Until recently the outlook for patients in South Africa with extensive burns was bleak. The best they could hope for were highly specialised transplant techniques, depending on the availability of resources. If they survived, patients faced long and excruciating hospital stays, with mixed results at the end of their treatment alongside a very substantial bill. In some cases the total cost of skin grafting can be up to R1 800 000.
A new technique developed by doctors at Tygerberg Hospital is now challenging this prognosis for serious burn victims, offering life-saving, viable and affordable treatment and making their previously bleak outlook much brighter.
Dr Wayne Kleintjies, head of the adult burn unit at Tygerberg Hospital developed the new technique, which makes use of the patient’s own skin, which is then externally cultivated in a laboratory from skin harvested via a skin biopsy. Other options, using skin from donors or other species are soon rejected and have proven to be of limited value. The new technique is remarkable in the sense that it offer patients treatment at the fraction of the cost that similar techniques would normally cost. "With our new technique, we treated the first patient with a total cost of R995," Dr Kleintjies said.
Dr Wayne Kleintjies discusses the procedure
The technique is not entirely new, but the culture method differs dramatically from others in its simplicity, effectiveness, biological safety and modest cost. The technique costs around R1 000 whereas comparable treatment with existing methods could stretch to R1 800 000. A great advantage is that no immunosuppressant drugs are needed because the patient’s own skin is used. Dr Kleintjies explained that the technique is revolutionary due to the fact that no expensive and extensive laboratory equipment is needed. "We can now grow skin in the room next to the patient", Kleintjies said. "The simplicity of the technique, the cost effectiveness and the effectiveness is comparable to other skin culture techniques and also important is the fact that it is absolutely biologically safe. This makes it very suitable for use in a third world country."
Dr Kleintjies explains the technique in short: "You need a skin biopsy from the patient. The skin is then cut up in smaller pieces, then you grow the skin for 14 days. Once the skin has grown out in layers, you can place it on the patient."
Kleintjies further explains that it differs from the current well known Epicel (the technology that was used in the Pippie Kruger case), in that with Epicel the skin is cultured in a major laboratory. "The skin cells are grown on mice cells. With our technique you don't need expensive laboratory equiptment. No animal material is used, making it biologically safe."
Listen to Western Cape Health MEC Nomafrench Mbombo discuss the potential impact of the treatment across the third world
Western Cape Health MEC, Mrs Nomafrench Mbombo said that she is excited that the new technique will make access (for patients) to this innovation possible." She further said that the new technique will help treat many patients. "In the Western Cape we have a lot of shack fires. There is a great need."
During the press conference Dr Kleintjies said that burns covering more than 30% of the total body area are life-threatening in most cases. "Patients will certainly benefit from this new technique."
Two patients already treated
This new technique, referred to by Kleintjies as the "Tygerberg Burns Unit technique", has been successfully used in the past year on two patients. A 16-year-old boy was discharged from the ICU only two weeks after receiving the transplant and the second patient, who had 63% total body surface area burns, was out of the ICU in four weeks.
Full application was made to Stellenbosch University’s Health Research Ethics Committee in 2014 to request that the procedure be extended to help other patients.
Dr Kleintjies said the idea for the new technique came about while he was treating the sixteen-year old patient that suffered extensive burns following an assault. The patient was in ICU for three months and his condition was rapidly deteriorating. "He was basically just skin and bones", Kleintjies said. "It was not possible to operate on the patient because he was too weak. The only resort was to use cultured skin, but unfortunately the Epicel product was not available due to an import ban." Dr Kleintjies said he prayed out of desperation to save the patients life. "Fortunately, God gave me insight into the new technique" he says
The patient that received skin cultured from the new technique is currently in the general burns ward.
Dr Kleintjies with Health MEC and the patient
Hope that new technique is not commercialised
The exact details of the new culture technique have not yet been made public. Kleintjies said that he hopes this technique will not be commercialised. "There is a risk that companies will make this technique available at a price. For us in third world countries, with lots of burn patients, price is very important. I know that, if you are not careful, people can copy the technique and sell it at a high price. This will defeat the purpose of making it available as a cost effective way to safe many patients." Dr Kleintjies said he is currently awaiting final feedback on the pending patent for the technique.
A host of other techniques are available, but none of them prove to be cost effective. This is particularly important in this country, where the South Africa Medical Research Council (SAMRC) estimates that approximately 3.2% of the adult population in South Africa suffer from thermal injuries a year. In a press release from the Western Cape Department of Health, it is stated that "the primary goal with the method is to save the patients' lives. The secondary goal is to do it safely and within budget."
"We are very proud of our clinicians; their relentless quest for excellence and their spirit of innovation," Dr Beth Engelbrecht the Head of the Western Cape Department of Health said in a press release.
Dr Beth Engelbrecht and Dr Kleintjies