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
BURNSBurns 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 epidermisHealing time is 1 week or less
2nd DegreeEpidermis + DermisHealing time – several weeks, deeper burns take longer
3rd DegreeEpidermis, Dermis and Subcutaneous layersHealing time – many weeks, usually requires excision and grafting and can cause complications including amputation and loss of life
HISTORY OF BURN TREATMENTThe 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 burnsFabricius 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 TREATMENTProfessor 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 SKINTissue engineering of the skin is a combination of
all of thisSkin grafting was an innovative method when it
was first implementedTissue engineering is starting to be the bridge
between the conventional methods of burn treatment and Xiang's holistic method
CURRENT METHODSConventional: 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 ENGINEERINGA 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>.