Conflicts in Iraq and Afghanistan brought a surge in burn and blast wound injuries from improvised explosive devices. Many who sustain such injuries endure years of rehabilitation and countless surgeries.
Finding innovative strategies to heal these complex wounds more quickly, with fewer complications and less long-term impact from scarring, contractures and disability is a high priority for military medicine. In 2008, the Department of Defense established the Armed Forces Institute of Regenerative Medicine, or AFIRM, led by the Wake Forest Institute for Regenerative Medicine and Rutgers University. AFIRM was designed as a partnership between academia, industry and the government to deliver regenerative medicine therapies with the goal of restoring form and function to the most critically-injured wounded warriors.
“Regenerative medicine is a rapidly growing area of science that aims to unlock the body’s own ability to rebuild, restore or replace damaged tissue and organs,” said Kristi Pottol, director of the Tissue Injury and Regenerative Medicine Program Management Office. “Much of regenerative medicine research in the civilian sector is focused on finding ways to reduce the burdens of chronic illness — diabetes, heart disease and others. The DoD wants to use these technologies to treat complex traumatic injuries.” At Fort Detrick, Maryland, the Tissue Injury and Regenerative Medicine Project Management Office at the U.S. Army Medical Materiel Development Activity is monitoring the progress of two new burn treatments under development with DOD funding: ReCell and StrataGraft.
Skin wounds are categorized by the amount of total body surface area involved and by the layers of skin tissue involved, both of which determine how the body responds, how the wounds heal and therefore, which treatment strategies are necessary. The larger and deeper the skin injury, the less likely it is the wound will heal without intervention. That’s where innovations like ReCell and StrataGraft come in, Pottol said. The standard treatment for burn wounds is to harvest healthy skin from elsewhere on the patient’s body and to use it to cover the burn wounds. This creates another wound on an already fragile body and is extremely painful for the patient.
ReCell, by Avita Medical, harnesses the skin’s own regenerative properties. In the operating room, surgeons take a sample of healthy skin about the size of a postage stamp and place it into the ReCell device to create a suspension of individual skin cells. Within 30 minutes, the resulting cell suspension can treat a skin wound, which is 80 times larger than the skin sample taken. ReCell speeds the healing process, decreases the need to harvest skin from donor sites and improves the appearance of the burn scars. StrataGraft is for more severe burns. Developed by Stratatech Corporation, StrataGraft is a living, meshable, suturable human skin substitute that reproduces many of the structural and biological properties of normal human skin.
Patients with extensive skin injuries sometimes do not have enough remaining healthy skin to take skin grafts from to cover all of the skin injuries with one procedure. In such cases, burns are covered with cadaver skin or synthetic dressings while waiting for donor sites to heal to re-harvest the site. Unfortunately, after about two weeks, the body rejects cadaveric or synthetic coverings.
The promise of StrataGraft is that it may eliminate the need for donor sites altogether. Surgeons would have a ready supply of tissue “off-the-shelf,” saving donor sites, reducing trips to the operating room and minimizing complications.
“The promise of both of these new technologies is that they could be the first substantial change in how burn and skin injuries are treated in the last half century,” said Dr. Wendy Dean, Tissue Injury and Regenerative Medicine Program Management Office medical advisor. “Sparing burn patients the pain of large donor sites, or offering surgeons a ready-made, permanent option for wound coverage could lead to a paradigm shift in skin injury treatment.”