Historic skin cloning op
Hope at last as Pippi’s skin flies in from US
SOUTH African surgeons were expected to perform a breakthrough life-changing operation today on a severely scarred three-year-old burn patient – using grafts that have been cloned from her own skin.
Little Isabella Kruger (fondly known as Pippi), who was burned on more than 80 percent of her face and body in an accident in December, will become the first patient in the country to undergo the surgery.
New biotechnology that enables a patient’s own healthy skin cells to be cloned into skin grafts to cover their burns is only available from a specialised laboratory in the US. The procedure is seldom done outside the US because of the logistics involved.
But Isabella’s mother, Anice, found out about the technology from the internet and, late this afternoon, her daughter’s new cloned skin is expected to be brought by a special courier to Johannesburg.
Genzyme, a cell therapy manufacturer, grew the grafts from two small pieces of Isabella’s skin. They booked two tickets on the flight yesterday – one for the courier and the other for the stainless steel box, containing 41 sheets of Isabella’s cloned skin, which was strapped into the seat next to him.
“The skin hangs vertically in the box and has to stay upright. Because it can’t be shaken around, it can’t go in the aircraft hold,” said Dr Alan Barrett, head of the medical department of Genzyme’s South African subsidiary company.
“The cloned skin looks like transparent plastic sheeting,” he said. “It is very thin and does not look like skin at all. The plastic surgeon will have to use blunt forceps so he doesn’t damage it.”
As the skin grafts have to be used within 24 hours of leaving the laboratory, no time will be wasted in getting them to the operating theatre at Netcare’s Garden City Clinic, Johannesburg. There the surgical team will be waiting to operate to enable Isabella to come out of the isolation area of the burns unit and start a new life.
The plastic surgeon performing the operation, Dr Ridwan Mia, had to get an import permit from the Department of Health to bring in the grafts in terms of the Human Tissue Act, as well as an export permit when he sent two skin biopsies from Isabella to Boston so that they could be cultured into grafts.
The airport clinic will collect the courier, who has the import permit with him, ensuring that he gets through customs quickly.
The two-hour operation will hopefully be the turning point for Isabella, burned at the family home in Lephalale in Limpopo.
Although her burns covered more than 80 percent of her body, she began to heal over the months, particularly on her face, although there is still some wound scarring – and 40 percent of her skin has since grown back.
But, she does not have enough healthy skin of her own to enable the plastic surgeon to do the necessary skin grafts to her face, chest, both arms, two burns on her legs, her sides and on a few other wounds.
The alternative was to use skin that had already healed, but Mia said that this posed enormous problems, “and we did not need to create new injuries”.
Then Isabella’s mother found the Genzyme website and its “Epi- cel” (cultured epidermal autografts) product, which can be grown to cover an entire body if need be.
A skin biopsy kit, containing an antiobiotic medium, was sent to the Garden City Clinic for Mia to take two 2cm x 6cm size biopsies of healthy skin from Isabella’s groin, which had been protected from the fire by her nappy.
In the US it took a week to isolate the cells from the biopsies and another two weeks to multiply until there were enough cells.
Epicel is manufactured with and contains residual amounts of mouse cells. The mouse cells are used as a structure, but as they do not contain DNA, cannot multiply, Isabella’s cells can.
Fighter
Asked if she was excited about the operation, Isabella’s mother said:
“If I was a balloon, I would probably have burst by now.”
For a long time after the tragic incident, Isabella’s prognosis was “very poor”, the plastic surgeon recalled.
And as she was on a ventilator for weeks, the once talkative toddler cannot speak and is only expected to begin talking again some six months after the operation. She was on a ventilator and had a tracheotomy for a total of 19 weeks.
“We took our lead from Isabella and as she improved, we moved to the next step. But she is a fighter and has come a long way. She defied all the odds,” Mia said, adding that he has never seen such a young child survive such severe burns.
It took almost two months to stabilise Isabella, which is considered an outstanding achievement, since the survival rate of such extensive burns in South Africa is less than 10 percent.
Her mother was unable to hold her for 12 weeks, because of her unstable medical condition and then because the pain was too severe.
It was 150 days before her family saw her smile.
After tonight’s operation, which will be filmed, Isabella will have to be immobilised for about a week to enable the grafts to take and develop a blood supply.
“We will put her in splints to stop her moving her elbows. We will keep her somewhat sedated so she is not too uncomfortable and is pain free,” Mia explained.
“We will open the first dressing in about a week, and then again two days later.”
All the dressings should be removed in two weeks. In the event that the grafting is not 100 percent successful, Isabella will still be able to access some of her cloned skin.
Her cells are being preserved in a freezer in Boston and additional sheets of skin can be grown from it.
Isabella saw her baby brother, Arno, who will be one later this month, for the first time since the accident at her third birthday party held at the hospital on Saturday.
She is expected to be in hospital for another three weeks, then she will be transferred to the Milpark Rehabilitation Centre for three to six months before going home.
As her new skin heals, she will be able to exercise more and more to overcome the muscle wasting.