Burn Center Officially Opens Offering Cutting-Edge Care

Minimally invasive skin graft
Dr. Steven Kahn checks on Tommy Porcha's mobility almost two weeks after he was burned.

The only burn center in the state, Steven Kahn, M.D., chief of Burn Surgery, established the South Carolina Burn Center at MUSC Health to provide comprehensive care for patients of all ages in both the inpatient and outpatient settings.

Prior to opening the new comprehensive center, most adults in South Carolina would travel to Georgia for burn care, while pediatric patients have been able to receive care at MUSC. Burn patients have access to more than 50 specialists and programs whether treated at the new adult burn unit, or the already established pediatric burn unit at the MUSC Shawn Jenkins Children’s Hospital, which is led by Dr. Aaron Lesher, M.D., MSCR.

Since it opened in May, the burn center has met the projections established for the 3 - 5 year mark and is changing what’s possible in burn care through innovation and discovery.

The adult burn care team recently performed the first reported successful minimally invasive skin graft in the U.S. When Tommy Porcha, 54, suffered deep second-degree burns over 17% of his body, he was able to be treated at MUSC Health’s burn center, 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 treat 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 Kahn 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.

For burn care, the first step for the surgeon is removing all of the damaged tissue. This is typically done visually, using a knife. But NexoBrid, derived from pineapple stems, eats away at dead tissue without touching 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.

This precision cleaning of the wound means patients have more dermis preserved and are less likely to need a skin graft, he 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.

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.

The new technique and the accompanying data will be presented at the American Burn Association Annual Meeting in 2021. The burn center also performs research regarding telemedicine, firefighter safety, regenerative medicine, reconstructive surgery, treating burn shock and smoke inhalation, non-opiate pain management, and minimally invasive burn care.