Synthetic Skin Offers New Hope

Experts at the Bridgeport Hospital Burn Center are pioneering a new treatment to help burn patients who have been living with severe scars for several months and even years.

Recently approved by the US Food and Drug Administration, the new procedure involves the use of a synthetic skin covering known as Integra that allows patients to regenerate their own skin so that it is elastic, strong, and flexible. They can then move the burned body part, such as their arm, leg or face, more freely.

“We can now offer new hope to patients who have been living with the consequences of severe scars for years,” said Dr Nabil Atweh, chairman of Surgery at Bridgeport Hospital.

In treating severe burns, surgeons often cover a burned area with a skin graft. The skin used in a grafting procedure typically is taken from elsewhere on a patient’s own body. Scar tissue is common and can restrict a patient’s ability to move in a full range of motion.

“In the past, one of the most devastating consequences of a burn was that patients were left with severe scars that made it difficult or impossible to move their hands, arms, legs, neck, or other parts of the body,” said Dr Philip Fidler, acting medical director of the Burn Center. “For many burn victims, walking, writing, holding a fork, or other everyday functions were a constant challenge.”

Human skin consists of an outer layer (epidermis) and a second layer (dermis). The epidermis ensures protection against infection and dehydration while the dermis is responsible for the mechanical resistance and elasticity of the skin. Developed by Johnson & Johnson, Integra, consisting of a porous layer of cross-linked fibers and an outer silicone layer, is applied to the wound. The epidermal layer, or exterior layer, prevents loss of fluid and protein while providing mechanical protection. The dermal layer, or inner layer, provides the scaffold that allows the body to regenerate new dermal skin tissue that is elastic, strong, and flexible.

A few weeks after the initial application, the silicone layer is removed and replaced with a very thin epidermal graft removed in a minimally invasive procedure. The collection of the thin epidermal graft from the patient is much less painful and results in less scaring and earlier recovery of the donor site.

Surgeons have been using Integra as an alternative to skin grafts for patients who are severely burned.

“Now we are able to use the same technology to help burn victims replace some of their restrictive scars to allow then to return to a more normal range of motion and activity,” Dr Fidler said.

Scarring has been a special concern in treating children who are severely burned. As children continue to grow, the inelastic qualities of traditional skin grafts can cause severe scarring and restricted range of motion. Because Integra creates a new dermal layer of skin that can grow as a child grows, it reduces the incidence of scarring and also makes it less likely that patients will need additional grafting procedures later in life.