HHS performs world-first burn treatment

HAMILTON, Ont. – A holiday mixer for fraternity and sorority members near London’s Western University last December turned into a terrifying scene when a fire broke out, sending five young women to hospital.

Western student Kaitlin Jeffrey (pictured), 18, of Toronto was the most seriously injured, with deep burns to her face, neck, hands and arm. She was transferred to Hamilton Health Sciences (HHS) Hamilton General Hospital (HGH), home to one of Ontario’s two regional burn centres – where the most seriously injured patients in the province are treated.

Dr. Marc Jeschke, a globally recognized burn surgeon and medical director for the regional burn program, has been leading her care.

Jeschke was determined to restore Jeffrey’s face and neck to as normal as possible by avoiding skin grafts to those areas.

His innovative treatment plan included a novel, world-first biological treatment using exosomes that produced “absolutely remarkable” results, particularly to Jeffrey’s face.

Saving face
Jeffrey’s face suffered deep partial to full thickness burns, meaning these were serious injuries that most likely would have resulted in skin grafts. Her neck fared worse, with full thickness burns that destroyed all skin layers.

Worldwide, the current standard treatment for patients with deep burns is skin grafting surgery, where a thin layer of healthy skin from another part of the body is placed over burned skin so it can connect to blood vessels and begin healing. Grafting helps protect the wound, reduce the risk of infection, and allow new skin to grow. But it also leaves skin with scars and a patch-like appearance.

“My vision for Kaitlin was to avoid skin graft surgery to her face and neck at any cost,” says Jeschke. “You can do the best graft on the planet but you won’t return the skin to normal. And for a young person, a skin graft to the face and neck would be absolutely devastating.”

Jeschke is also a world-renowned burn researcher; HHS’ vice president of research and innovation, and chief scientific officer; and a professor of surgery at McMaster University, HHS’ key academic partner. He has been on forefront of new and emerging burn treatments for more than two decades.

With further research, Jeschke hopes the world-first treatment he used to save Jeffrey’s face and neck from grafting surgery will become the standard of care in Canada. As a step toward this goal, he recently shared his findings in a case report and submitted it for publication in scientific journals. A case report focuses on findings from a single patient or small group, typically highlighting a first-ever observation.

Life changed in a flash
Jeffrey was halfway through her first year at Western when she attended the frat house party with her Alpha Gamma Delta sorority sisters. A flash fire erupted when a trophy being used in a game was ignited, and someone poured an accelerant over it.

Jeffrey had been ready to head home for the night, and about to call for an Uber when an intense burst of flame suddenly struck her face, neck and body, and singed away her hair.

“I remember being on fire for about a minute,” says Jeffrey, who burned her hands while frantically patting down her face and hair.

Jeffrey was taken by ambulance to a London hospital, and after staff realized the severity of her burns, she was sent to Hamilton General Hospital in an Ornge land ambulance specializing in critical care.

“In Hamilton, the care was amazing,” says Jeffrey. “Each and every member of the burn team has had a huge impact on my life.”

A few days into her stay, Jeschke asked Jeffrey and her parents if they might be interested in a never-before-tried burn treatment on her face and neck using exosome injections as an alternative to grafting.

Exosomes are tiny particles released by cells that carry signals from one cell to another to help coordinate rapid healing and tissue repair, and reduce inflammation. For this procedure, exosomes came from stem cells taken from umbilical cord and amniotic tissue. With exosome therapy, these particles are collected, typically from lab-grown cells, and injected into the injured areas to rapidly accelerate healing.

“We trusted Dr. Jeschke, and wanted to do whatever it took for the best possible outcome,” says Jeffrey.

An innovative plan
Tapping into years of research, Jeschke felt that exosome therapy was the best option for Jeffrey. Exosomes had been studied for years as part of burn research, but not yet in humans. However, some clinical trials involving humans have used exosomes for different types of wound healing, with promising results.

After getting the green light from Jeffrey, her parents, and HHS’ president and CEO, Jeschke sent an urgent application to Health Canada to try exosome therapy on compassionate grounds. Receiving no objection, Jeschke and his HHS team became the first in the world to perform this treatment on a burn patient. Exosomes were sourced from the United States. Jeffrey’s two treatments, which took place several days apart, used 1 trillion exosomes.

Treatments involved debriding wounds and then injecting the exosomes into them. Debriding is where doctors carefully remove dead or damaged skin from a burn to help prevent infection and allow healthy tissue to heal.

“The exosome treatments are extremely safe, and the results were absolutely remarkable,” says Jeschke. “You can’t tell by Kaitlin’s face that she once suffered burns.”

She also healed faster, and with better results, than another student whose burns were serious, but not as severe. The other patient wasn’t a candidate for exosome treatment because their injuries did not require skin grafting.

The backup plan: a “vampire” facial
In addition to exosome therapy, Jeffrey also had platelet-rich plasma (PRP) applied topically to her wounds. “PRP was done in the event that exosome therapy didn’t work as effectively as we hoped,” says Jeschke. “We felt that with the addition of PRP, there would still be some benefit.”

PRP can be used in Canada for skin rejuvenation, acne scarring, and, in some cases, wound management. It’s more widely used in the United States, including by celebrities, where it earned the nickname the ‘vampire facial’ because the person’s own blood is drawn, processed to concentrate the PRP, and then applied to the skin.

Jeffrey’s neck still has active scarring – the phase of healing when a scar is still developing and can appear red and raised before settling into its final form. She’ll return to HGH’s regional burn centre for PRP and laser treatments to work on that area.

While Jeffrey’s face and neck were spared grafting surgery, she had grafts for burns to her hands and right arm.

A life-altering experience
Jeffrey remembers the first time she saw herself in hospital, shortly after the fire. “It was shocking, and I was terrified that I would be disfigured for life,” she says, adding that she’s incredibly grateful for the exosome treatments.

“It’s honestly a miracle,” Jeffrey says of results with respect to her face, adding, “Being injured in the fire has also had deep impact on my mental health, and it’s something I’m continuing to deal with. But having such good results, particularly to my face, is helping me move forward.”

Jeffrey and her family are extremely grateful to Dr. Jeschke and the entire burn centre team.

“Like Dr. Jeschke, my family and I would love to see exosome therapy become the standard of care for patients like myself in Canada, so that when horrific things happen, it doesn’t change people’s lives forever,” she says.