South Australian of the Year working to make skin grafts a thing of the past

Inside South Australia
January 21, 2016
By David Russell

South Australian of the Year Dr John Greenwood is on the cusp of a medical breakthrough that would do away with the need for skin grafts.

Dr Greenwood has developed a method of growing large amounts of a patient’s own skin cells, which can then be used in place of a skin graft. The process involves operating on a burn straight away and sealing the resulting wound with a polyurethane product. At the same time a small piece of skin is removed to be cultivated in a custom-built bioreactor, the first of its kind in the world.

“It’s only a small piece of skin that we need… we degrade that into the two components – the epidermis and the dermis – and culture the two until we get to a certain maturity of cells, then we seed the dermal cells into polyurethane and into the reactor,” Dr Greenwood told Inside South Australia.

“Six days later we seed the epidermal cells into the reactor on top of dermal cells, and that gives us a two later skin; a full thickness skin. Basically a skin graft based in polyurethane foam.”

Twenty-eight days after the burn is operated on the “seal” can be removed and the incubated skin product can be applied. “So the first material is very good a buying us time and protecting the wound and improving the wound bed, but you still need a skin graft with it at the moment. The second product is designed to mean you don’t need a skin graft at all.

“The polyurethane is then shed from the surface, and leaves all the cells behind as a layer of skin… the result is really quite amazing.”

While small amounts of skin have previously been able to be grown and used in pig wounds, producing large amounts of skin wasn’t possible. That’s problematic for burns treatment because adults can require up to 1.8 square metres of skin. The bioreactor being used to grow the skin cells is almost complete and is currently undergoing a validation process.

Dr Greenwood is South Australia’s entry into the Australian of the Year Awards, which will be announced on Australia Day. He was recruited from the UK in 2001 in response to a government investigation and report that revealed poor outcomes for burns victims.

“I pretty much had carte blanch to develop my own surgical protocols based on things I’d seen in the UK and the US, but also a lot of new things that I knew would work, but people weren’t prepared to try. So we piloted a lot of things.”

As Director of the Adult Burns Centre at the Royal Adelaide Hospital Dr Greenwood and his team treat patients suffering from a broad range of injuries, including thermal and radiation burns, cold thermal burns from liquid nitrogen and liquid petroleum gas, electrical burns and chemical injuries. He encounters situations everyday most people would find extremely confronting, but says his training and the exposure he received as a young surgeon prepared him well.

“You’re introduced to these kinds of injuries over a great many years and you see some of them managed very well, and some managed poorly, and that’s how you gauge how you would like to do things when you become a specialist.

“It’s an apprenticeship… you don’t get thrown in the deep end managing these things on your own; you do acclimatise to them. You realise ‘here is a problem I am going to solve, and this is how I’m going to do it’.”

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