海角社区

By developing a new burn and wound care technology, known as spray-on skin, and increasing coordination between hospitals and emergency services across Louisiana, an 海角社区 Health New Orleans surgeon has helped reduce the length of hospital stays and the mortality rate from burns by more than half in several parishes.

Baton Rouge鈥擠r. Jeffrey Carter, associate professor of surgery at 海角社区 Health New Orleans School of Medicine, didn鈥檛 consider crawfish and the local tradition of boiling them around Easter when the decision was made to open their new Burn Center, part of University Medical Center, in late March 2018. But as its medical director, he filled every bed with patients on their first day open, as 80-quart pots with spicy seafood boil accidentally tipped over at homes in the area, cooking not just crawfish, but skin.

Last fall, during Hurricane Ida, the Burn Center reached capacity again. As residents fired up generators, their sole source of power for days or weeks, some of which exploded or had fuel catching on fire, 41 people with severe burns ended up in Dr. Carter鈥檚 and his team鈥檚 care.
 
Only a week later, Jazmyne Sylve arrived. She was pregnant and suffered severe burns from an exploding propane grill outside her apartment complex in Slidell, as did her partner and 6-month-old baby. Almost 40% of Sylve鈥檚 body was burned, including both legs, and since the risk of dying from a burn is calculated by adding the burn percentage to the patient鈥檚 age, her odds were not good.

Even if she survived, Sylve was expected to remain at the hospital for a minimum of three months, according to national statistics. What Sylve didn鈥檛 know, however, is that Dr. Carter had spent over a decade developing a new technology for burn and wound care, performing some of the first compassionate-use surgeries (using experimental technologies to save lives that otherwise would be lost) using spray-on skin in Louisiana even before the technology received FDA approval in 2018. It鈥檚 now commercialized under the name .

鈥淚f they鈥檇 had to rely on skin grafts to heal my burns, which is the traditional method and the only method most doctors know about, I would have had a 1-in-2 chance of coming out of that, and since I was pregnant, so did my baby.鈥�

Jazmyne Sylve

Thanks to the work of Dr. Carter, his team, and the new spray-on skin technology, Sylve recovered quickly and was able to leave the hospital, along with her family, in three weeks.

鈥淲ithout ReCell, I would probably still be in the hospital right now,鈥� Sylve said last month, as she was getting ready to celebrate the holidays with her family. 鈥淚f they鈥檇 had to rely on grafts, they would have had to strip my whole back to do it, and instead of 8-10 hours, my surgery took 2-3 hours. My left leg was all ReCell, and unless you look closely, you can鈥檛 tell I was burned at all.鈥�

Her experience is not uncommon, according to Dr. Carter.

Part of the savings come from getting patients to the right place for the right care. By working with the state and the Louisiana Emergency Response Network (), which manages care coordination for critically injured Louisianans, Dr. Carter is helping to make sure burn victims are routed directly to the nearest burn center鈥攖o New Orleans, Baton Rouge, Lafayette, or Shreveport鈥攊nstead of to nearby emergency rooms. He鈥檚 also working with the Louisiana Department of Health on designing and delivering burn kits to first responders, so people with minor burns鈥攊ncluding fire fighters鈥攃an get immediate treatment and avoid trips to emergency rooms and burn centers. The goal is to get burn victims faster and better care, but also increase disaster capacity and preparedness across the state.

鈥淗alf of all burn transfers, from one place to another, are actually not needed,鈥� Dr. Carter said. 鈥淭he challenge is that few medical professionals have education on burns and get really scared when they get a burn patient, so they just ship them off, and those transfers are expensive and delay care.鈥�

鈥� Using ReCell, we鈥檝e been able to cut recovery times in half by accelerating healing and also reduce the hospital stay for all Louisiana burn patients by three days,鈥� Dr. Carter said. 鈥淭his means less suffering, less risk for complications and infections, and significant savings for both the patients and the state鈥攁t least $9 million over three years. 鈥�

Dr. Carter trains at least a dozen other doctors each month on burns and on using the spray-on skin technology, which he began developing more than 10 years ago under a grant from the Armed Forces Institute of Regenerative Medicine, or AFIRM. (He does not make money from the training nor the technology, however, since he, as all 海角社区 faculty and staff, is a state employee. Instead, he routes proceeds charity.)

鈥淲hat鈥檚 great about burn research is that it translates very quickly,鈥� Dr. Carter said. 鈥淲hile most trauma research in the civilian world doesn鈥檛 translate well to the military, where explosions and penetrating injuries are more common, burn research does.鈥�

Research translation is not only about relaying content, however. It鈥檚 also about educating people on how to use new technology; when, where, and why.

鈥淓ducation on how to treat burns is key,鈥� Dr. Carter continued. 鈥淲e can create new technologies, but if we don鈥檛 do the education, they don鈥檛 have an impact.鈥�

When the Burn Center at University Medical Center in New Orleans opened in 2018, the mortality rate from burns in the surrounding parishes (Orleans, Jefferson, St. Bernard, and Plaquemines) was 7.9%, more than double the national average. Within two years, Dr. Carter and his team got the number down to 3.6%.

