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To Our Children Section

Breakthroughs: Medicine- Saving Burn Victims
Discover Magazine, September 1994

THE PROGNOSES FOR THE TWO young girls rushed to the burn unit at St. Joseph's Medical Center in Fort Wayne, Indiana, last winter weren't promising. Third-degree burns covered 35 percent of one girl's body and the entire lower half of the other girl's; the latter was given a fifty-fifty chance of surviving. Yet both girls were released from the hospital within two months, at least a week or two ahead of  schedule, and are now well on the way to recovery. They owe their good fortune to a new permanent skin-replacement product.

Third-degree burns destroy the dermis, the capillary-rich layer of skin just below the outermost skin surface. (First-degree burns redden the skin; second- degree burns cause blisters and some damage to the dermis.) These wounds are particularly dangerous because they leave the body defenceless against invading germs. No one has made a barrier more effective at preventing infection than human skin, so surgeons have used cadaver skin to treat burns since 1881. Unfortunately, the body's immune system always rejects the graft, usually within two weeks, forcing surgeons to continually replace the cadaver skin.

Now researchers at LifeCell Corporation in The Woodlands, Texas, have developed a permanent replacement for the dermis. AlloDerm, as the researchers call their product, is made from cadaver skin just like traditional grafts. But there's one crucial difference. LifeCell researchers remove all the skin cells in the cadaver dermis, since they are the targets of the immune system's wrath. Without the cells, the dermis consists of a matrix of connective tissue-- collagen and other proteins--that the immune system doesn't attack.

In healthy skin, cells called fibroblasts continually help regenerate the dermis. Although LifeCell's procedure removes the fibroblasts, it leaves the dermis' protein scaffolding intact. This is critical because the protein in the AlloDerm signals fibroblast cells elsewhere in the body to move in and replace the missing fibroblast cells in the AlloDerm. "Once the AlloDerm is grafted, within days you see thepatient's own fibroblast cells migrate up into the AlloDerm and take up housekeeping right where the other fibroblast cells were removed," says Jane Lea Hicks, a LifeCell vice president. "The fibroblasts begin to reconstruct the skin using the AlloDerm as a template."

"AlloDerm expedites the healing process and gets patients out of the hospital sooner," says Robert Voorhees, the medical director of St.  Joseph's Regional Burn Center. Although Voorhees cautions that his staff hasn't yet been able to do any long-term monitoring of patients treated with AlloDerm--only a few such operations have been performed--he remains optimistic. "It seems to be about the best thing we have for covering large areas quickly with the least amount of problems."

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