burn victims return to a normal life.
Boyce ST, Kagan RJ, Meyer NA, Yakuboff KP, and Warden GD: Cultured skin substitutes combined with Integra� Artificial Skin to replace native skin autograft and allograft for the closure of excised full-thickness burns. J. Burn Care Rehab. 1999;20:453-61.
Reporters may call the NIGMS Office of Communications and Public Liaison at 301-496-7301 to obtain the name of a scientist in the NIGMS Division of Pharmacology, Physiology, and Biological Chemistry who can comment on this work.Writer: Alison Davis, Science Writing Contractor
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8/9/2018 5:41 PM
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