Reopened burn center offers cutting-edge care

August 13, 2020
the patient and nurse laugh together as she applies a bandage to his arm
MUSC nurse practitioner Elizabeth Halicki puts bandages on Tommy Porcha's burn wounds. Photos by Sarah Pack

A Dorchester County man is home a week earlier than might typically be expected after an MUSC Health team performed the first reported successful minimally invasive skin graft on a burn in the U.S. 

Tommy Porcha, 54, suffered deep second-degree burns over 17% of his body on July 26. Care for burns like Porcha’s hasn’t changed much since the 1970s whereby a surgeon would have performed a skin graft by removing almost all the skin from Porcha’s thighs, then stretching it and placing it over the wound to regrow.

Luckily for Porcha, MUSC Health’s recently reopened burn center is one of a handful of burn centers in the U.S. that is participating in a study of using an enzyme gel rather than traditional surgery to remove burn wounds. In addition, MUSC Health regularly uses a regenerative technology that utilizes a skin cell spray rather than entire sheets of skin.

The combination of these two technologies allowed Steven Kahn, M.D., chief of burn surgery, to avoid a conventional skin graft and, instead, perform a more precise repair that should result in less scarring over the burned areas and more long-term mobility.

When the accident happened, Porcha was helping a friend to burn old logs on his property near Woodland High School. But he was distracted for just a moment.

“That one second it took to distract me was all it took to explode,” Porcha said.

He managed to launch himself forward off the pile as the flash burn scorched the back of his neck, arms and leg.

“It was such an intense heat,” he recalled. The pain of his exposed wounds was excruciating as the sunlight hit them – nonetheless, Porcha drove himself to Summerville Medical Center.

The staff there told him he needed to be treated at a burn center. Until recently, for many adult South Carolinians, that would have meant going to the burn center in Augusta, Georgia. But Kahn was brought on board in July 2019 with the task of creating a comprehensive burn center in Charleston to care for patients of all ages. This essentially involved reopening MUSC Health’s adult burn center, closed since 2002. Kahn and his team began taking adult patients in May, which turned out to be perfect timing for Porcha.

the patient lifts one arm overhead while the doctor looks at the wound 
Dr. Steven Kahn checks on Tommy Porcha's mobility almost two weeks after he was burned. The shirt that Porcha was wearing provided some protection from the fire.The three rectangular wounds below his right shoulder are where Kahn took skin to create the skin cell spray for the minimally invasive skin graft.   

The first step for the surgeon is removing all of the damaged tissue. This is typically done visually, using a knife – obviously with great skill that comes from years of experience, but still, surgeons can’t see down to a cellular level with their eyes. That’s where the enzyme therapy comes in.

The product, called NexoBrid, is derived from pineapple stems. It eats away at dead tissue but won’t touch living tissue – even minute traces of living tissue invisible to the surgeon, Kahn said. The product is awaiting approval from the U.S. Food and Drug Administration after completing phase 3 clinical trials.

“The enzyme is more likely to preserve a small amount of healthy dermis, the underlayer of the skin, to help with healing,” Kahn said.

This precision cleaning of the wound means patients have more dermis preserved and are less likely to need a skin graft, he said. If they do need a conventional skin graft, it is usually about a third of the size of what might be expected because so much of the still-living dermis has been protected. But although conventional skin grafts are lifesaving, they aren’t a perfect solution. They’re painful, they leave scars and they can tighten up over time, Kahn said.

Porcha was able to avoid a conventional skin graft. With the wound cleaned with the enzymatic solution, Kahn believed Porcha was a good candidate for another relatively new technology – Spray-On Skin Cells. Even if there aren’t enough remaining dermis and healthy skin cells that can heal on their own after wound cleaning, the skin cell spray can be used to replace missing cells and allow healing where it wouldn’t have otherwise occurred without a graft. 

“I thought we could spare him a lot of pain and suffering by avoiding a large donor site. He had 17% burns, and half of the area needed a skin graft."

Dr. Steven Kahn

“I thought we could spare him a lot of pain and suffering by avoiding a large donor site. He had 17% burns, and half of the area needed a skin graft. But there was a thin layer of dermis left after the enzyme was put on – enough that I felt comfortable using the skin cell spray,” Kahn said.

Instead of taking all of the skin from Porcha’s thighs, Kahn removed three sections from an unharmed section of his back of about a half-dollar size each. The skin from those donor sites was then placed in the ReCell device to incubate for about 20 minutes. In that time, the skin was broken down and turned into a skin cell spray capable of covering 80 times the area of the donor sites.

“That’s very dramatic compared to regular grafting,” Kahn said. With a conventional skin graft, he explained, “We usually only expand one to three times the original size, and the more you expand them, the worse the scar and the worse the functional outcome is.”

The regenerated skin cells are then sprayed over the wound, where they begin to grow.

Kahn said the spray can be used without a graft only on certain burns, like Porcha’s deep second-degree burns. The enzyme is available only through a clinical trial, and this is the first reported combination of the two technologies in the United States. If only one or the other had been used, Porcha would have still needed a graft, Kahn said.

Porcha is grateful for the entire team, which in addition to Kahn includes nurses, physical therapists, occupational therapists, and dietitians.

“I’m blessed to have you in my corner,” he told Kahn.

About the Author

Leslie Cantu
MUSC Catalyst News

Keywords: Features