Grafting
hope
Page 3
 Usually,
though, the grafts aren’t meant to be long term replacements
since blood vessels can’t grow into them fast enough to keep
them alive. They’re just patches to loosely complete the structure
of the skin to fool the fibroblasts into building only a thin layer
of scar between the graft and the skin. To make grafts take, doctors
must perform microvascular surgery to connect blood vessels in the
graft to the pipe work of the damaged area. The procedure is costly,
time-consuming and excruciating intricate. In many instances, the
damage to the supporting blood vessels is too extensive, and the
operation fails.
For some patients, there just isn’t enough skin to go around.
When too much of a patient is covered in burns, other fillers have
to be found. Thirty years ago, this likely would have been refrigerated
cadaver skin. Today, artificial skins offer a more reliable, more
sanitary solution. The most commonly used artificial skins are made
of a thin sheet of silicon covering a thick layer of specially processed
collagen taken from cow bone. This loosely packed collagen is soaked
with nutrients that act like comfort food to the fibroblasts, drawing
them out of the frenzied pace and to the slower process of replacing
the cow collagen with their own. With the fibroblasts following
the cow collagen template, the result is much less tightly packed,
leaving something less than skin but much more tactile than a scar.
In as little as two years, artificial skin grafts may leave patients
like Lisa with scars virtually indistinguishable from real skin.
King is currently developing a technique in which he grafts a layer
of epidermis scavenged from the patient’s body onto the artificial
skin collagen. The trick is putting the epidermis on in the small
window of time after enough small blood vessels have worked their
way into the collagen to provide blood flow, but before the collagen
has been completely rebuilt by the body’s fibroblasts. Without
blood flow, the cells will die from lack of oxygen and nutrients.
If the collagen has to be rebuilt, it’s officially a healed
scar and the epidermis can’t grow into it. If successful,
the end result (which has already been tested on a few firemen)
looks, wrinkles, and stretches like skin, although it does lack
the ability to sweat or to grow hair.
Those problems, however, might be solved by the work Dr. Steven
T. Boyce at the University of Cincinnati. With Boyce’s technique,
a sample of the patient’s epithelium is taken and then grown...
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