28 May 2015
Until recently the outlook for patients in South Africa with extensive burns was bleak. The best they could hope for were highly specialised transplant techniques, depending on the availability of resources.
If they survived, patients faced long and excruciating hospital stays, with mixed results at the end of their treatment, alongside a very substantial bill. In some cases the total cost of skin grafting can be up to R1.8-million.
A new technique developed by doctors at Tygerberg Hospital is now challenging this prognosis for serious burn victims, offering life-saving, viable and affordable treatment and making their previously bleak outlook much brighter.
Dr Wayne Kleintjes, the head of the adult burn unit at Tygerberg Hospital, developed the new technique. It makes use of the patient’s own skin, which is then externally cultivated in a laboratory from skin harvested via a skin biopsy. Other options, using skin from donors or other species are soon rejected and have proven to be of limited value.
The new technique is remarkable in the sense that it offers patients treatment at a fraction of the cost that similar techniques would normally cost. “With our new technique, we treated the first patient with a total cost of R995,” Kleintjes said.
The technique is not entirely new, but the culture method differs dramatically from others in its simplicity, effectiveness, biological safety and modest cost. The technique costs about R1 000; comparable treatment using existing methods could stretch to R1.8-million. A great advantage is that no immunosuppressant drugs are needed because the patient’s own skin is used.
Kleintjes explained that the technique was revolutionary because no expensive and extensive laboratory equipment was needed. “We can now grow skin in the room next to the patient,” Kleintjes said.
“The simplicity of the technique, the cost-effectiveness and the effectiveness is comparable to other skin culture techniques and also important is the fact that it is absolutely biologically safe. This makes it very suitable for use in a third world country,” he said.
“You need a skin biopsy from the patient,” he explained the technique in broad brushstrokes. “The skin is then cut up in smaller pieces, then you grow the skin for 14 days. Once the skin has grown out in layers, you can place it on the patient.”
It differed from the well-known Epicel technique – the technology that was used for young burn patient Pippie Kruger – in that with Epicel the skin was cultured in a major laboratory. “The skin cells are grown on mice cells. With our technique you don’t need expensive laboratory equipment. No animal material is used, making it biologically safe.”
Western Cape Health MEC Nomafrench Mbombo was excited that the new technique would make access for patients to this innovation possible. It would help to treat many patients.
“In the Western Cape we have a lot of shack fires. There is a great need,” she said.
Speaking at a press briefing announcing the breakthrough, Kleintjes said that in most cases, burns covering more than 30% of the total body area were life- threatening. “Patients will certainly benefit from this new technique.”
Two patients already treated
This new technique, which Kleintjes called the “Tygerberg Burns Unit technique”, has been successfully used in the past year on two patients. A 16-year-old boy was discharged from the intensive care unit only two weeks after receiving the transplant and the second patient, who had 63% total body surface area burns, was out of the unit in four weeks.
Full application was made to Stellenbosch University’s Health Research Ethics Committee in 2014 to request that the procedure be extended to help other patients.
Inspiration from patient
Kleintjes said the idea for the new technique came while he was treating the 16- year-old, who was burned following an assault. The patient was in intensive care for three months and his condition was rapidly deteriorating.
“He was basically just skin and bones,” Kleintjes said. “It was not possible to operate on the patient because he was too weak. The only resort was to use cultured skin, but unfortunately the Epicel product was not available due to an import ban.”
Kleintjes said he prayed out of desperation to save his patient’s life. “Fortunately, God gave me insight into the new technique.”
The boy is now in the general burns ward.
The exact details of the new culture technique have not yet been made public. Kleintjes said he hoped it would not be commercialised. “There is a risk that companies will make this technique available at a price. For us in third world countries, with lots of burn patients, price is very important,” he said.
“I know that, if you are not careful, people can copy the technique and sell it at a high price. This will defeat the purpose of making it available as a cost-effective way to save many patients.”
The doctor said he was awaiting final feedback on the pending patent for the technique.
A host of other techniques are available, but none of them prove to be cost- effective. This is particularly important in this country, where the South Africa Medical Research Council estimates that approximately 3.2% of the adult population suffer from thermal injuries a year.
The Western Cape Department of Health stated that “the primary goal with the method is to save the patients’ lives. The secondary goal is to do it safely and within budget.”
“We are very proud of our clinicians; their relentless quest for excellence and their spirit of innovation,” said Dr Beth Engelbrecht, the head of the department.