In another medical first for South Africa, a doctor and his team at Tygerberg Hospital in Cape Town have performed an innovative skin transplant technique (twice) that could curb the prohibitive costs of treating severe burn survivors in the public health system.
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According to Dr Wayne Kleintjes, the pioneer of this procedure and head of the adult burns unit at Tygerberg Hospital, a strip of conventionally cultured transplant skin measuring 7-10 centimetres cost about R70 000 in 2014.
When treating survivors with burns on over 40% of their total body area surface, the price of the procedure becomes problematic.
The technical method of the procedure is the innovative part. It has a lot of similarities with the basic autograft skin transplant. The conventional technique has prohibitive costs and is mostly used in first world countries and we've simplified it quite dramatically.— Dr Wayne Kleintjes
Dr Wayne Kleintjes shows the results of his groundbreaking skin transplant technique. Picture: EWN/Monique Mortlock.
How it works:
Klientjes says the procedure involves a composite cell growth process. A form of autografting or own-skin transplant; the skin tissue is removed from the patient, cut up into smaller cells and grown for 14 days. Once the skin cells have reproduced themselves, the skin is then transplanted back onto the patients body.
We’ve simplified the technique by restricting the use of different kinds of skin tissues and only use the patient’s tissue.— Dr Wayne Kleintjes
There are different kinds of skin grafting procedures to transplant skin cells. Here are two popular existing procedures:
1. Allografting is the use of another person’s skin in a transplant procedure.
2. Xenografting refers to the use of skin from other species such a pig’s skin, but is not entirely biologically safe.
These two skin transplant techniques are only temporary skin covers and have a high rejection rate post-procedure.
What makes it different:
The procedure differs from other standard skin culture techniques in its affordability, biological safety and comparative simplicity.
The procedure cost the hospital a fraction of the fees associated with Epicel Cultured Epidermal Autograft (CEA), the conventional autograft technique.
In the case of the first patient treated using the procedure, the CEA would have costs R1.8 million to cover the burn wounds; instead the total expenses only amounted to R995.
In the case of the second patient, much older and with more surface area to cover, the costs incurred amounted to R1 094.
Kleintjes says that costs are reduced as there is no need for the use of expensive laboratory space, operating theatres, radiation facilities and other imported products or preparatory equipment.
No animal materials are used in the skin culture process, making it safer and more effective, according to Kleintjes.
Some autogafting materials such as CEA are cultured in laboratories in the US, and using other animal materials. Because of health hazards, an import ban was placed on CEA last year.
Because of the reduced complication, patients have shorter stay in the hospitals, creating the potential for the state to treat more burn survivors.
The first success: A 16 year-old survivor's story
A 16 year-old boy, who suffered assault-related burns after his home was set alight in a petrol-bombing, was the motivation behind the new technique.
The young patient spent three months in the Intensive Care Unit (ICU) and weighed 19 kilograms at one point in his deteriorating state.
‘It took us two weeks to produce enough skin to cover his whole body. He was up in the Intensive Care Unit in a week and in the second week we moved him to the general ward.— Dr Wayne Kleintjes
The doctor says that they initially predicted a 75% successful graft rate, but three weeks into recovery they discovered 78% of the skin had taken and healed, a 6% improvement from what has been recorded in medical literature thus far.
Dr Kleintjes with the young recovering patient at Tygerberg Hospital's burn unit. Picture: EWN/Monique Mortlock.
When and how we can expect a roll out:
We will be very selective in using the technique and are looking at how we will apply it in our protocols. I have a sense that it will be reserve for patients with burn wounds of 40% or more.— Dr Wayne Kleintjes
Patent rights and research
Dr Kleintjes says that he cannot yet reveal all the details of the procedure until it is patented.
He and his team are in the process of legal negotiations for the rights to the procedure and he says wants to protect public health services and prevent the technique from being commercialised and sold back to them in future.
Kleintjes and his team also plan to submit their findings to the South African Medical Journal.
Accessibility in the public health sector
The Western Cape Health MEC Nomafrench Mbombo says that she is excited by this development and anticipates a positive response from those living in informal settlements; subject to more shack fires in winter months and lacking the funds for such treatment.
It promotes the access of this procedure. Poor people will be able to access this technique. In the Western Cape we have a lot of shack fires, and some of the patients with severe burn can be treated because of this new intervention.— Health MEC Nomafrench Mbombo
Listen to the full conversation on CapeTalk's John Maytham show: