“In a very real sense, the burn patient is the universal trauma model,” Pruitt said.
“Tat is, everything that happens in the burn patient, in terms of organ system dysfunction, pretty much happens in mechanical trauma patients.” Patients who are shot, for example, experience the same changes that burn patients experience, except that mechanical trauma patients’ experiences are accelerated, causing life- threatening changes at a faster rate.
SPRAY-ON SKIN
The Burn Center participated in the clinical trials of ReCell, a technology that deconstructs a small biopsy of a patient’s skin and dilutes it in a solution that can then be sprayed onto a wound. From there, the patient’s skin cells will populate the wound and regrow skin. (U.S. Army photo)
“So, the mission of the unit has expanded to include all of trauma, including combat injury patients, and it has, in the last several years, become the center of combat casualty care research by the integration of all three military services, Army, Navy and Air Force,” he said.
StrataGraft is a ready-made, off-the-shelf skin substitute comprising two layers. One layer is an epidermal component— the outermost layer—and the other layer is a dermal component, the layer of tough connective tissue beneath the surface.
“Te epidermal component is derived from an immunologically privileged epidermis from neonates called NIKS cells. Tose cells will not be immunologically rejected by the patient, unlike every other type of skin we might transplant from somebody else to a patient,” Cancio said.
NIKS, or near-diploid immortalized kera- tinocyte skin, is made with keratinocytes, cells that make up the vast majority of natural human skin and primarily protect skin from environmental damage, like bacteria.
NIKS cells used in the StrataGraft treat- ment “are basically a special type of skin
cell that comes from somebody else and we put them on the patient’s excised wound bed and, ideally, this technology will go ahead and become part of the patient. And then over time, the patient’s own skin cells will grow into the product and replace the epidermal cells from somebody else with the patient’s own cells,” Cancio said.
StrataGraft is still in clinical trials, Cancio said. Te Burn Center is participating in two of those trials; one to evaluate the product in patients with partial-thickness (second-degree) burns and another to evaluate the product in patients with full- thickness (third-degree) burns.
UNIVERSAL MODEL Te Burn Center has expanded its mission in the decades since 1970, from focusing almost exclusively on burns to encompass- ing many aspects of mechanical trauma as well as burn injuries.
Te National Defense Authorization Act for Fiscal Year 2017 mandated that the primary mission of the military health system is readiness, Cancio said. Te center continuously brings in medical personnel from all over the armed services for team training. “We believe that this burn center contributes significantly to training people to be prepared to deploy to the combat zone and take care of severely injured patients,” he said.
Te complexity of burn care is not just restricted to a skin problem. Major burns impact all organs and systems of the body, Cancio said, from the psychologi- cal, to the heart, lungs, kidneys and the patient’s ability to function from a physi- cal and occupational therapy standpoint.
“All those organ systems are affected by burn injury, so whether you’re a critical care nurse, a surgeon, whether you’re an occupational physical therapist or another therapist, respiratory therapist, you get excellent exposure to very critically ill patients at this Burn Center, so we feel that our training mission has only intensified
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THEN & NOW
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