BURN TREATMENT AND TISSUE ENGINEERING OF THE SKINPresentation By:

Cara Nunez

BACKGROUND

Skin: Epidermis Dermis Hypodermis/

Subcutaneous Layer

Functions of the Skin: 1. Protect the body

2. Sensation

3. Heat Regulation

4. Control of Evaporation

5. Absorption

6. Water resistance

7. Storage/Synthesis

8. Aesthetics/Communication

BURNS

Burns are generally classified by depthThe time they take to heal are directly

related to the depth of the burn1st and minor 2nd degree burns are painfulSerious 2nd degree and 3rd degree burns do

not hurt because the nerve endings are destroyed

BURNS (CONT.)

1st DegreeOnly epidermis

Healing time is 1 week or less

2nd DegreeEpidermis + Dermis

Healing time – several weeks, deeper burns take longer

3rd DegreeEpidermis, Dermis and Subcutaneous layers

Healing time – many weeks, usually requires excision and grafting and can cause complications including amputation and loss of life

HISTORY OF BURN TREATMENT

The overall goal of burn treatment is to fully heal the skin with minimal scarring and full functionality, while also managing the patient's pain

Mankind has been trying to heal burns since the discovery of fire

Ebers Papyrus (1500 BC) lists a mixture of cattle dung and black mud as “just what the doctor ordered” for burns

HISTORY (CONT.)

For many years there was very little consensus on how to treat burns

Fabricius Hildanus, a German Physician, first classified burns into three degrees in the 1600's

After World War I the preferred treatment was surgical skin transplantation → Less scarring than before

HISTORY (CONT.)Wide use of

firebombs in the Korean war of the 1950's

The U.S. Army Burn Center in San Antonio, Texas makes it a standard to skin graft patients with 30% or more total body surface area burns

HISTORY (CONT.)The new standard of

treatment became to excise the necrotic tissue and replace it with grafts of healthy skin, usually taken from the patient's legs

This is effective, but the patient is still disfigured, covered in scars and can suffer from chronic life long pain

CONVENTIONAL WESTERN BURN TREATMENT In many cases grafting is

not possible because there simply is not enough healthy skin left

Doctors have been able to culture and grow skin since the 1970's

These sheets of skin are extremely fragile and take weeks to grow – precious time in which a patient can develop an infection and die

HOLISTIC TREATMENT

Professor Xu Rong Xiang of China

introduced a new, holistic method of burn treatment in the 1970's

“Moist Exposed Burns Treatment” (MEBT)

“Moist Exposed Burns Ointment” (MEBO) [patented]

No surgical excision!

TISSUE ENGINEERING OF THE SKIN

Tissue engineering of the skin is a combination of all of this

Skin grafting was an innovative method when it was first implemented

Tissue engineering is starting to be the bridge between the conventional methods of burn treatment and Xiang's holistic method

CURRENT METHODS

Conventional: Work to improve methods

for growing cultured skin Specialized scaffolds can

be used to support more complex/thick layers of epidermal cells

This is called ex-vivo skin growth

Pros:Highly effective for 2nd degree burnsThe skin is the patient’s own and does not need to be taken from another body site

Cons:As of now, this method still leaves major scarringThis method cannot regenerate destroyed nerve endings

CURRENT METHODS (CONT.)

Holistic Method:Using MEBO allows for

regeneration of the tissue

This area of research is quickly moving towards stem cells as a method allowing more natural skin regrowth

Pros:The skin that regrows will have less scarring than grafted skin

Cons:This technique is not as tried and tested as skin grafting - however, it is more widely used in China and has shown great success in clinical trials there

THE FUTURE OF SKIN TISSUE ENGINEERING

A suspension of the patients own skin stem cells can be evenly sprayed like paint onto the burn

This technology is still being tested but seems very promising

RESOURCES

Bianco, Paolo, and Pamela Robey. "Stem Cells in Tissue Engineering." NATURE. Macmillan Magazines Ltd, 1 Nov. 2001. Web. 13 Oct. 2012. <http://users.isr.ist.utl.pt/~sm3/biomedica/tissue-engeneering/Tiss_eng_2.pdf>.

Gallico, MD, Gregory, Nicholas E. O'Connor, MD, Carolyn Compton, MD, and Olaniyi Kehinde, B.A. "Permanent Coverage of Large Burn Wounds with Autologous Cultured Human Epithelium." The New England Journal of Medicine (1984): 448-51. Print.

"Glossary about MEBT/MEBO." Glossary about MEBT/MEBO. China Herb Store, n.d. Web. 13 Oct. 2012. <http://www.chinaherbstore.com/MEBO/glossary-about-mebt-mebo.html>.

Horch, Raymond E. "Future Perspectives in Tissue Engineering." Journal of Cellular and Molecular Medicine (2007). Print.

RESOURCES (CONT.)

Pomahac, and Svensio. "Tissue Engineering of Skin." Division of Plastic Surgery, Brighom/Children's/Harvard, 1998. Web. 13 Oct. 2012. <http://filebox.vt.edu/p/pomur/skin%20engineering.pdf>.

"Video -- The Skin Gun -- National Geographic." Video -- National Geographic. National Geographic. Web. 13 Oct. 2012. <http://video.nationalgeographic.com/video/national-geographic-channel/shows/explorer-1/ngc-the-skin-gun/>.

Weeks, MD, Bradford S. "Brief Introduction to the History of Burns Medical Science." Burns Regenerative Medicine and Therapy (2000). Karger.com. 2000. Web. 13 Oct. 2012. <http://content.karger.com/ProdukteDB/Katalogteile/isbn3_8055/_76/_61/Burns_Intro.pdf>.