Numerous surgeries, skin grafts await Tega Cay burn victim Connor McKemey
01/04/2009 12:13 AM
01/05/2009 7:08 AM
Inch by inch, surgeons are cutting away the painful remnants of that terrible night just days before Christmas.
Almost daily, Connor McKemey is wheeled into an operating room at an Augusta, Ga., burn center, where an elite team of specialists carefully, painstakingly removes the burned skin from his back, his face, his arms, his legs.
When they have done as much as his 13-year-old body can handle, his newly cleansed wounds are covered with cadaver skin to prepare them for grafting.
In a few weeks, surgeons will graft Connor's wounds with his own skin -- skin that was harvested from a small area of his body that wasn't burned by the fire; skin that today is growing in a laboratory in Massachusetts.
Connor was burned over 85 percent of his body when a fire erupted out of an outdoor fireplace at his family's Tega Cay home two weeks ago.
Most of the burns he suffered were third-degree burns -- meaning they injured the full thickness of the skin, as well as the underlying tissue.
Connor is on a machine that breathes for him because the inside of his lungs were burned slightly during the accident and the extent of his burns makes it difficult for him to breathe on his own.
Doctors continuously monitor Connor's body for complications from being burned -- infection, pneumonia, organ failure.
"Every day is a wait game," said Connor's mother, Karin McKemey, who was burned during the accident trying to help him. "He is a strong and very active person, which has helped him."
'Most dramatic injury you can have'
Each year, more than 40,000 people are hospitalized because of burn injuries, according to a report by the American Burn Association.
More than 60 percent of those are admitted to one of the nation's 125 burn centers; 94 percent of those admitted to a burn center have survived, the report states.
Burn injuries are more common during the winter months because people are doing activities to keep themselves warm, such as boiling water and building fires, said Dr. Richard Cartie, a pediatric burn care specialist at the Joseph M. Still Burn Center in Augusta, where Connor and his mother are being treated.
Pediatric patients suffering from burn injuries tend to be more resilient to complications than adults because their organs are younger, he said.
Regardless of age, recovering from burns is complicated because it affects every aspect of the body.
"It is the most dramatic injury you can have," Cartie said.
Patients are usually taken to surgery within the first 24 hours so doctors can begin removing burned tissue -- a tedious process that tends to take many surgeries, depending on the extent of the burns, said Dr. Fred Mullins, medical director at the Augusta burn hospital.
Typically a burned patient will remain in critical condition until all of the burned skin is removed and the body is covered with skin grafts, he said.
As a general rule of thumb, Mullins said, a burn patient will stay in the hospital at least one day for every percentage point that his body is burned. In Connor's case, that could mean at least 85 days.
Connor still faces more surgery to remove burned skin, his mother said, and in the coming weeks will receive skin grafts.
Keeping the swelling down
Initially, one of the biggest complications from being burned is swelling, said Cartie. When the body is burned, it tries to fix itself by sending material to the burned area, which results in inflammation.
The injury also causes blood vessels and capillaries to leak fluid, compounding the problem, he said.
"This makes for considerable swelling, which can compromise blood circulation and put pressure on organs," Cartie said.
Leaking fluid also causes a patient's blood pressure to drop, so he must be given more fluid -- creating a vicious cycle.
"We use so much fluid," Cartie said, then "we have to fight to get rid of it."
Because of the almost-daily surgeries, Connor's doctors say he needs a lot of blood, his mother said.
The McKemeys' neighbors are planning a blood drive this month for Connor.
Third degree burns cause a tremendous amount of pain because nerves have been injured, said Mullins. As the burned areas are covered with new skin, the nerves settle down and get better. As the patient heals, the pain goes away.
Nurses keep Connor heavily sedated to control his pain. From time to time, the amount of medication is reduced to allow Connor to come out of sedation for a short time, so doctors can see how he is responding to treatment, his mother said.
Postings by family friend Reid Lancaster on the CaringBridge Web site report that when asked if he is in any pain, Connor responds by shaking his head no.
Another complication in the initial phase of a severe burn is that it increases the body's need for calories.
"It's like turning the thermostat up and opening all the windows," Cartie said.
During the first 24 to 36 hours after being burned, the body uses all its available stores of energy, he said. This can be a problem in children, because they usually do not have large fat reserves, so the body tends to break down muscle for energy.
To keep up with the increased caloric demand, children are given liquid food by a tube placed through the nose into the intestines.
"Most kids are on double calories throughout their hospitalization," Cartie said.
Another potential problem from being burned is infection because of the large amount of open tissue from the removal of burned tissue.
"Tissue is cleaned off regularly in the operating room," Cartie said, "but even under the best conditions, you can expect infection."
Infection is dangerous because it can cause all the same symptoms the body experiences when it is initially burned, so large doses of antibiotics are given.
Only after all the burned skin has been removed and the underlying tissue is healed, Cartie said, is the tissue ready to accept skin grafts.
Because of the extent of his burns, a patch of Connor's skin was sent to a lab in Cambridge, Mass., to be grown for grafting.
Enough skin is grown in about 16 days to cover all of the body, according to Genzyme, the company that grows the grafts.
The graft will be surgically attached and eventually will grow into the underlying tissue, Mullins said. The grafted skin is only the surface layer, so it does not contain hair follicles and sweat glands.
Since the graft will be Connor's own skin, as it heals, it will grow with him.
Right now, the McKemeys -- Mom, Karin; Dad, George, just back from a year on active duty in Iraq; and brothers Tripp and Quinn -- remain optimistic.
They are trying to rebuild their lives while they spend every possible moment with Connor.
"When I say the names of his friends, he stirs," said Karin McKemey about her visits with Connor. "When I start saying people are praying for you, that's why you have to fight hard, too, we feel his wiggle."
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