Skin Injury Treatment

The prevalence and risk of burns injuries requiring hospitalization to our Warfighters has been 209 cases over the past 10 years (compared to 114,061 civilians cases reported over the same period). The metric for the duration of hospitalization is approximately one day for each 1% of the total body surface area (TBSA) – This is significant as the 209 hospitalized military cases alone reported >20% TBSA to impacted by the injury. There is also a high morbidity and mortality associated with burn injury in both military and civilian populations (21% and 30% respectively) though recent advances in resuscitation and critical care have led to a significant reduction.

Additionally, military trauma (i.e. blast injury) creates not only large wounds but also large areas of fibrosis and scar formation. These scars are often very visible and can often draw unwanted attention to the Wounded Warrior. In some instances the scars become so extensive and thick that they can limit movement of joints and greatly restrict the patient's ability to move.

It is the intent of current efforts to improve burn and wound healing management and further minimize acute complications and chronic functional impairment.

Current treatment options include administering antibiotics and tissue excision for deeper burns which are then replaced with tissue substitutes. However, it is the intent of the current effort to mitigate the problems associated with these methods and use regenerative medicine (i.e. tissue engineering and the novel use of cells, scaffolds and biomaterials) to:

• Prevent wound infection and afford for an environment conducive to skin regeneration
• Prevent inflammation following burn injury and prevent subsequent injury progression
• Speed generation of a viable wound bed and reduce reharvest time of autograft donor sites
• Enhance the ability of autologous cells and tissues to cover larger surface areas
• Improve the quality and function of skin substitutes for burn wound grafting (i.e. elastic and pigmented and possessing sweat glands and hair follicles) when autografts are not immediately available
• Primarily prevent and secondarily manage scars

The Skin Repair Program continues to address the clinical challenges of burns and inflammation, healing without scarring, and skin replacement by using new technologies in regenerative medicine and tissue engineering (i.e. the novel use of cells, scaffolds and biomaterials) to provide surgeons with advanced tools and new options for repair, regeneration and restoration of skin, bone, soft tissue and blood vessels damaged in burn injuries. The goal is to afford victims of severe military or civilian trauma to be able to recover from their injuries more rapidly, more reliably, with function and esthetics.

References:

• David Herndon, Total Burn Care, P.19, 2007.
• American Burn Association, National Burn Repository® 2013.