Not a ‘Skin’ Deep Problem
By Priyangwada Perera
Samanali had a heated argument with her husband. Sure, such arguments are more than common, you would say. But Samanali was pregnant. Emotions were running high and she was extra vulnerable. The husband also did not know how to handle the situation better. He would not back out in the argument. “I will set myself on fire,” Samanmali threatened. She knew her condition. She had no intention of harming her unborn baby but she was hurt and sad and this was her way of retaliating. It was just a believable threat in the ideal environment, everything close at hand just enough to give her husband a scare. What actually happened was unexpected. Before she knew it, her mock threat malfunctioned. She had set herself on fire. Her skirt caught fire first and then both the legs. “It was a full thickness burn or what we call a totally burnt skin. Nearly 40 per cent of her body was burnt. On top of it, she was pregnant,” explained Consultant Plastic Surgeon Dr. Gayan Ekanayake.
We have all heard of organ donors. That noble act of giving a whole new life to someone else is nothing less than heroic. Yet, have you wondered for one moment as to what is considered as the largest organ in the human body? It is the skin. However, nobody speaks of skin donation. Yet, how on earth one can donate skin, you might wonder. It definitely was a mystery till I heard of a ‘Skin Bank’.
Skin donated can save lives
Taking the instance of Samanali, Dr. Ekanayake explained further. “In such a burn, we usually take the skin of the patient to replace the burnt skin. But where 40 per cent of her body is burnt, taking out another 40 per cent of her skin to repair the damage means Samanmali loses 80 per cent of her skin. That cannot be done. Furthermore, if this skin gets rejected by her body as sometimes it does, she would end up with nothing but a big wound.”
This is where the human cadaveric skin is needed. The ideal method of treatment is to remove the burnt skin and put processed cadaveric skin. Once burnt skin is removed, it should either be replaced with patient’s own skin or something to cover that area till the skin gets healthy enough to be transplanted.
“The reason we cover the wound with someone else’s skin is to help the wound heal. Due to the burn, if it gets infected, the transplanted skin too will be lost.” However, one has to remember that it is not the transplanted skin that stays. That skin is kept for a week or two till the operated burn area becomes ready to accept its own skin.
Why skin donation is vital
“Skin is the biggest protection to our organs. That is why it is essential that the inner organs are protected when one’s outer layer is burnt and destroyed. This is a method of buying time. Otherwise we have to use extremely expensive skin substitutes which are not even available here in Sri Lanka. So, cadaveric skin is our only option,” Dr. Ekanayake said.
That is why skin donation is vital. “Once the wounds are healed, cadaveric skin has to be removed piece by piece. It is only after that we can graft the patient’s skin. Once a skin graft is done, it takes about two weeks to heal. Then, they are safe to go back home,” Dr. Ekanayake made it sound so simple. Allograft is human cadaver skin that is donated for medical use. It is used, “As a temporary covering for cleaned or excised wound surfaces before permanent placement.” To say it in simplest terms, “Cadaver skin is put over the excised wound and stapled in place,” as a temporary burn wound covering.
Lack of storage facilities
Dr. Ekanayake said that Sri Lanka is 40 years behind the world. After all, skin grafting is not new. “We could ask people to donate skin. That was not the problem. But we never had a specific storage facility. Even at present, we take skin from those who die of kidney diseases and so on. If this is to be done in a private hospital, it will cost at least Rs 15 to 20 million,” he put the facts in place.
We had to ask about the requirements if someone is interested in donating skin. “We take the skin of anyone but those who die of cancer or those who die due to various infections,” said Dr. Ekanayake. What comes to any lay person’s mind is how the complexion is going to be matched and so on. But that is an irrelevant question. Complexion does not matter. Any skin would work because once the wound is better that skin is removed in a couple of weeks. Hence, he re-emphasised that the donated skin is going to be used only as a temporary cover.
Prompt reactions matters
As exciting as it sounds, one needs to know how to deal with such a situation. All bravado and knowledge aside, there a crucial things to remember. “One has to remember that such cadaveric skin grafting works only on fresh wounds. Prompt reaction is what matters. The speed and efficiency that you show in bringing a patient to the hospital is crucial. The skin that is grafted as a temporary cover will reduce the pain, minimise infection. On top of it all, it will prevent the body from developing other burn-related organ failures,” said Dr. Ekanayake.
Skin being the biggest safety net the body has, the burn will affect the vital organs. What happens in the end is that the victim dies of organ failures. To avoid this, prompt action is necessary. When thinking of the importance this holds, one would think why the officials have not taken notice. “Only the National Hospital Colombo is planning the facility. That too is thanks to Lady Ridgeway Hospital (LRH) that enables collaboration with the LRH Tissue Bank.” Consultant Cardiologist Dr. Duminda Samarasinghe has let them share the heart valve storage facility.
Harvesting skin is done only through national organ donation programme at present. The volume of skin is not adequate to meet the demand at present. Expanding this service means more people are needed on the ground. On top of it all, their biggest drawback is the lack of office space and equipment at present. They do not have the means to start an office. With no office, no office staff, being a fully functioning, full-fledged institute serving people is looking like a farfetched dream.
Volunteers and donors needed
Dr. Ekanayake relies on sponsors and has set his heart on volunteers. Skin donation can be promoted. They even have the idea of creating a donor card, similar to what is given to those who register for organ donation. What if they promote and there is an overwhelming response? Where would they store these? “We are already 40 years behind the world. India started it 10 years ago. They harvest cadaveric skin from funeral homes even. Once again due to lack of manpower, it cannot be done here.”
When asked who can donate skin, Dr. Ekanayake said they only exclude those who have suffered from cancer, HIV and Hepatitis. They take precautionary methods to determine this. “But we want to emphasise that receiving cadaveric skin is almost as safe as organ donation. We vouch for your identity and protection,” he assured. Next step is to start growing skin here in Sri Lanka. As of now, their all hopes are on volunteers. “We have trained people. The knowledge to grow skin is available in Sri Lanka. But we need to establish a bank with a laboratory.” Once we start growing skin our burn survival will improve to match any developed country.
Proposed National Skin Bank, still in its infancy
With underdeveloped facilities, the proposed National Skin Bank is fading in the struggle to achieve their desired goals; goals of establishing a fully-fledged centre with an organ retrieval system as well as facility to harvest skin. Despite talent, dreams are in a stagnant position due to the lack of resources.
Through the help of the Government and philanthropists, if they manage to make it a reality it is going to be saving many lives. Once this treatment is done, there are better survival rates. Post surgery promises normal life expectancy and a normal life. Burn injuries are definitely some of the most feared injuries among them all. Both fear of extremely painful death and even survival with worse physical and mental scars are what is associated with burns.
The very things essential and crucial have failed to reach the priority list. But it is up to every single individual to think of what is more important. Just because you decide to have your skin donated after your death, one need not worry about how the corpse would look like inside the casket. There are expert ways of doing it and no skin is taken from places visible. Thinking of it now, one might feel there is no such necessity to sign up as someone who would like to donate skin. Life is such we never know who would be in need of such a taken-for-granted yet crucial organ such as skin.
It may be you or loved one that will need this facility since any one at any place or time could get a burn injury. You can either decide to lift up some other person’s life and die like a hero. Or else let yourself be wasted to dust and ashes. Who would miss that chance to become a hero?