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SOME BURN VICTIMS GAIN AS MUCH AS 60 LBS. FROM THE SALT-BASED FLUIDS USED TO STABILIZE BLOOD PRESSURE |
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10:52 a.m. Himel wants no head movement that could retard
healing, so two physical therapists arrive, dip a large,
heat-sensitive plastic sheet into a warm fluid to make it
flexible, place it on the woman's chest and begin to cut and
mold it to her chin.
11:07 a.m. The therapists wrap the woman's chest, first in gauze, then in an Ace bandage. 11:20 a.m. Removing the breathing tube, the anesthesiologist awakens the woman, who clenches her fists, moans and begins to shiver. The nurses cover her with a prewarmed blanket while Himel makes a note to the intensive-care staff, stressing that he does not want her blood pressure to exceed 130 systolic. If it did, she might bleed through her sutures. 11:27 a.m. More than 3 1/2 hours after entering the operating room, the woman is wheeled out to the intensive-care unit to begin what will likely be more than a year of recovery and additional surgery. Because the patient's acid burns, while severe, were confined to her face, neck and chest, skin taken from elsewhere on her body could be used for grafts. "Most people still get their own skin grafts because it's what your body accepts most readily," says Himel. But for many patients with more widespread damage, the healthy skin that remains is insufficient to cover their wounds. For those patients, New York Hospital maintains a skin bank, which provides its burn team with a large store of frozen cadaver skin. Unlike the patient's own skin, cadaver skin is soon rejected by the immune system, which recognizes it as foreign. But it survives long enough to protect the wound from bacteria and viruses while stimulating the patient's own skin to grow. The skin bank owes its success to hospitals throughout New York State that call the New York Hospital-Cornell burn team whenever they receive consent to release a newly deceased cadaver. Nancy Gallo, director of the bank, immediately dispatches a pair of assistants to the calling hospital and books an operating room, where the assistants take blood from the body for later tests for infectious diseases, then peel away skin from the back, chest and legs of the cadaver. Keeping the skin iced and in a sterile jar, they race it back to New York Hospital where, frozen in liquid nitrogen, it can keep for as long as five years. But before it can be judged suitable and released for grafting, two months of testing are required.
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