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UAB Burn Center Provides Spray-On Skin and Other Innovative Treatments

The first week of February is National Burn Awareness Week, so we are highlighting UAB’s Burn Center and Trauma Burn Intensive Care Unit (TBICU) to learn more about what this specialized team does and the cutting-edge treatments it provides to patients with burns.

Director of the UAB Burn Program James Hwang, MD, Surgical Physician Assistant Peter Yen, and the TBICU staff share some fascinating details about innovative and promising ways to treat patients with burns, along with insight about how burn care has evolved in recent years.

Spray-On Skin

The first burn care technique that we’ll highlight is the Avita RECELL System. This spray-on skin technique likely will be the subject of patient clinical trials at UAB. The product recently was approved by the Food and Drug Administration, and both Dr. Hwang and Yen have experience in using it.

RECELL is a burn treatment device that helps medical professionals use a small sample of a patient’s own skin to produce a suspension of Spray-On Skin Cells. It can be applied to a patient’s burn site in as little as 30 minutes to regenerate a new outer layer of skin. The major benefit of RECELL is that it requires only a small amount of donor skin to cover a large wound area. Using RECELL, providers can cover up to approximately 80 square centimeters of wound with only one square centimeter of donor skin.

“Due to this significant reduction in the donor site requirement, the morbidity and complications associated with donor harvest are dramatically reduced, along with the ability to cover large surface area with a single skin grafting surgery versus the traditional serial skin grafting technique,” Yen says.

Yen says a key benefit of RECELL is that the donor site is used only sparingly, which reduces the risk of creating more donor scarring. While other burn treatments require two or more autografting surgeries, depending on the wound size and the patient’s health status, this treatment covers a large surface area with only a single autografting surgery.

Currently, Dr. Hwang and his team are working with Avita to begin conducting clinical trials for the product with UAB patients.

EZ Derm

Another burn care treatment is the Mölnlycke Healthcare EZ Derm product, which uses grafted porcine (pig) skin for partial skin loss injuries and as a skin substitute for temporary wound coverage. It is used for partial-thickness skin loss injuries, as a test graft before autografting, and also as a protective covering to be used over meshed skin grafts.

Yen says porcine skin often is used to provide temporary wound coverage for superficial second degree burn wounds in order to immediately close the wound, decrease the risk of infection and contamination, and to immediately reduce pain.

“Typically these wounds heal in approximately two weeks with minimal pain, which translates to having good functional range of motion to participate in activities of daily living,” Yen says.

UAB Medicine’s TBICU uses this product to temporarily cover deep second- and third-degree wounds that are not fully ready for the final stage of skin grafting.

Advancements

As described in the two previous examples, there have been many advancements in wound dressings and skin/dermal substitutes in recent years. Yen has seen many of these firsthand, having been a burn physician assistant at various trauma burn centers since 2001. For example, silver-impregnated dressings, such as Mepilex Ag foam dressings and ASSIST Silver, are now commonly used as part of a wound care regimen.

“The unique property of silver within the dressing is the ability to kill bacteria without causing any antibiotic resistance compared to traditional pharmacological agents,” Yen says. “The silver activity remains therapeutic for up to a week, allowing providers to change the dressing every three to seven days versus the traditional daily change. The real benefit to the patient is less frequent dressing change, thus less pain, less narcotic pain medication use, and potentially shorter length of stay in the hospital.”

In addition to the EZ Derm treatment, Integra and PriMatrix dermal substitutes can be surgically implanted over deep wounds that have exposed bone, tendon, muscle, or large soft tissue defects. PriMatrix is made from fetal bovine (cow) collagen, and Integra is made from shark cartilage and bovine collagen. These types of technology often reduce the need for limb amputation.

“We have had great success using these products here at UAB for limb salvage and soft tissue reconstruction,” Yen says.

Challenges

As with any medical specialty, treating patients with burns has its own challenges and rewards for health care providers. Yen says the most challenging and unique aspect of treating burn patients is that these injuries and the road to recovery is a continuum. From the initial phase of acute care and fluid resuscitation to potentially multiple surgeries, pain management, wound care, nutritional needs, and psychological needs, the road to recovery can be long and difficult.

“The most challenging aspect of taking care of burns in my opinion, from the beginning to the end, is the challenge of achieving adequate pain control without causing immediate or long-term harm to the patient,” says Lindsay Keen, a UAB TBICU nurse practitioner.

These challenges are further complicated when patients are under the influence of various substances at the time of their injury, making them more susceptible to drug dependency. Even if patients are able to make it through the recovery period, dependence on pain medication and other substances is a common problem. For that reason, the TBICU works closely with the UAB Pain Management Services and UAB Addiction Recovery to assist trauma patients in every way possible.

Still, working in burn care can be a rewarding specialty, especially when patients return for clinic visits and report on how well they are doing and how much they appreciate the level of care and compassion they received at UAB Medicine.

“The most rewarding aspect of caring for burn patients is being a part of the transformation from sometimes completely debilitated patients with poor initial prognosis to a fully, or at least mostly, functional person with high quality of life,” Keen says. “We love seeing the transformation of our patients after discharge from clinic as we watch them return to their lives, families, and – oftentimes – their careers.”