鈥淧eople in this region were twice as likely to die鈥攁 huge testament to the unmet needs in this part of the country鈥攁nd today, we鈥檙e actually doing better than most,鈥� Dr. Carter said. 鈥淲e鈥檝e also made spray-on skin part of our hospital standard of care, so it鈥檚 offered to all patients who could benefit from it, regardless of insurance status or ability to pay. In fact, we鈥檝e been able to stay profitable simply by taking care of everybody. That鈥檚 because our average cost per patient has gone down, by getting people home faster.鈥�

Spray-on skin is created by taking a small sample of a person鈥檚 healthy skin, big as a thumbnail and thinner than a one-dollar bill, and allowing enzymes to separate the top layer of the skin, the epidermis, from the layer underneath, the dermis. Between these layers are progenitor cells, a kind of stem cell that can replicate into different types of cells. When progenitor cells are put into a solution that鈥檚 sprayed over open wounds or burns, they replicate quickly, creating new skin.

While burn surgeons used to have to rely on same-sized grafts鈥攕uch as a piece of skin the size of a hand to heal a burn the size of a hand, 1:1 ratio, thus creating another wound that can cause pain, infection, and scarring鈥攖he ReCell technology allows for a ratio closer to 1:80 and the spray-on skin solution can be applied to donor sites for grafts and ReCell samples as well.

In good American fashion (the innovation behind spray-on skin was originally patented by an Australian researcher, Dr. Fiona Wood), Dr. Carter has further 鈥渟upersized鈥� the technology. Initially used to treat an area of skin smaller than a sheet of paper, Dr. Carter and colleagues are teaming up to use several ReCell kits at once during one single surgery鈥攏ot multiple surgeries鈥攖o treat up to 75% of a patient鈥檚 skin.

The New Orleans Burn Center has become a national leader in research on burns and their care. Dr. Carter鈥檚 team is currently engaged in nine funded research projects. One of them is a $90-million multicenter effort to develop a multispectral camera system in combination with artificial intelligence, or AI, to help with burn patient triage. It鈥檚 funded by the Biomedical Advanced Research and Development Authority (BARDA) and Dr. Carter is the principal investigator, working with an 海角社区 engineering alumnus, Sean King, on the hardware development.

鈥淢ost doctors cannot look at a burn and tell whether it requires surgery or will heal on its own,鈥� Dr. Carter said. 鈥淭hey鈥檙e right about 50-60% of the time, which is not much better than a coin flip, or just guessing. Burn surgeons do better, but not great. We鈥檙e right about 75% of the time, which means that one-quarter of our patients either get surgery when they don鈥檛 need it, or don鈥檛 get surgery when they do need it. As a result, we delay recovery and put some at additional risk of infection and complications.鈥�

鈥淚t鈥檚 like taking a basic science lab and bringing it into the operating room.鈥�

Dr. Jeffrey Carter

By developing AI to recognize patterns in images taken with both visible and invisible (infrared) light and then correlating those patterns with known outcomes whenever surgery wasn鈥檛 performed鈥攖he patient healed, or didn鈥檛 heal鈥攖he researchers have already reached 91% accuracy. They haven鈥檛 allowed the AI to tell them what to do yet, however鈥攖hey鈥檙e still in the training phase, hoping to achieve even greater accuracy.

鈥淭he future of this technology is amazing,鈥� said King, who graduated from 海角社区 with a master鈥檚 degree in mechanical engineering in 2018 and now works for SpectralMD in Texas in partnership with Dr. Carter. 鈥淚t鈥檚 going to save hospitals and patients a lot of time and a lot of money. It鈥檚 a win-win for everybody.鈥�

鈥淲hen you work with burn patients, you also know this鈥攖hey don鈥檛 like to be touched,鈥� Dr. Carter added. 鈥淪o, any technology that doesn鈥檛 contact the patient and also doesn鈥檛 expose them to lasers or ionizing radiation while assuring better outcomes is ideal.鈥�

The camera system he and his colleagues are building will be roughly the cost and size of an ultrasound cart, available in most urgent care settings.

Another project involves using ReCell, but in a new way, to treat hernias. These form when organs or internal tissue break through a hole in the muscles, such as in the abdomen. Hernia repair is one of the most common types of surgery with more than 1 million performed each year in the United States. Using the ReCell system鈥檚 ability to remove the top-most layer of skin and the progenitor cells underneath (which otherwise could begin growing new skin inside the body), surgeons get a clean piece of dermis to help patch the weakened region of tissue. A provisional patent for the technology was filed last year, and a colleague of Dr. Carter鈥檚, Dr. Herb Phelan, professor of surgery at 海角社区 Health New Orleans and surgical critical care specialist at University Medical Center, recently received a LIFT2 grant from the 海角社区 Board of Supervisors to further advance the technology.