August 3, 2022 is a day Nora Gracia will never forget. That day, her 7-year-old son, Jayden, had just finished playing outside in the family’s backyard. Nora was getting ready to cook dinner.
“I was cooking carrots and potatoes in a bowl of water in the microwave,” said Nora. “While I was waiting for the veggies to cook, I had some laundry outside. I told Jayden I was going to bring the clothes inside and start folding them while we waited for dinner. I was outside for just a minute.”
Then, while Jayden was in the kitchen, the unthinkable happened.
At first, Nora didn’t realize the severity of Jayden’s situation because of his sudden reaction. He was very calm and he didn’t scream at all. When Nora took his clothes off – she began to panic.
“Jayden’s skin was falling off,” said Nora. “Immediately, the first thing that came to mind was to put him in the bathtub with cold running water. I was trying to cool him down.” The prompt action that Nora instinctually performed was appropriate first aid for a scald burn. “Then I wrapped him in a towel and I rushed him to the ER near our home in Crosby, Texas,” said Nora.
When Jayden got to the ER, the care team evaluated and cared for his burns right away. They gave him medicine so he wouldn’t feel any pain or discomfort, and put medicated dressings directly against his wounds. However, since Jayden suffered severe burns, he needed to be transferred to a pediatric burn center quickly.
The Children’s Memorial Hermann Transport Team transferred Jayden and Nora via ambulance to Children’s Memorial Hermann Hospital in the Texas Medical Center. As a Level I pediatric trauma center, Children’s Memorial Hermann Hospital is equipped and ready to care for the most critical and severe cases. The transport team regularly transfers pediatric and neonatal patients from community hospitals, clinics and ERs when a higher level of care is required.
A higher-level of burn care
When Jayden arrived at the ER at Children’s Memorial Hermann Hospital, he had extensive burn injuries to his chest, torso, thighs and genitalia. He had deep second-degree burns in some areas and superficial second-degree burns in other areas. His burns covered 10% of his body.
While in the ER, Jayden’s bandages were removed, and the pediatric surgery team along with emergency care providers cleaned his second-degree burns thoroughly and removed any dead tissue and foreign debris to expedite wound healing and prevent infection. Jayden was sedated for this procedure. After his wounds were cleaned, a special medicated dressing was placed on his deep burns. Bandages secured the dressings on the wound.
Since Jayden needed specialized burn care and treatment for his multiple injuries, he was admitted and treated in the pediatric burn treatment program.
Children’s Memorial Hermann Hospital in the Texas Medical Center operates as the only pediatric burn treatment program in Houston. Children are admitted and treated by board-certified pediatric surgeons affiliated with McGovern Medical School at UTHealth Houston, who provide a full range of services, including care for minor burns, skin grafting and reconstructive surgery for severe burns. The program team also includes nurses, physician assistants (PAs), nurse practitioners (NPs), a burn tech, occupational and physical therapists, and Child Life specialists that specialize in burn care management.
An innovative skin grafting surgery
“The doctors were concerned about his right thigh,” said Nora. “His right thigh was more severe than other affected areas of his body. Since Jayden had deep second-degree burns, he needed to undergo skin grafting surgery to help his wounds heal with minimal scarring and discoloration.”
In August 2022, Jayden had skin grafting surgery, but his surgical team at Children’s Memorial Hermann Hospital used an innovative and nontraditional approach to treating his severe burns.
Skin grafting is currently the standard of care used to treat many pediatric burns but this can be painful and often requires more donor skin to cover the damaged skin. Instead of harvesting skin from one part of the body and using it to cover another – which is the traditional approach to skin grafting surgery – Jayden’s surgical team used a system for an epidermal autograft, a minimally invasive, regenerative skin grafting procedure that involves taking a small skin sample from the patient and reducing it to a solution that can be sprayed over the burned area to cultivate new cells. The solution contains major cell types like keratinocytes, fibroblasts and melanocytes, which all play important roles in skin-tissue repair and regeneration. This process allows for less donor skin to be used and, oftentimes, improves a patient’s pain and enhances the cosmetic appearance of the scars.
