Tilapia skin as burn bandage

When I was 18, I learned the value of knowing what to do in an emergency. It was 4:30 in the morning, and my 12-year-old sister Elena was too excited about a school field trip the next day to sleep.

She had been asked to bring rice for her classmates, so she got out of bed and headed for the kitchen of our home while the rest of the family are still sleeping.

Elena put rice and water into a pot, and placed it on top of our earthen stove. Then she emptied the last of a kerosene container onto the firewood and lit it. The wood initially caught fire, but the flames died down a few seconds later. She found another can that she thought contained kerosene and poured it straight onto the dying fire.

In fact, it was gasoline, which immediately burst into flames.  Shocked, Elena dropped the can, spilling gasoline over her feet.  In an instant, she was literally on fire.

Just at that moment, I walked into the kitchen to get a drink of water and was horrified to see Elena engulfed by flames. Remembering my first-aid training at secondary school, I grabbed a wet blanket that was soaking in a laundry basin and wrapped it around her to smother the flames.

Elena’s cries of pain woke the entire family, and we rushed her to the hospital—still wrapped in the wet blanket. My quick action probably saved my little sister’s life. “If you had not been around, it would have been worse,” the emergency room doctor told me later. “Good thing you knew what to do.”

It took for my sister three months to recover from the burn to her feet and legs. But before that, she had to endure the pain of the treatment. Her burns were bandaged with gauze and silver sulfadiazine cream.

“It’s a burn cream because there’s silver in it, so it prevents the burns from being infected,” explained Dr. Jeanne Lee, the American interim burn director at the regional burn center at the University of California. “But it doesn’t help in terms of debriding a burn or necessarily helping it heal.”  Another not-so-good thing about the gauze-and-cream dressing is that it has to be changed every day.  “I really hated it each time they have to change the dressing,” said my sister, who now lives in the United States.  “Every time the nurse unwrapped the gauze bandage, I cried in pain.”

But it may soon be a thing of the past, should the Philippines follow what Brazil has done recently.  Health professionals from all over the world were stunned when doctors from the historic city of Fortaleza used the skin of tilapia as a bandage for second- and third-degree burns.

“Burn patients look as if they’ve emerged from the waves,” wrote Nadia Sussman, in a news report circulated by Reuters. “They are covered in fish skin—specifically strips of sterilized tilapia.”

The innovation arose from an unmet need. “Animal skin has long been used in the treatment of burns in developed countries,” Sussman noted.  “But Brazil lacks the human skin, pig skin and artificial alternatives that are widely available in the United States.”

In Brazil the three functional skin banks can meet only 1 percent of the national demand according to Dr. Edmar Maciel, a plastic surgeon and burn specialist leading the clinical trials with tilapia skin. Because of this, most burn patients are bandaged with gauze and silver sulfadiazine cream.

As artificial skin is not always available, Maciel thought of using the tilapia skin as burn bandage.  In his study, he found out that the tilapia skins contained huge amounts of collagen proteins, which are very important for scarring.  “Another factor we discovered is that the amount of tension, of resistance of tilapia skin is much greater than in human skin,” he was quoted as saying.  “Also the amount of moisture.”

There are three types of burns, according to The Doctors Book of Home Remedies. First-degree burns are painful and red.  They occur from sunburn, scalding and other minor accidents.  These are the kind of burns that can be treated at home.

Second-degree burns ooze, blister and are painful.  They result from severe sunburn or from brief contact with hot oven coils or other household accidents. These may be treated at home if the burn is confined to a small area of surface skin.

But third-degree burns are extremely dangerous – even if they don’t hurt (the result of destroyed nerve endings). They leave skin charred and turn it white or cream-colored. These kind of burns can be caused by fire, chemicals, electricity or any prolonged contact with hot surfaces.  For these, you’ll need immediate medical help.

Other burns that demand a doctor’s immediate attention, according to the home-remedies book, include: burns on the face, hands, feet, pelvic and pubic areas, or in the eyes; any burn that you aren’t sure is first- or second degree; burns that show signs of infection, including a blister filled with greenish or brownish fluid, or a burn that becomes hot again or turns red; or any burn that doesn’t heal in ten days to two weeks.

