Tygerberg From The Air

New Skin Grafting Technique Could Make Treatment Accessible To All

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A novel approach to skin grafting could offer medical professionals with a breakthrough technique which will allow them to treat burns and other skin problems in new ways. Using the patient’s own skin, the procedure will lead to benefits for many burn victims who are treated in hospitals all over the world, it is hoped. Developed by Dr Wayne Kleintjes, who is head of the adult burns unit at that hospital at Stellenbosch University in South Africa, the technique has already been described as potentially life-saving in many burns cases as well as being a cost-effective transplant compared with other methods now in use.

Tygerberg From The Air

Image: Tygerberg from air by Dfmalan Creative Commons 3.0

Dr Kleintjes, who is also a lecturer in surgical sciences, has called his new technique an 'autograft'. Following his first successful use of the technique in May 2015 at Tygerburg Hospital on a sixteen year old patient, the innovative approach has now been announced to the world. The provincial medical authorities in South Africa described Dr Kleintjes technique as a 'bold and innovative breakthrough' after he 'autografted' a culture transplant on some severely burned patients. Kleintjes' technique is said to be able to help the skin of burn victims to recover both quickly and effectively. Nevertheless, it is the low-cost settings that it can be done in which is now getting most attention from medical professionals around the world because his method does away with the need for expensive and specialist laboratory equipment.

According to Dr Kleintjes, the procedure is not completely new, but has been developed from tried and tested techniques that are already widespread. However, his culture method differs somewhat from others due to its simplicity and modest price. His technique could ultimately cost only a few per cent of what a comparable treatment using existing methods currently does. Despite the biological safety needed for successful skin grafting, which has a cost implication, the principle advantage of Kleintjes' system is that little or no immuno-suppressant drug course are required. This is because the technique makes use of the patient's own skin which is not attacked by the body's immune system when it is grafted on.

Nonetheless, using patient's own skin has been done many time before. Dr Kleintjes explained that his approach breaks new ground in medical science because no expensive laboratory kit is needed to grow this skin. Under the current methods, skin cultures are grown in laboratory conditions which might be miles away, requiring extensive equipment and a thorough administrative system. “We are now able to grow skin in the room right next to the patient in their hospital,” he said. “The simple nature of the technique, its value for money and its effectiveness compared with other skin culture procedures makes it very suitable for use in a developing country,” Kleintjes continued. “It is also important to point out the fact that it is absolutely safe.”

IncubatorExpanding on his technique in broad terms, Kleintjes said that the medic first takes a small skin biopsy from the patient. Providing this is healthy, the skin is then split up in smaller sections under the scalpel. “You then grow the material for a fortnight in an incubator – once the skin has grown out into layers – it is possible to you place it on the patient, where it can take hold,” he added.

The medic has been keen to point out how he was inspired to develop the new approach. Following months of not being able to fully treat a teenage burns patient, Kleintjes said the he was also faced with a similar burns case – this time a young boy. Last autumn, this led him to pray for a solution. The unnamed child had been the victim of a petrol bomb incident and remained in the hospital’s intensive care unit with a similarly poor prognosis. After many weeks which saw no improvement in the condition of his skin, the boy had lost nearly all of his muscle tissue. The boy could have been treated at a high cost with other techniques, if sufficient money could have been raised, but Kleintjes instead turned to divine inspiration. “The only way forward was to make a plan for ourselves,” he said. “I asked God for some insight and he gave the solution to me,” he added. According to the hospital where the boy was treated, within a few weeks of performing the autograft, the transplant take up rate was at 78 percent, meaning that was highly successful.

Some of the exact details of the new skin grafting technique have yet to be put into the public arena. According to Kleintjes, the current hope is that his procedure will not be commercialized, but made available to all to use. He has already expressed some concern that there may be a risk of companies making the technique available at inflated prices. “For us in countries like South Africa, price is a very important factor in the treatment of burns victims,” he said.

“We know that, if we do not take sufficient care, some people will copy the technique and sell it at an inflated rate,” Kleintjes went on. “This would defeat the purpose of making it available.” Backed by the calls from other professionals for a cost-effective way to save many patients, the doctor said he was waiting for the final clinical feedback from his patients before proceeding with the patent he has pending for the procedure.

The Western Cape Department of Health, which covers the area Kleintjes works in, echoed his comments, stating that the primary goal of the method is to better the chances of patients treated by it. “Its secondary aim is to do so safely and within budget,” it said. Head of the Health Department, Dr Beth Engelbrecht, also agreed that the innovation should change the costs of the way serious burns victims are treated in the province in future. She said the plan was to try to prevent profiteering. In the event that it is commercialized in future, she said that the money gained should be of benefit to Stellenbosch University.