BUILDING BRAND-NEW SKIN
“Surgical Research Institute Enters 25th Year of Burns Research,” a February 1970 article in Army Research and Development Newsmagazine, the predecessor to this magazine, detailed how, after extensive laboratory study, investigators at the Burn Center put the drug into a water-soluble white cream to be applied topi- cally to burned areas.
“Tat is the compound which that article refers to as ‘burn butter,’ and it is used to this day for the treatment of burn wounds,” Cancio said. “Since then, there have been a lot of other products that have come out and that we use for burn wounds treat- ment, but Sulfamylon was really the first and foremost of those treatments.”
In the 1940s and ’50s, an otherwise healthy adult with burns over 40 percent of his body had a 50-50 chance of surviving, said Dr. Basil A. Pruitt, former commander and director of the Burn Center. Te survival rate improved by 1970; that year Pruitt, then a lieutenant colonel, told reporters that Sulfamylon successfully prevented infection in second- and third-degree burns covering
up to 60 percent of the body, and reduced the bacteria count in burn wounds more effectively than any other known topi- cal application.
“Today, if you have an 80 percent burn, you have a 50-50 chance of living or dying, and that’s real progress,” Pruitt continued.
“Tat’s statistically documentable progress.” Te medical staff at the Burn Center is responsible for that progress.
TREATMENT AND CARE Te delayed approach to surgery at the Burn Center in the 1970s meant leaving a burn wound open and debriding it—remov- ing dead, damaged or infected tissue—daily in hydrotherapy to prepare the patient for a graft. While that approach was sound, it still left patients open to the risk of infection, even when Sulfa- mylon was applied.
“We don’t do that anymore,” Cancio said. Now, the center performs excision—the surgical removal of dead tissue—as soon as possible, especially if the patient has deep wounds, before grafting with the patient’s own skin or a homograft—donor skin.
Speed of care is a key factor with burn wounds, Pruitt said. If burned and dead tissue remains on the patient, it not only can increase the risk of infection, but also increase the amount of scar- ring that could occur, particularly if the wounds are deep. “You take it off, it limits any extension of tissue destruction by any invasive bacteria,” he said.
Another key factor in burn care is the patient’s ability to heal. Accelerating wound healing, particularly in patients with exten- sive wounds, is a goal of the Burn Center. Two future technologies, ReCell and StrataGraft, are closest to accelerating healing, Cancio said.
“ReCell is a technology in which we take a small biopsy of the patient’s normal skin, we scrape off the epidermal cells from that biopsy, we dilute them in a solution and we spray it onto the freshly excised wound bed. And those little skin cells grow and populate the wound bed and replace it with skin. So, sometimes ReCell is referred to as spray-on skin,” he said.
NAVIGATING TREATMENT
To avoid giving burn patients too much intravenous fluid, which can create swelling that can cause life- or limb-threatening complications, the Burn Center developed Burn Navigator, manufactured by Arcos Medical Inc. The bedside computer helps guide resuscitation in burn patients. (U.S. Army photo)
ReCell has completed Phase III clinical trials, meaning that the Burn Center is waiting to hear from the U.S. Food and Drug Administration and the manufacturing company that the product is available for purchase and, therefore, clinical use. “As I under- stand, that will happen pretty soon,” Cancio said.
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Army AL&T Magazine
October-December 2018
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