‘Spray-on skin’ helps young man regenerate skin tissue

Avita Medical’s ReCell a game-changer for burn care.
Aug. 16, 2022
Louk with mom Candace Herrera at UCHealth University of Colorado Hospital in early August, five months after the bonfire accident and subsequent ReCell and skin-graft surgeries. Photo by Sonya Doctorian for UCHealth.
Louk Thomas with mom Candace Herrera at UCHealth University of Colorado Hospital in early August, five months after the bonfire accident and subsequent ReCell and skin-graft surgeries. Photo by Sonya Doctorian, UCHealth.

The gasoline can was about empty as the backyard bonfire got going, and Louk Thomas made the mistake of shaking out its last dribbles over the flames. Fumes exploded as if inside an engine’s cylinder. The fire scorched his hands, arms, and face. When the smoke cleared, 30% of his body had been burned. Louk took a shower, his chief worry being what his mom would say when she got home.

If that seems a boyish concern given the gravity of the moment, well, it was: Louk (pronounced “Luke”) was 15 years old on that evening this past February – even if, at 5-foot-11 and more than 200 pounds, he didn’t look it.

His mom, Candace Herrera, thought only this: My son needs to get to a hospital.

Doctors at the hospital near the Herrera home in Farmington, N.M., saw that Louk needed specialist burn care. Louk and his mom were soon on a medevac flight to the UCHealth Burn and Frostbite Center on the Anschutz Medical Campus in Aurora. They arrived at 1:30 a.m., and Louk immediately received critical care to stabilize him and care for his wounds under the direction of his surgeon Dr. Arek Wiktor, the Burn Center’s medical director.  Typically, those burns would feature skin grafts harvested from Louk’s own thighs, shoulders, and back. And while Louk would receive traditional skin grafts on his hands, arms, and elsewhere, his face would benefit from a treatment seemingly straight out of science fiction: spray-on skin.

Louk all bandaged up after his spray-on skin treatment. Photo courtesy of Candace Herrera.
Louk bandaged up after his spray-on skin treatment. Photo courtesy of Candace Herrera.

ReCell, as this spray-on skin is called, is very much real, and it’s based on U.S. Food and Drug Administration (FDA)-approved science developed by California-based Avita Medical. Instead of harvesting skin from one part of the body and using it to cover another, ReCell’s approach involves taking a small skin sample and then chemically and physically filtering out the keratinocytes, fibroblasts, and melanocytes, all which play critical roles in skin-tissue regeneration. Those end up in a solution that’s then sprayed over the area where skin should be. It all happens in the operating room.

“It’s kind of like if you were to have a field and plow it, and then plant some seeds, those are the new skin cells” Wiktor said.

‘Spray-on skin’

FDA-approved in September 2018, ReCell has shown to be most effective with certain types of burns – in particular, second-degree burns. While Louk had third-degree burns on his hands, arms, and elsewhere, his facial burns were deep second, nearly third degree. Wiktor would apply traditional skin grafts to the third-degree burns; ReCell would be the best option for the lesser burns on Louk’s face, the surgeon decided, and for good reasons.

Skin grafts take three to four weeks to heal; ReCell’s “seeds” regrow skin in about half that time. Also, ReCell doesn’t require daily dressing changes, which are painful and can lead to significant scarring. Those differences can mean less time in the hospital and fewer pain medications. Perhaps most strikingly, a postage-stamp-size biopsy of healthy skin liquified and sprayed on can cover an area 80 times larger than the biopsy itself. With skin grafts, one can achieve at best a roughly 6:1 coverage ratio, Wiktor says.

Another benefit: Skin-graft donor sites are themselves wounds that must heal, and ReCell means fewer of them with smaller footprints.

Wound healing and burn recovery

Louk’s facial bandages stayed on for five days after the spray-on skin treatment, during which, as Herrera put it, “He looked like the Michelin Man.”

Louk shortly after his facial bandages were removed. Photo courtesy of Candace Herrera.
Louk shortly after his facial bandages were removed. Photo courtesy of Candace Herrera.

Louk approached his treatment with the toughness of the cowboy he is (he competes in team roping). Did he wish he hadn’t been burned? Yes. Was he dwelling on the mistake?