“Children’s Memorial Hermann Hospital is one of only a handful of burn centers across the country using this new technology, which has proven to be very effective for treating certain types of burns, particularly second-degree burns,” said KuoJen Tsao, MD, professor of Pediatric Surgery and chief of the Division of General and Thoracic Surgery at McGovern Medical School at UTHealth Houston, and pediatric surgeon affiliated with Children’s Memorial Hermann Hospital. “By spraying new skin cells over a much larger surface area, we are able to distribute the cells broadly and evenly over the wounds while using as little donor skin as possible. This new approach can have a significant impact on a patient’s recovery leading to faster healing, less pain and scarring, and improved cosmetic results.”
Jayden recovered and was ready to go home four days later.
“Jayden did well,” said Nora. “After surgery, he was relieved that he didn’t have to go through dressing changes because the areas that were treated could not be disturbed. When he was first admitted to the hospital, he had dressing changes every day – once in the morning and once in the evening. The nurses put wet gauze directly on the wound and covered it with a dry dressing so it wouldn’t stick to the wound during dressing changes, which made things less painful for Jayden.”
A few weeks later, when Jayden came in for his first follow-up appointment, his pediatric surgeon removed the protective plastic layer that covered the skin graft and noticed that his burns were healing well – some faster than others. After his follow-up visit, Jayden continued wearing burn dressings and going through dressing changes every day until the wounds healed and closed fully. The medical team educated Jayden and his family on the importance of the protection of newly healed scars from mechanical trauma and sun exposure.
Wound care and recovery
While waiting for his wounds to heal, his occupational therapists monitored his scarring for any signs of raised scarring, which is an abnormal response to wound healing where extra connective tissue forms within the original wound area. Raised scars can be hypertrophic, where they are contained within the original wound area, or keloid, where they spread beyond the original wound area and do not regress. Jayden had presented with red, hypertrophic, irritated scarring of the right thigh.
Jayden’s chest, genitalia and left thigh healed rather quickly, however, because of the hypertrophic scarring on his right thigh, Jayden was prescribed custom compression garments. The garments, made out of nylon spandex material, are used to provide custom pressure over the scars. Jayden also uses silicone inserts to help with maturation and flattening of the scar on his right thigh. Jayden will wear his compression garments for more than 15 hours per day until his scars mature.
“Jayden’s skin has improved a lot since his procedure,” said Nora. “He has no scarring on his chest – just normal skin. The only thing we’re waiting for is his natural pigmentation to return. His right thigh is taking the longest to heal. When he wears his compression garment every day, the scar becomes softer and flatter. We put moisturizing lotion on the scars at least three times a day. Jayden will continue to wear his compression garment until the scars mature completely. As part of Jayden’s rehabilitation, he also went through physical therapy to help him regain the endurance, strength and balance needed for activities such as getting into a chair, standing up and walking.”
Beyond the physical trauma, Nora says the accident has impacted her son in other ways.
Treating the whole burn patient
For patients like Jayden, burn injuries can bring both physical and emotional trauma to a child. As part of the Pediatric Burn Treatment Program, the team is very much focused on addressing the physical and emotional trauma of burn injuries, as well as the secondary trauma that often occurs within the hospital setting as patients acclimate themselves to a new and unfamiliar environment.
Especially for kids, there is pain and fear and anxiety associated with burn injuries, dressing changes and procedures. Child Life specialists play a critical part in helping burn patients reduce the anxiety by preparing them for what to expect during and after a procedure. Additionally, the burn team employs techniques to improve pain management for these patients.
“In the last year, we have more consistently introduced soft casting over long-term dressings to assist in the area of pain management,” said Jennine Johnston, an occupational therapist with Children’s Memorial Hermann Hospital. “We have a soft casting technique where we can cast patients’ extremities in positions that prevent contracture and they don’t have to change the dressings or the cast for up to seven days. This technique is very helpful for pain management, anti-contracture positioning and protection of the wounds while they are healing.”
The burn team also now has a burn technician who streamlines wound dressing changes for patients and their families. “Having a full-time tech on our burn team to manage this critical aspect of wound care has been beneficial to us, our burn patients and their families,” said Jennine.
Nora is grateful to the burn team who helped Jayden in his healing and recovery.
“It will take time for Jayden to heal completely,” said Nora. “He is in good spirits – and I am just thankful for the high level of care he received, which has made a huge difference in his recovery.”