An Update from the Burn Center
from Clinical Update, Fall 2003
Abstract: The Burn Center at Wake Forest University Baptist Medical Center is one of only two burn treatment centers in North Carolina. With a focus on the latest treatment technologies and quality of life enhancements, the center is actively engaged in research to improve outcomes for patients.
The Burn Center at Wake Forest University Baptist Medical Center, one of only two burn centers in North Carolina, offers the latest treatments and technologies to burn patients, including artificial skin therapies, a vacuum device that may speed healing, and hair restoration.
“Being burned can be one of the most stressful things that can happen to the body,” said Joseph A. Molnar, M.D., Ph.D., assistant professor of plastic and reconstructive surgery and associate director of the Burn Center at Wake Forest Baptist. “Without its protective barrier, the body cannot regulate temperature, retain fluids or fight off infection. And, the dead tissue destroyed in the burn makes an ideal breeding ground for bacteria.”
Artificial skin therapy
Artificial skin provides a way to bridge the gap for burn patients when there is not enough of their own skin to provide grafts.
Integra® artificial skin is a two-layer product commonly used for permanent dermal regeneration for treating severe burns. Artificial skin is not only used to protect the wounded area, but it helps to promote re-growth of a natural skin instead of scar tissue.
After removing tissue destroyed by the burn, surgeons place the artificial skin over the wounded area and leave it there for a few weeks. During this time, the patient’s own cells make their way to the artificial skin to create a new dermis. The top layer of the artificial skin is then removed and a very thin sheet of the patient’s own skin is applied. Over time, a normal epidermis, minus the hair follicles and sweat glands, is reconstructed from these cells.
“The bottom layer becomes incorporated into the body to serve as a foundation for re-growth of dermal tissue,” said Molnar. “The upper layer, a thin, temporary silicone sheet, is removed once the blood supply is brought into the artificial skin. The body accepts it as itself and there has been no evidence of rejection by the body.”
What’s New in Research?
Molnar said a vacuum device developed by Medical Center doctors may further enhance the value of artificial skin.
Vacuum-Assisted Closure (V.A.C.™) uses a vacuum through a closed-cell foam apparatus placed directly in the wound to remove wound edema and stimulate cell growth, promoting an increased healing response.
“Multi-center clinical trials are underway to combine artificial skin and the V.A.C.,” said Molnar. “We’re using the V.A.C. over the artificial skin to try to speed up the rate of healing and to make the artificial skin easier and more consistent to work with.”
Molnar is the principal investigator of a prospective international trial to evaluate a new treatment modality for acute burns that may speed healing and minimize the need for surgery. This study is currently underway at 14 burn centers throughout North America and Europe.
Hair Restoration
While initial treatment focuses on saving lives, quality of life issues are also an important part of burn care. Hair restoration is one way to help patients look and feel better, said Molnar. In this case, Molnar applies techniques he uses in his cosmetic hair restoration practice to help burn patients.
“Burn patients have more challenges because they may have an entire section of their scalp without hair,” said Molnar.
Treatment can include tissue expansion, where a silicone balloon is placed underneath the skin to stretch out the scalp with repeated injections of saline, as well as using hair plugs to cover bald areas and to create eyebrows.