1. BURN TREATMENT AND TISSUE ENGINEERING OF THE SKIN Presentation By: Cara Nunez

2. BACKGROUND  Skin:  Epidermis  Dermis  Hypodermis/Subcutaneous Layer  Functions of the Skin:  1. Protect the body  2. Sensation  3. Heat Regulation  4. Control of Evaporation  5. Absorption  6. Water resistance  7. Storage/Synthesis  8. Aesthetics/Communication

3. BURNS Burns are generally classified by depth The time they take to heal are directly related to the depth of the burn 1 st and minor 2 nd degree burns are painful Serious 2 nd degree and 3 rd degree burns do not hurt because the nerve endings are destroyed

4. BURNS (CONT.) 1 st Degree  Only epidermis  Healing time is 1 week or less 2 nd Degree  Epidermis + Dermis  Healing time – several weeks, deeper burns take longer 3 rd Degree  Epidermis, Dermis and Subcutaneous layers  Healing time – many weeks, usually requires excision and grafting and can cause complications including amputation and loss of life

5. HISTORY OF BURN TREATMENT The overall goal of burn treatment is to fully heal the skin with minimal scarring and full functionality, while also managing the patient's pain Mankind has been trying to heal burns since the discovery of fire Ebers Papyrus (1500 BC) lists a mixture of cattle dung and black mud as “just what the doctor ordered” for burns

6. HISTORY (CONT.) For many years there was very little consensus on how to treat burns Fabricius Hildanus, a German Physician, first classified burns into three degrees in the 1600's After World War I the preferred treatment was surgical skin transplantation → Less scarring than before

7. HISTORY (CONT.) Wide use of firebombs in the Korean war of the 1950's The U.S. Army Burn Center in San Antonio, Texas makes it a standard to skin graft patients with 30% or more total body surface area burns

8. HISTORY (CONT.) The new standard of treatment became to excise the necrotic tissue and replace it with grafts of healthy skin, usually taken from the patient's legs This is effective, but the patient is still disfigured, covered in scars and can suffer from chronic life long pain

9. CONVENTIONAL WESTERN BURN TREATMENT In many cases grafting is not possible because there simply is not enough healthy skin left Doctors have been able to culture and grow skin since the 1970's These sheets of skin are extremely fragile and take weeks to grow – precious time in which a patient can develop an infection and die

10. HOLISTIC TREATMENT Professor Xu Rong Xiang of China introduced a new, holistic method of burn treatment in the 1970's “Moist Exposed Burns Treatment” (MEBT) “Moist Exposed Burns Ointment” (MEBO) [patented] No surgical excision!

11. TISSUE ENGINEERING OF THE SKIN Tissue engineering of the skin is a combination of all of this Skin grafting was an innovative method when it was first implemented Tissue engineering is starting to be the bridge between the conventional methods of burn treatment and Xiang's holistic method

12. CURRENT METHODS Conventional: Work to improve methods for growing cultured skin Specialized scaffolds can be used to support more complex/thick layers of epidermal cells This is called ex-vivo skin growth Pros:  Highly effective for 2 nd degree burns  The skin is the patient’s own and does not need to be taken from another body site Cons:  As of now, this method still leaves major scarring  This method cannot regenerate destroyed nerve endings

13. CURRENT METHODS (CONT.) Holistic Method: Using MEBO allows for regeneration of the tissue This area of research is quickly moving towards stem cells as a method allowing more natural skin regrowth Pros:  The skin that regrows will have less scarring than grafted skin Cons:  This technique is not as tried and tested as skin grafting - however, it is more widely used in China and has shown great success in clinical trials there

14. THE FUTURE OF SKIN TISSUE ENGINEERING A suspension of the patients own skin stem cells can be evenly sprayed like paint onto the burn This technology is still being tested but seems very promising

15. RESOURCES  Bianco, Paolo, and Pamela Robey. "Stem Cells in Tissue Engineering." NATURE. Macmillan Magazines Ltd, 1 Nov. 2001. Web. 13 Oct. 2012..  Gallico, MD, Gregory, Nicholas E. O'Connor, MD, Carolyn Compton, MD, and Olaniyi Kehinde, B.A. "Permanent Coverage of Large Burn Wounds with Autologous Cultured Human Epithelium." The New England Journal of Medicine (1984): 448-51. Print.  "Glossary about MEBT/MEBO." Glossary about MEBT/MEBO. China Herb Store, n.d. Web. 13 Oct. 2012..  Horch, Raymond E. "Future Perspectives in Tissue Engineering." Journal of Cellular and Molecular Medicine (2007). Print.

16. RESOURCES (CONT.)  Pomahac, and Svensio. "Tissue Engineering of Skin." Division of Plastic Surgery, Brighom/Children's/Harvard, 1998. Web. 13 Oct. 2012..  "Video -- The Skin Gun -- National Geographic." Video -- National Geographic. National Geographic. Web. 13 Oct. 2012..  Weeks, MD, Bradford S. "Brief Introduction to the History of Burns Medical Science." Burns Regenerative Medicine and Therapy (2000). Karger.com. 2000. Web. 13 Oct. 2012..