New healing, hope for burn victims
Mike McAneny, 38, of Sequim was burned over 60 percent of his body in February when fire chased a trail of gasoline back to a gas can he was holding. Doctors gave him dim hopes: less than an 8 percent chance of survival.
He's been out of the hospital a month now. His skin is healing smoothly; scarring is minimal.
Ernie Libby of Montana has been in the hospital for six weeks. He suffered days of excruciating pain after severely burning his legs and stomach in an accident similar to McAneny's in April.
Now he's going through rehabilitation, expecting to walk from the hospital with minimal scarring.
Seventeen-month-old Emily Woodrow, who suffered burns over 65 percent of her body in a Ballard house fire, has undergone five surgeries at the University of Washington Burn Center at Harborview Medical Center. Rushed there May 1, she was given a 25 percent chance of survival. Now doctors have doubled it.
Though survival still seems a feat, to carry on a life with minimal physical traces of the fire would seem even more spectacular.
But Gregg, McAneny and Libby, also treated at the Harborview burn center, could tell Emily it is possible. They're examples of the results doctors are getting from a relatively new technology in severe-burn treatment, an artificial skin called Integra.
"I think it has saved some lives," said Emily's doctor, David Heimbach, director of the UW Burn Center at Harborview. But he said the product's main roles are to minimize scarring and pain.
If all goes well in Emily's case, he said, she could be released from Harborview toward the end of July.
If anyone in the United States would know, it's Heimbach. When Integra was first developed in the 1980s, Heimbach became the principal investigator in a nationwide clinical trial of the product. Of the 131 patients Integra was tested on, 38 were under his care at Harborview.
Since its Food and Drug Administration (FDA) approval in 1996, Integra has become widely used on life-threatening cases in burn centers across the country, hailed by doctors as a tool that garners far better results than traditional methods of skin grafting.
How Integra works
The human body has two layers of skin: the outer layer, called the epidermis, and the inner layer, called the dermis. Together, they are the thickness of a credit card, Heimbach said.
Integra is primarily used in third-degree-burn cases, in which both layers of skin are destroyed. Surgeons must quickly remove dead skin, or it could lead to deadly infection. Then the Integra, made of a mixture of fibers and an outer silicone layer, is applied to the wounds.
The inner layer of Integra serves as a template, giving direction for blood vessels and collagen, the dermis' structural protein, to grow outward.
Without the template, blood vessels would have nothing to steer their reproduction. The result would be elevated scars.
"Integra was invented as a way to get the body to regenerate the dermal portions," said Dr. Arnold Luterman, director of the University of South Alabama Burn Center, which also played a major role in the early studies of Integra. "Basically, the principle is like putting up a building. You have to give the skin a scaffolding to grow into."
"It's a quantum lifesaving measure," he added.
Once blood vessels and collagen have grown into the artificial dermal layer — a process that can take two weeks to a few months — surgeons can peel off the outer silicone layer of Integra. That's when they perform grafts using the patient's own skin.
Grafts are far less painful when Integra is used because doctors need graft only a thin, epidermal layer over Integra. Before, the grafts would have to be deeper to compensate for the dermal layer.
Since Integra's FDA approval, Heimbach has treated about 100 patients with the artificial skin. Nathan Gregg, the Grant County teenager, was one.
It was around 1 p.m. July 31, and Gregg had spent the morning working on a wheat combine at his parents' 560-acre farm, where he often burns piles of brush.
He tried to burn the pile by gathering grass and lighting it with a match. But the wood wouldn't catch, so he grabbed a can of diesel fuel. He felt the direction of the wind and then tossed the fuel into the brush.
The smoldering grass ignited it, and fumes that had leaked from the can exploded in flames. He fell to the ground, finding himself at Harborview later that day.
It has been more than eight months since his release. He said he can do everything he did before the explosion. He works out regularly. And, he said, many people cannot tell he has been burned.
"What Integra did for my skin was tremendous," he said. Though it's slightly different in tone, he said his skin looks and feels like it did before the accident.
Lisa McAneny, Mike McAneny's wife, said her husband is doing well since his release from Harborview on May 2. McAneny, who fights fires in Idaho for the Forest Service, was trying to get a fire pit started behind his home in Sequim on Feb. 16.
When he splashed gasoline on a hot spot, flames chased the fuel back to the can in his hand, causing an explosion.
He still has to wear special garments to apply pressure to his wounds, and after spending 26 days on a respirator, it's difficult for him to speak for very long. Still, he is recovering well, his wife said.
"Mike's skin is beautiful," she said. "It's really soft to the touch. It doesn't feel different. You look at it and say, 'Wow, that was awesome.' "
Until recently, Integra could not be used in the United States to help people who'd lived for years with heavy scarring, which can be unsightly and functionally limiting.
But on April 23, the FDA approved Integra for use in reconstruction, said Kien Nguyen, product director of Johnson & Johnson Wound Management, the company that markets Integra.
That means people with scars will be able to have them removed, and new skin can be created with the use of Integra.
Nguyen said surgeons will be ready to use the product and accept reconstruction patients in three to six months.
A second chance at healing
Ernie Libby, the patient from Montana, considers the product's benefits twofold. The 28-year-old landscaper splashed gasoline on a smoldering pile of wood pallets in April. The fire chased the gas back to the gas can and burst into flames.
Libby also could have used Integra more than 20 years ago. That's when, as a child, he was seriously burned on part of his left leg when he knocked a gas can over, also near a burning pile of wood. Before the accident in April, Libby had a sizable scar on his left leg from the childhood mishap.
That scar was burned off in the recent explosion but is expected to heal along with the new burns.
Life can go on as normal after a life-threatening burn, according to Michael Hunziker, a middle-school teacher from Pierce County.
Hunziker was burned five years ago when a gas-powered pressure washer backfired. A gas can he was holding near the engine exploded, leaving him with burns on his legs that penetrated to his muscle.
Doctors at the UW Burn Center at Harborview used Integra to treat his injuries. And while Hunziker said he can see where he was injured, he can do everything he could do before the accident.
"I don't think about the fire anymore," he said. "I see the extent of my injuries, but it doesn't bother me."
Hunziker wants to make sure people with severe burns aren't too upset. He regularly goes back to Harborview to meet new patients and their families.
He tells them to look at him, that everything is going to be OK.