By David Russell
A miracle of medicine has come to the aid of victims of the Pinery bushfires, with new burns treatment technology developed in Adelaide over 10 years coming out of trial just one month before the tragedy.
South Australian of the Year and Director of the Adult Burns Centre at the Royal Adelaide Hospital Dr John Greenwood is currently treating two of the bushfire victims. The patients, who presented with “major burns”, are being treated with a synthetic polyurethane product that enabled their burned tissues to be removed straight away, helping to avoid a range of potential medical complications and dramatically improving patient outcomes.
“If you leave a burn on the outside of the body, it starts to break down and poison the internal systems, causing the patient to become immunosuppressed and interfering with their organ function, so that they tend to drift into multi-organ failure, and death,” Dr Greenwood told Inside South Australia.
“Additionally, if you leave (the burn) they become extremely hyperaemic after a few days, so that even with adrenaline injected under the burn they bleed heavily during removal of the burn in surgery.”
If the burn is removed straight away, there is much less blood lost during the operation. The other advantage of removing a burn immediately, according to Dr Greenwood, is that it gives the patient a much greater chance of surviving the complications resulting from smoke inhalation.
“A lot of the people we see with big burns come from enclosed space injuries, (like) house fires and car fires, where they suffer smoke inhalation airway and lung injuries.
“That starts to cause a real problem at about two days, when the chemicals left in the lungs by smoke make the patient really sick. If you haven’t got the burn off by that time, then the patient (and the ICU) must fight on two fronts – the burn and the airway problem. Very often they can’t survive those two things together.”
South Australian of the Year and Director of the Adult Burns Centre at the Royal Adelaide Hospital Dr John Greenwood. Photo: Australian of the Year Awards.
“So if you come to the Royal Adelaide with a big burn, once the Emergency Department and Trauma teams have ensured no other (hidden) trauma, you go to surgery straight away and we remove the entire burn in one go, irrespective of burn size. That’s not often done anywhere else.”
It is this need to remove a burn straight away that lead to Dr Greenwood developing the synthetic polymer product. When a very large burn is removed it leaves an open wound, which in some cases can cover more than half the body. That wound then needs to be closed, otherwise contraction and terrible scarring result.
This procedure is usually either done with a skin graft from another part of the body, or with a collagen product if skin grafts are not available. The problem with collagen is that there is substantial risk of infection, because bacteria can attack it, and it is extremely expensive. Because of this it’s only used by around 40% of surgeons in the first world, and only very rarely in the developing world.
With those challenges in mind Dr Greenwood set out to find an alternative, synthetic, option. In 2004 he went to the CSIRO, which lead him to Victorian polyurethane producer PolyNovo Biomaterials.
“They had a lovely technology, but they didn’t really have an application for it. So I pitched the potential to create these products which would get rid of the need for skin grafts, and they were really excited about that. They were a new company with no real capability to fund such a significant research programme, so I took that on and did the research in Adelaide.”
That research lead to the production of a polyurethane foam, that was trialled on patients in 2011 and then a bilayer product for burn and surgical wounds in 2012. It worked perfectly; the patients didn’t react to the material at all. The material is now offered to patients by Plastic Surgeons at the Royal Adelaide Hospital for complex surgical wound repair.
“We then did a five-patient burn trial, which was completed a month before the Pinery fires. The results were excellent, so we had no hesitation in recommending the material to relatives of the injured patients from the Pinery bushfires.
“The timing of all these things has been very fortuitous. In the beginning, you have a question, and the solution is something you have to search for and introduce. The solution leads to questions of its own, so the research and development process is like a long road, and you just keep going, occasionally making turns or just changing direction subtly as you move along. That’s how we got to the point we’re at now.”
Dr Greenwood and PolyNovo are now working to make the polymer material available to surgeons around the world. They have been successful in securing a $29m contract with the US Biological Advanced Research and Development Authority to take the material through a multi-centre trial in the United States.
“Once you’ve got that kind of regulation, global regulation will follow in many domains. Because this material is quite resistant to infection, and relatively inexpensive, more surgeons are likely to use it, including surgeons in economically less well-off countries.”