“Spraying and replenishing the skin” seems like pure science fiction to some, but for others it is already a reality of clinical treatment. For the first time in Europe, the Red Cross Hospital in Kassel, Germany, has applied a new method developed by Australian medical doctors for people with severe skin burns.
The 5-year-old girl, Deborah, will be discharged from the hospital tomorrow, and Dr. Noah, the head doctor, wanted to see the little patient again before she was discharged, especially the healing of the area they treated with the skin spraying method, which made both the doctor and the patient very happy.
A year ago, an accident left Deborah with severe burns on part of her skin. For a year, little Deborah underwent numerous surgeries, and a few weeks ago, surgeons in Kassel sprayed Deborah’s own skin cells on her chest to make new skin grow over the burned area.
The key technology for this method is a scientific achievement from the University of Cambridge in England, called “Recell-Kit”, which means “regenerative cell kit”. The clinical application of this result was developed in Australia for the treatment of severely burned people. Now, for the first time in Europe, plastic surgeons in Kassel have applied this new skin grafting method on Deborah.
The entire “regenerative cell kit” looks unimpressive, a box about the size of an ordinary lunchbox with three pits containing a special liquid for the surgeon to handle the skin cells directly in the operating room. Very important here, and one of the great advantages of this method, is that the size of the patient’s autologous skin fragments needed for the procedure is much smaller than what has been required by other methods to date, greatly reducing the impact on the patient. NOAA describes: “The maximum autologous skin piece we need is no more than 2 cm square, about the size of a typical postage stamp. You saw little Deborah earlier. We took a small piece of skin from her inner thigh and then processed it directly in the operating room with this ‘regenerative cell kit’. It is important that the skin slice be so thin that the donor area, the thigh area, can recover itself after the surgery. Nevertheless, there will be scars in the donor area, so our efforts are directed at minimizing the donor area. This ‘regenerative cell kit’ takes us a big step in that direction.”
The procedure begins with surgeons holding forceps in their hands and using a special enzyme to separate the upper, or superficial, layer of skin from the lower layer of skin in the selected postage-stamp-sized donor area. After a few passes, the spray containing the freshly excised skin cells is prepared and ready for use. Noah describes: “What we get is a suspension that is made up of a salt solution and the individual cells that are isolated. We sucked this suspension into a syringe and then placed a spray device on the end of the syringe, just like the thing on a small perfume bottle. With a simple press, this cell suspension can be sprayed in the form of a fine-grained mist onto the site of the patient’s trauma or burn.”
All of these steps are done in the operating room in a single pass, taking only 20 to 30 minutes before and after the skin is removed and sprayed with the patch. However, the maximum area of trauma that can be covered with this new method is only the size of a palm. For larger wounds, the traditional method, in which the hospital sends the patient’s skin cells to a special laboratory, where they are cultured and multiplied over several days or even weeks, and then returned to the hospital for use, is extremely expensive.
Now, in Kassel, Dr. Noah is also applying this so-called “skin spraying method” to the plastic surgery department. This fall, they will use this new method for the treatment of patients with severe pigmented lesions, also known as leukoplakia. Until now, leukoplakia has been an incurable disease. The introduction of the new method has filled dermatologist Majer with confidence. He believes that another advantage of the “skin spraying method” here is that the surgeon can spray all other types of cells in addition to pigment cells, i.e. melanocytes, and let them mix to produce new skin. In this mixture there are stem cells, melanocytes, which are responsible for coloring the skin, cells that eventually produce keratinocytes, and the skin cells that are formed,” says Noah. The skin cells are the largest part of the mixture. Of course, there are also immune cells in there. In other words, all the various shapes and sizes of cells contained in our skin can be contained in this suspension and applied to the patient’s skin through the spray method.”
The most important aspect of this application, Noah emphasized, is to find the correct cell formulation for each patient so that the suspension that is sprayed on can produce the correct skin. He continued, “The spray-on skin, the cells that we spray on, first have to survive on the nutrients provided by the wound and then take root in the wounded tissue to form stable skin. Because all the cells are taken from the patient’s own body, there’s naturally no immune rejection whatsoever.”
At least in the case of little Deborah, 5, there was no immune rejection, and all went well with the surgery. Tomorrow, she will finally be able to go home.