After the burn: Encouraging results from autologous fibroblast therapy in treatment of injuries

Key Points

National report - Open-label experience in a small series of patients indicates that autologous fibroblast therapy (Isolagen) is a promising approach for rejuvenation of acute and chronic burn injuries, according to Chris Inglefield, M.D., a consultant in plastic surgery, London.

Dr. Inglefield discusses his experience using autologous fibroblast therapy in six patients with chronic hypertrophic restrictive scars and atrophic scars secondary to burn injuries, and in a single patient with an acute burn injury.

Involved areas included the face, hand, neck and chest. Time elapsed since the burn injury in the patients with chronic scars averaged about nine years (range, 23 to 456 months).

The treated patients benefited from reduced restriction of movement, improved scar pliability, skin softening and reduction in cracking of chronic scars.

One patient with a chronic scar and the patient treated for an acute burn injury underwent subsequent reconstructive surgery to further improve the outcome.

"Our results suggest that patients' own cells can be utilized to induce natural skin repair processes and to achieve, for the first time, true regeneration of normal skin architecture," Dr. Inglefield tells Dermatology Times.

"Now, randomized, controlled trials are needed to document the efficacy and safety of this novel approach," he says.

Dr. Inglefield and other surgeons in England have acquired extensive experience using autologous fibroblast therapy to improve facial acne scarring, and for facial rejuvenation of photodamaged skin. Since 2003, more than 7,000 patients have been treated for these indications.

The idea of using the autologous fibroblast therapy in burn victims arose from a patient who had been badly burned in a house fire and requested the treatment to see if it might improve her chronic scarring, Dr. Inglefield says.

"We anticipated there would be some improvement in the quality of the scarring, but really were surprised by the magnitude of response, as we considered that the major remodeling had long been completed," he says.

The rationale for using the autologous fibroblast therapy as a regenerative technology in the acute burn injury patient aimed to improve the healing process and minimize scarring development.

"Active dermal components are needed for normal skin healing, but are absent in deep partial- or full-thickness burns. As a result, these injuries can go on to heal with excessive scarring," Dr. Inglefield says.

"The administered autologous fibroblasts synthesize collagen and elastic tissue that are incorporated into the dermal architecture to allow more normal healing," he says.

The autologous fibroblast therapy is derived from a skin biopsy. The processed cells are cryopreserved and can be stored indefinitely.

The injection technique involves multiple passes through the dermis, with the bevel of the needle pointing downward. The chronic burn injury patients received a mean of 3.8 treatments (range, 1 to 10), with each treatment involving between 40 and 180 injections.

The patient treated for an acute burn injury had undergone autologous fibroblast therapy one year earlier as an anti-aging cosmetic therapy, and so had cells in storage that allowed post-burn treatment to begin at six weeks after the injury.

Treatment was administered initially to the left temple and cheek, and additional injections were subsequently administered to treat the mid and lower face. Each treatment session involved about 30 to 40 injections.

The injections are administered after application of a topical anesthesia cream. All patients experienced moderate pain that was transient. There was also some erythema, swelling and bruising, but these reactions were all mild to moderate, and also short-lived.