Tygerberg Hospital Doctor Performs Successful Skin Culture Transplant

In another bold and innovative breakthrough, the Western Cape Government Health can proudly announce a ground-breaking technique by a team of doctors at Tygerberg Hospital and Stellenbosch University as they performed the world’s first successful life-saving and cost-effective skin culture transplant.

A local but world-class innovation by Dr Wayne Kleintjes, head of the adult burns unit at Tygerberg Hospital and lecturer in Surgical Sciences of Stellenbosch University, resulted in two burns patients’ lives being saved. In order to perform the innovative procedure, Dr Kleintjes developed a technique which is similar to other techniques using cultured autograft (own) skin, but it differs in that certain products used for the skin culturing, have not been used previously for this purpose. The new technique makes use of the patient’s own skin, which is cultivated from skin harvested via a skin biopsy. Up to this point it is similar to other techniques, but the culture method differs dramatically from others in its relative simplicity, its effectivity, biological safety and modest cost.

Other options for skin transplants include allografts (using donor skin) or xenografts (using skin of other species). However both of these methods are only temporary skin covers, and are usually rejected by the recipient after 2 – 4 weeks.

Between November 2014 and February 2015 it has already been used successfully on two patients, with dramatic effect. The first such patient to receive this treatment was a 16-year-old boy who had been in ICU for three months with no improvement. As a victim of a fire, he was too weak for ‘normal’ skin grafts, his weight dropped to only 19 kilograms. Realising that he needed something dramatic to save his patient, Dr Kleintjes embarked on the treatment which is sparsely documented in literature. The results were extraordinary in that the patient was discharged from ICU only two weeks after receiving the transplant. The second patient with 63% total body surface area burns was out of the ICU in 4 weeks after the transplant with a total of only 2 skin graft sessions to complete wound closure.

“I just knew that we needed a special intervention to save the boy. Even though fundraising had been planned with the family to secure the funding for an Epicel Cultured Epidermal Autograft (CEA) transplant (as Pippie Kruger had), there was an import ban placed on the product. Thus the only way out was to make a plan ourselves,” Dr Kleintjes said.

Once the first procedure was successful, a second patient was treated in February 2015. The primary goal with the method is to save the patients’ lives. The secondary goal is do it safely and within budget – an important aspect of all public health care. The total cost incurred by the hospital products was R995 and in comparison, the Epicel Cultured Epidermal Autograft techniques would have cost at least R1.8 million rand to achieve similar cover for the first patient. The continued use of the technology and the fine-tuning thereof will be the subject of a research study conducted by Dr Kleintjies at Stellenbosch University faculty of Medicine and Health Sciences.

The Head of Department Dr Beth Engelbrecht comments: “we are very proud of our clinicians; their relentless quest for excellence and their spirit of innovation – often within a cost-constrained environment. Currently this project is at a developmental stage. Once it gains momentum it could be introduced as part of the normal provincial protocol and could be shared with other provinces and the private sector”.

Up to now the outlook for patients in South Africa who had suffered extensive burns was rather bleak. The current conventional treatment methods range from rudimentary management of pain and discomfort to highly specialised transplant techniques, depending on the availability of resources.  If they survive, patients faced long and excruciating stays in hospital ICU units with mixed results at the end of the intensive treatment. The detrimental effect of serious burns on victims and their families also cannot be over-estimated.

The availability of this new technique has challenged the way we assess a serious burn victim’s prognosis. Now we can offer life-saving, viable and affordable treatment, making the previously bleak outlook much brighter.

Find out more in the factsheet and infographic.

Credits due to other medical personnel:

• Dr Nico Stevenson (Surgery Registrar, Tygerberg Hospital)
• Dr Grant Thomas (Emergency Medicine Registrar, Tygerberg Hospital)
• Dr Imraan Goolam (Surgery Registrar, Tygerberg Hospital)
• Dr Kaveto Sikuvi (Emergency Medicine Registrar, Tygerberg Hospital)
• Prof. Ben Page (Stellenbosch University Department of Anatomy and Histology)
• Medical interns (Brogan Salence, Stephan Thaele and Celeste von Drunig) and nursing staff, and medical students at the adult burns unit of Tygerberg Hospital.