In her Reuters report, Sussman wrote on how the doctors utilized the tilapia skin among burn patients: “In patients with superficial second-degree burns, the doctors apply the fish skin and leave it until the patient scars naturally.  For deep second-degree burns, the tilapia bandages must be changed a few times over several weeks of treatment, but still far less often than the gauze with cream.”

According to Maciel, the tilapia treatment cut down the healing time by up to several days and reduces the use of pain medication.  “The tilapia skin sticks to the wound and creates what we call a buffer effect,” he explained. “It blocks outside contamination, it prevents the loss of moisture, and it stays bonded to the bed of the wound until it heals over.”

If you are still wondering how it is done, the Daily Mail gives this information: “Before the fish skin is used, doctors remove its scales, muscle tissue, toxins and get rid of its distinct smell.  It is then stretched and laminated before being stored in refrigerated banks in strips of 10 centimeters by 20 centimeters for up to two years.

“The result is something similar to human skin, which remains flexible and easy to mould around a wound. It is then placed over the patient’s damaged skin for up to 11 days before being removed.

“Then, doctors remove the scaly skin using petroleum jelly to lift, slide and ease the dressing away from the healed area.”

The tilapia-based skin substitute may not be available yet in the Philippines, but the medical breakthrough is a good news.  After all, the country lacks substantial human skins available for burn patients.  In the last five years, the number of burn cases in the country has considerably increased. For instance, at the Davao-based Southern Philippines Medical Center, the only hospital with a burn unit in Mindanao, about 300 burn patients are treated each year.

The tilapia skin is the first aquatic animal skin to be used on burn patients.  Tilapia is widely farmed in Brazil and whose skin, until now, was considered trash.  But with this recent discovery, the tilapia skin may already be one of the most valuable skins in the future.

In the Philippines tilapia is now the second-most popular table fish—after bangus.  The fish is a native of Africa and was introduced in the country in the 1950s.  Today, “the Philippines is now the fourth-largest producer of tilapia in the world,” said Dr. Rafael D. Guerrero, a fishery expert who’s now an academician of the National Academy of Science and Technology.  The country is just behind China, Egypt and Indonesia.

With that, the use of tilapia skin in treating burns should be pursued, urged Vanessa Duma-an, a journalism student of the Ateneo de Davao University.  In a recent feature, she wrote that a patient with major burn injuries needs, on the average, P10,000 to P20,000 for treatment.

“A single dressing sizing up to 20 x 20 centimeters is priced up to P1,000,” she pointed out.  “Imagine if someone is injured from the hip downward.”

In batting for tilapia skin as burn bandage, she wrote: “Not only it can help in medical terms; those in the fish industry can finally go the fish’s skins to good use.”

Duma-an added: “If clinical trials will be pioneered in the country and show continuing success, we can only hope that this medical, and if not, also an agricultural breakthrough, will be processed on an industrial scale and be part of the public health system for a more efficient, environment- and patient-friendly treatment for burn victims.”

Most people think burns are only caused by fires.  Not likely some chemicals and electrical current can burn, as well. “Although the skin is usually the part of the body that’s burned, the tissues under it also can be burned, and internal organs can be burned even when the skin is not,” The Merck Manual of Medical Information said.

Tissues that are burned may die.  When a burn damages tissues, fluid leaks from blood vessels, causing swelling.  In an extensive burn, loss of a large amount of fluid from abnormally leaky blood vessels can cause shock.  In shock, blood pressure decreases so much that too little blood flows to the brain and other vital organs.

“About 85 percent of burns are minor and can be treated at home, in a doctor’s office, or in a hospital’s emergency department,” the Merck manual said.

But not all burns—especially major burns—can be treated at home. “For more serious burns, you must seek professional help,” the Philippine Society of Burn Injuries pointed out. “Burns left unattended may lead to deformation of the body.  Open wounds, especially, may develop infections and further complications.”

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