Bioengineered skin a boon for burn patients

MUSC's Burn Service will begin using bioengineered skin cultured from foreskins of circumcised babies to treat burn patients.

The introduction of the new treatment coincides with the MUSC Medical Center’s celebration of Burn Week (Feb. 1 - 7).

During clinical trials, the bioengineered skin (Dermagraft-TC) was found to provide significantly faster healing compared to similar wounds treated with the standard care. Its typical one-time application reduced the need for frequent and painful dressing changes. Because Dermagraft-TC is transparent, it allows the medical staff to visually monitor the wound without disturbing it.

In October, the product received U.S. Food and Drug Administration approval for treating partial thickness burns, also called second-degree burns, where there is damage to the epidermis (the upper layer of the skin) and the upper portion of the dermis (the lower layer of the skin). These burns are the most common type of burn injury requiring medical attention. They are often caused by accidents around the home, such as scalds or contact with hot appliances. Earlier in the year, approval was given for use of the product for third degree burns where the epidermis, entire dermis and underlying tissue are damaged.

Standard care for patients with second degree burns includes the use of topical antimicrobial agents to ward off infection in conjunction with wound debridement (the removal of burned tissue) and sterile dressing. Third degree burns usually are covered with cadaver skin to prevent infection and prepare the wound bed for eventual placement of autograft tissue (skin from an unburned portion of the patient’s own body). The treatment can cause severe discomfort for the patient.

The Dermagraft-TC is used in place of the sterile dressing and antimicrobial agents for second degree burns, and in place of the cadaver skin covering for third degree burns. Cadaver skin has several drawbacks, including limited supply, severe bleeding upon removal, potential for clinical rejection, and the risk of disease transmission from donor to recipient.

Dermagraft-TC combines a bio-engineered human dermal layer and a synthetic epidermal layer. The bioengineered human dermal layer is produced through the culturing of cells derived from foreskins of circumcised babies that is normally discarded. The dermal cells are removed from the foreskin and cultured onto a commercially available biosynthetic material bonded to a nylon mesh which acts as a three-dimensional scaffold.

After a brief growth period, Dermagraft-TC is frozen to minus 70 degrees Celsius, and stored in cassettes ready to be shipped for use. Each cassette contains two, five-by-seven and one-half inch sheets of Dermagraft-TC. The material remains sterile inside the cassette until thawed and opened for use. In partial-thickness wounds, Dermagraft-TC is placed onto the burn, where it remains until the wound is healed; and in third degree burns, the Dermagraft forms a wound bed for eventual placement of autograft tissue.

“We have just acquired a huge freezer for storage of this material,” said Florence Simmons, nurse manager of the burn unit. “We also had to arrange for additional freezer facilities in the operating room suite.”

Andre Hebra, M.D., an MUSC pediatric surgeon, has used Dermagraft-TC once previously on a severely burned child and was pleased with the results. Now that the Medical Center has adequate storage, the material will come into more frequent use.

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