Changes to the way that skin grafting and treatment are done at Singapore General Hospital (SGH) have benefited close to 250 patients. The patients recovered faster and stayed a shorter time in hospital, a two-year SGH study has shown.
The changes include a new way of skin grafting for major burns that reduces reliance on skin donors, and the use of ‘substitute skin’ for second-degree burns for greater pain relief, less frequent dressing changes and easier monitoring of wounds. In addition, surgical cleaning of the wounds is also done in a day, instead of two previously.
According to the study, the 250 patients stayed in hospital for an average of 13 days versus 17 for another group of 100 burns patients who were treated before the changes were implemented. Overall infection rates were reduced by 70 percent.
“Burns patients often require care from a multi-disciplinary team, and could go through months, even years, of treatment and rehabilitation. Adopting a standard set of steps in treating burns patients allows us to tighten the processes and allocate resources more efficiently. It also provides a clear direction for everyone’s roles at various stages of the patients’ recovery,” said Assistant Professor Chong Si Jack, Consultant, Department of Plastics, Reconstruction and Aesthetic Surgery, who is the lead in developing the new treatment protocol.
Burns patients sent to SGH first undergo surgery to remove damaged skin tissue to avoid bacteria growing in the wounds and infections. Patients with second-degree burns are given a ‘substitute skin’, also known as a biological dressing, within 24 hours after their wounds have been cleaned. The dressing protects the wound and is similar to a new layer of skin which gives the wound time to recover.
A micrograft-allograft dual grafting technique is adopted for those with major burns as the method uses only a small area of undamaged skin to treat extensive burns.
The undamaged skin is cut into tiny 3x3mm squares and arranged in a grid-like format on a 5 x 5cm piece of allograft ie; skin from a deceased skin donor. Doctors then use the sheet of combined skin to cover the patient’s burn wounds and stimulate skin growth.
“With the new skin treatment methods, we were also able to achieve rapid skin coverage, reduce infection rate and burns conversion for our patients. Infections are the leading cause of complications and death in burns patients, and one of the most challenging concerns for the burns team," Dr Chong said.
In the past, second-degree burns were managed with different types of conventional dressings. Third-degree burns were treated with patient’s own skin tissue or skin from the Skin Bank. But the Bank often has a shortage of skin donors, while heavily burnt patients have very little undamaged skin to spare.
The SGH Burns Centre is a regional and national burns unit, managing 93 per cent of adult burns patients in Singapore with an average of 220 inpatients each year. It is the only specialised burns centre in Singapore and the major burns referral centre for the Southeast Asian region. The centre is a fully equipped burns facility comprising an 8-bed intensive care unit, a specialised burns operating theatre, rehabilitation rooms and a skin bank.