Ms Bronwyn Dearman1,2, Professor John Greenwood1
1Skin Engineering Laboratory, Adult Burns Unit, Royal Adelaide Hospital, Adelaide, Australia, 2The University of Adelaide, Faculty of Health Sciences, School of Medicine, Adelaide, 5000
The biodegradable temporising matrix (BTM) is our standard of care for patients with >30% TBSA deep burns. A 95% TBSA burn presented in December 2018. After total eschar excision on arrival, BTM was applied to 90% of the body 2 days later. With no meaningful donor site, we obtained TGA Special Access Scheme B approval to use Composite Cultured Skin (CCS). We have been developing this technology, alongside the BTM, since 2004. Twenty six CCSs were grown in an ISO 7 cleanroom environment in a semi-automated bioreactor. Two small split thickness skin grafts were obtained to provide the fibroblasts and keratinocytes, which were isolated and mass cultured in Cell Factories to obtain relevant cell numbers. The matrix (1mm thick polyurethane foam) was pre-soaked in plasma. In the bioreactor cassette (25cm x 25cm), fibroblasts were seeded onto the matrix with thrombin until the keratinocytes were seeded. The total co-culture period was 14 days. The CCSs were applied after BTM delamination and dermabrasion, and dressed with Mepitel and Acticoat. Punch biopsies, VapoMeter readings (TEWL) and Vivascope confocal imaging were performed to indicate wound healing and skin barrier function. Clinically, robust epithelium was visible with CCS ‘take’ by at least day 18 post-application. Early CCS batch take was irregular and additional CCSs produced. Some widely meshed split skin, and Meek, grafting were used to cover difficult areas, yielding poorer cosmetic results. At 5 months post burn, this 95% TBSA deep burn patient is alive, healed and will soon be discharged to rehabilitation.
Bronwyn Dearman, a Medical Scientist at the Adult Burns Unit, Royal Adelaide Hospital has been instrumental in establishing the first Skin Laboratory for SA providing both a clinical service and the development of the Biodegradable Temporising Matrix (BTM) (a product now in fledgling global use in burn communities). To complement this first stage and assist in abolishing the need for a skin graft, the development of the Composite Cultured Skin substitute (CCS) encompasses her current research interests.