Working in burn injury is challenging seeing lives changed in an instant with lifelong consequences. Our children are especially vulnerable with those under age four most commonly affected. Some years ago, we treated a child who survived a major burn injury who subsequently lost the battle with cancer.
I wondered if surviving the burn injury had an impact on the risk of cancer later? Western Australia is known for its data linkage expertise, and I was privileged to collaborate and build the team that explored the lifelong impact of burn injury. The answer is yes – burn injury does have an impact for life across many body systems.
The most surprising thing in our published work was that 94% of the children and 86% of the adults in our database of 34,000 requiring hospital admission for burn injury were not major burns. The questions now are, why is the response to burn injury changing the life trajectory, what is the underlying mechanism driving the changes in inflammation and the immune response, and who is vulnerable?
It is clearly not simply related to the extent of the injury and the answers to those questions are vital in driving forward innovative therapeutic interventions to mitigate against the impact of injury.
In 2019, the Stan Perron Centre of Excellence in Childhood Burns was established at Perth Children’s Hospital (PCH), made possible by the support of the Perth Children’s Hospital Foundation. The centre drives and supports clinical excellence, research, education, and community engagement aiming to optimise care at all stages while driving forward the body of knowledge to continually improve.
The centre has built on previous work (e.g., exploring the mechanisms underlying the risk of malignancy and vaccine amnesia) in collaboration with Telethon Kids Institute.
The team has created a paediatric burn trauma biobank to obtain biological samples with over 140 children already recruited. This will underpin studies using a systems biology to understand the systemic and long-term physiological impact of burn injury. The biobank alone has led to a number of collaborations and importantly supports a number of early career and higher degree scientists here in WA. Early results have shown changes in neurological pathways and immune responses, guiding further in-depth work.
The More Than Skin Deep education program is another pillar being developed to improve the delivery of psychosocial care for children and young people and their families and the staff at the PCH Burn Service with the goal of improved patient outcomes and quality of life.
In addition to improving long-term systemic health, including mental health, the centre is focused on developing new methods for surgery to reduce scarring and improve the appearance of scar for children with burns. We are developing a 3D bioprinter that will print cells and a gel (matrix) to promote wound healing and reduce scarring. Collaborations with Inventia and University of Wollongong to develop this intra-operative printer aim to conduct the first human trials by the end of 2022.
Point of care chemistry is the holy grail when supporting decision making in surgery and at the time of dressing changes to understand and monitor the healing processes.
Working with Australian National Phenome Centre (ANCP), we are exploring the iknife technology building the library of knowledge around the chemistry of the skin, its surface and changes when injured and infected. How we can unscar the scar remains an area of intense activity with our laser and the research around understanding the changes in the cell phenotype.
Data innovation systems established initially with Microsoft and Lotterywest grants are now embedded at PCH, ensuring that the Burns Service, comprising both the adults and paediatric units, is a seamless service that supports clinical and research excellence.
The integrity of the clinical data is an essential, foundational piece of the work.
We want to best understand how we can treat the child as a whole and those around them to minimise the impact using a range of technologies such as multi-omics approach with cell biology, locally at the wound site and systemically.
While striving for new knowledge and interventions, we have driven care with cell-based therapies and rapid surgery to reduce the time to healing to reduce ongoing inflammation. Connecting with the children in our clinics over time, we are collecting outcome measures highlighting needs such as fitness and exploring the role of exercise in limiting the ongoing inflammatory changes.
It is a positive time with the capacity to answer questions with cutting-edge technologies and develop novel skin regenerative strategies.
Key messages
- Burns may have long-term impacts beyond the skin
- New surgical methods are improving outcomes
- Mental health and fitness also need focus.
Acknowledgement: The author heads the Stan Perron Centre of Excellence for Childhood Burns at PCH thanks to funding from the Perth Children’s Hospital Foundation
Author competing interests – nil