“I’m alive. I live day-by-day,” Louk said. “You can’t change the past, so you might as well get on with your life.”

But this cowboy was still a boy undergoing a total of 10 skin grafts through eight surgeries, and he was a long way from home. He wanted his mom close. For many of the nights over the seven-and-a-half weeks that Louk stayed in the Burn Center, Herrera wore a gown, gloves and mask for infection control while sleeping in the room with her son.

“You just hope that your kid’s OK,” she said later.

ReCell is now considered for every burn patient at the UCHealth Burn and Frostbite Center, Wiktor says. It can be used to speed the healing of donor sites and the gaps between sections of grafted skin when it’s slitted and stretched to apply to burn wounds several times larger than the donor site.

“We use this technique at least once or twice a week, because it’s such a powerful tool for us to achieve excellent wound coverage using as little graft as possible,” Wiktor said.

Dr. Arek Wiktor comparing the size of harvested skin a single ReCell kit can process with the spray coverage that kit can produce. Each kit can convert four 3-by-2 centimeter skin biopsies to cover an area that might otherwise require donor grafts as large as a patient’s entire back. Photo by Sonya Doctorian for UCHealth.
Dr. Arek Wiktor comparing the size of harvested skin that a single ReCell kit can process with spray coverage.  Each kit can convert four 3-by-2 centimeter skin biopsies to cover an area that might otherwise require donor grafts as large as a patient’s entire back. Photo by Sonya Doctorian, UCHealth.

Louk went home the third week in April. By then, he was asking his Burn Center caregivers when he might get back to team roping.

“They told me, ‘You won’t rope this summer,” Louk recalled. “I said, ‘Watch me.’”

On July 4, he was team roping again at an event in Durango. Despite precautions such as compression sleeves and gloves, the fresh skin on his thighs didn’t take kindly to it and blistered, he says. Small penance for getting back to his passion so quickly.

‘Like family’

Just over five months from the accident, Louk, his mom, and stepdad Rusty Herrera now drive the seven hours from Farmington to Aurora every six weeks for series of six laser treatments to smooth out his facial scars and improve their texture and flexibility. On a recent visit, Herrera said, “I still see my son when I look at him. Had we done the full skin grafts, I don’t think he would look the same. I’m so thankful.”

15-year-old Louk Thomas suffered burns to more than 30 percent of his body after an accident around a campfire back in February. The New Mexico teen was airlifted to UCHealth University of Colorado Hospital Burn and Frostbite Center, where he underwent nearly a dozen surgeries, including one involving innovative “spray-on skin.” Photo by Sonya Doctorian for UCHealth.
Louk Thomas, 15, suffered burns to more than 30% of his body after an accident around a campfire back in February. The New Mexico teen was airlifted to UCHealth University of Colorado Hospital Burn and Frostbite Center, where he underwent nearly a dozen surgeries, including one involving innovative “spray-on skin.” Photo by Sonya Doctorian, UCHealth.

Both she and Louk describe the Burn Center team as “like family.” In addition to the care they delivered, staff had reached out to country music star Tim McGraw during Louk’s stay. McGraw recorded a short video for Louk, saying the young cowboy should listen to his doctors and keep his chin up.

Herrera brings along Crumbl Cookies or candy on their visits to the Anschutz Medical Campus, she says. She can’t truly reciprocate for what the team has done for Louk, she says, “but maybe a cookie or a sweet will brighten their day.”

“I’m eternally grateful for Dr. Wiktor and his whole team,” Herrera said.

Louk is just as thankful.

“These people helped me so much,” he said. “They’re still helping me today.”

 

About the author

Todd Neff has written hundreds of stories for University of Colorado Hospital and UCHealth. He covered science and the environment for the Daily Camera in Boulder, Colorado, and has taught narrative nonfiction at the University of Colorado, where he was a Ted Scripps Fellowship recipient in Environmental Journalism. He is author of “A Beard Cut Short,” a biography of a remarkable professor; “The Laser That’s Changing the World,” a history of lidar; and “From Jars to the Stars,” a history of Ball Aerospace.

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