World first in severe burns management

21 June 2019

A South Australian patient has survived horrific burn injuries to 95 per cent of his body, and become the first person in the world to benefit from a new technique that treats burns without the use of skin grafts.

Director of the Adult Burn Service, Professor Dr John Greenwood, said his new Composite Cultured Skin (CCS) technology was developed at the Royal Adelaide Hospital’s (RAH) Skin Engineering Laboratory (SEL).

“33-year-old Glenn Ogg is the first person in the world to receive the CCS treatment after he suffered serious full thickness burns in a house fire in early December 2018,” Dr Greenwood said.

“The composite autologous skin is grown in a specially designed bioreactor and was developed in conjunction with SEL Scientists Bronwyn Dearman and Amy Li at the RAH.

“Not only did Glenn benefit enormously from this new technology, his initial treatment included another cutting edge technique known as Biodegradable Temporising Matrix (BTM), which is a skin dermal replacement that temporises the wound first and was also developed here in Adelaide.

“BTM works by not only ‘holding’ the burn wounds in a healthy condition, but improving them, for the five weeks it takes to grow CCS and was pivotal in the early survival and progress of the healing of Glenn’s wounds.

“Every aspect of how these two technologies works together has seen Glenn not only survive, but make a remarkable recovery in less than six months.

“It is a great testament to Burra Hospital, Medstar Retrieval Service, the RAH’s Emergency Department, Intensive Care Unit (ICU) and Burns Unit teams that Glenn was out of ICU and off the ventilator with normal kidney function in nine days, and first walked 28 days after the fire. Importantly, Glenn has had fabulous support from his family and friends.

“In a comparable case reported in the UK, a patient spent more than 40 days in the ICU, left hospital after a year still unable to walk.

“In many cases patients don’t survive and, when they do, they usually depend on a ventilator for months, and often experience severe kidney failure from tissue injuries.”

Professor Dr John Greenwood’s research creating both BTM and now CCS began with his distress that a small number of patients had injuries of such severity that they could not be treated.

A formal human trial of the CCS technology has been approved and will begin at the RAH once Glenn leaves the hospital and is transferred to Hampstead Rehabilitation Centre to begin the next stage of his rehab sometime in the next month

Glenn’s road to recovery

Glenn experienced 95 per cent total body surface area burns (85% full thickness) and severe smoke inhalation injury following a house fire on 4 December 2018. He has now been at the RAH for six months and his wounds are healed.

Treatment involved:

• Immediate removal of his entre deep burns, 85 per cent of total body surface area.

• Skin graft was taken from his scalp to create 26 pieces of CCS at the RAH’s Skin Engineering Laboratory.

• Each piece of full-thickness cultured skin was 25cm x 25cm and 1mm thick, and took five weeks to produce.

• Second surgery, 48 hours later, allowed BTM to be applied to all of his deep burn wounds.

• ICU specialists used a new treatment to help his recovery from smoke inhalation.

• BTM integrated completely into his wounds over the next six weeks. It produced an extraordinarily good result to his body – the material had uniformly integrated over his arms, legs, and torso. There were no signs of infection or contracture, which is the usual consequence of any grafting procedure.

• On day 28 following his injury, despite having no skin and only BTM in his wounds, Glenn took his first steps on the RAH Burns Unit.

• In mid-January 2019, the first batches of the CCS were ready and Glenn began the surgeries to completely close his burn wounds.

• The CCS has covered 50 per cent of his total body surface area, the remainder being covered by a mixture of standard grafting techniques.

Background information

The RAH Adult Burns Service, is the only Burns Unit outside of North America to achieve American Burn Association accreditation, which it has maintained since 2009.

It’s renowned for its innovation in burn care and with an exceptionally low mortality rate.

Composite Cultured Skin (CCS)

The CCS technique can create a composite autologous skin for severe burn patients and can grow up to 1.7 square metres of skin from a donor site of 10 x 10cm. 

Since 2015, the team have been designing and building a special machine, a bioreactor, allowing them to grow up to 20 large pieces of CCS at one time, with cellular feeding processes that are controlled by computer software.

This gives time for the cells to grow sufficiently to cover the burn, whilst it prevents the contractions and infection, and creates a vascular network onto which a person’s own skin will be transplanted.

For transplant specialists, this world first treatment is revolutionary and overcomes a huge immune barrier for tissue compatibility.

Biodegradable Temporising Matrix (BTM) treatment

BTM was developed by Professor Dr John Greenwood at the RAH, and was first used on a patient in 2014.

It has a polyurethane seal that prevents water loss through the wound, reducing the drive of the body to heal by scarring and contraction. It was designed to become part of a patient’s wounds, preventing contraction, resisting infection and producing a better bed for the CCS.

BTM has to date been used in 36 free flap donor site reconstructions (surgical wounds), 28 severe burn injuries, and 26 complex surgical wounds at the RAH, with no deaths despite several enormous burn injuries.

BTM is now regulated by the TGA for use in burns and wounds. It is highly effective when used prior to standard skin grafting and is also widely being used across Australia, USA, New Zealand and South Africa, and will soon be available in Europe.