A few days before Christmas, 7-year-old Belinda Bohaty of Strongsville, Ohio was playing with the valve on a water heater in her home when it suddenly opened, spraying steaming water on her face, chest, back and arms. Happily, her face and torso were not severely injured, but third-degree burns covered large portions of her upper arms.
Doctors feared that when the burns healed, deep scar tissue would limit the mobility of her elbows and shoulders. Now, thanks to a promising skin grafting technique developed by two doctors at the Children’s Hospital of Akron (but applicable to adults as well), Belinda is gradually regaining use of her arms and likely will not suffer serious long-term limitations.
Dr. Howard Igel, chief pathologist and director of laboratories at the hospital, and Dr. Aaron Freeman, the senior research associate, had been working on a way to grow human skin in the laboratory.
When Belinda entered the hospital, a small patch of healthy skin was taken from her thigh. In the lab Freeman and Igel diced the patch into small particles and laid them on a sheet of pigskin, long used as a temporary cover for third-degree burns. For two weeks, as the particles of skin were bathed in nutrient fluids, they grew to 20 times their original size and attached themselves to the pigskin.
By then Belinda’s condition had stabilized, and she was taken back into the operating room. A surgeon laid the strips of pigskin over the burns, anchoring them with bandages. As the particles of skin grew to 50 times their original size and completely covered the burn, the pigskin was sloughed off.
In the standard treatment for massive burns, surgeons lay strips of healthy skin in a latticework web across the wound, on a ratio of one square inch of skin to every nine square inches burned. When such grafts fill in, the skin is usually splotchy and the outlines of the latticework are visible.
Aside from the potential cosmetic advantages, Igel’s and Freeman’s method may enable surgeons to cover severely burned victims more rapidly, thus greatly diminishing their chance of dying from fluid loss or infection. Currently, 50% of the people who suffer third-degree burns over 50% of their bodies die. For those burned over 75%, the survival rate is near zero.
“If I told you we were damn proud of what we’ve done I’d be understating it,” says Dr. Freeman. “As it’s tested at burn centers across the nation, our method will be revalidated.” He and Igel have been a research team for seven years and still meet each day just to talk over ideas. “We have very intense collaboration on everything we do—in fact it gets so we don’t know who’s doing what,” says Igel.
They first got together while engaged in cancer research at the National Institutes of Health in Bethesda, Md. They continued to collaborate even after Igel left Bethesda for Akron in 1968, consulting by telephone with occasional visits, until Igel lured Freeman to Akron. “Hell, he was a good two years ahead of anyone else in the field. And I wanted to be in on it,” Freeman says. “Besides, he offered me more money.”
Peering over the tip of his ever-present cigar, Igel allows as how Freeman has a real “green thumb” when it comes to scientific research—”the kind of stuff you don’t learn from textbooks, a gut reaction about what we should try next.”
Though they are hopeful that their treatment will become routine for third-degree burns, so far they have only published results of grafts done on rabbits. “There just hasn’t been enough time to study the long-term results on humans,” says Freeman. “But we’re ready to become the world’s first burned rabbit treatment center.”