The South Carolina Burn Center with Steven Kahn, M.D.

Burn injuries can happen quickly, to anyone, almost anywhere. For those with severe burns, getting to a burn center for care is essential. Patients don’t need to travel far to get specialized care for severe or even more routine burns. The South Carolina Burn Center at MUSC Health offers the most cutting edge treatments for its patients. Dr. Steven Kahn, Chief of Burn Surgery, shares details about the center and many cutting edge treatments such as regenerative technology that improve the lives and appearances of those with severe burns and scars.

“We're not only focused on physical scars, but also the emotional scars of an injury, not just for the patient but also their family. We're focused on recovery and reintegration back to doing what you were doing before you're injured, even in a very large, catastrophic burn injury. And we have a team of specialists who do nothing but take care of burns.”
- Steven Kahn, M.D.

Topics Covered in this Show

• Kahn talks about coming to MUSC Health to open the new comprehensive burn center in May of 2020, more than 20 years after the original adult portion of the burn center at MUSC Health had closed. In addition to the existing pediatric burn center unit for patients 15 and at the Shawn Jenkins hospital, there is now a unit for patients 16 and up at the main university hospital.
• Kahn and his team treat second and third degree burns at the center using minimally invasive burn care when possible.
• The majority of burns seen at the center for children are scald burns and for adults it is from cooking with grease.
• The comprehensive team at the burn center includes a physical therapist, an occupational therapist, care managers, dieticians, pharmacists and a psychologist that only takes care of burn patients.
• MUSC Health was the first in the country to successfully use a novel combination of two revolutionary products – Nexobrid® is an enzymatic burn debridement and Recell®, is a point-of-care regenerative skin-grafting therapy – in a minimally invasive skin graft procedure.
• His team has now used this dual treatment on 11 patients with great success.
• Kahn also has a research interest in firefighter safety and has published several papers looking at risks of injury, particularly related to firefighter gear use.
• Kahn’s team have also become scar experts for people with wounds of all kinds. They have a laser scar revision program where they use a laser to deliver drugs into scars that helps thin the scar out and remodel over time. This equals better functional and cosmetic outcomes.

Read the transcript

Erin Spain [00:00:04] Welcome to Advance with MUSC Health, I'm your host, Erin Spain. This shows the mission is to help you find ways to preserve and optimize your health and get the care you need to live well. Burn injuries can happen quickly to anyone almost anywhere. And for those with severe burns, getting to a burn center or for care is essential. Patients don't need to travel far to get specialized care for severe or even more routine burns. The South Carolina Burn Center at MUSC Health opened last year and offers the most cutting edge treatments for its patients. Here with details is Dr. Steven Kahn, Chief of Burn Surgery. Welcome to the show.

Steven Kahn. M.D. [00:00:47] Thank you. It's a pleasure to be here.

Erin Spain [00:00:48] Well, as I mentioned, the South Carolina Burn Center is brand new. Tell me about the need for a center like this and the region and how it came about.

Steven Kahn. M.D. [00:00:57] Approximately 20 years ago, MUSC used to take care of burn patients of all ages. In 2002, the adult portion of the burn center closed down and we continue to care for pediatric patients. We were fortunate enough to be able to reopen the comprehensive burn center in May of 2020, and this was a big effort on behalf of the state and multiple stakeholders at MUSC to reopen. So we could provide this important public health service for South Carolinians to keep people from having to go out of state to get high quality burn care when someone can recover close to home, where their family and their support system in their resources are. It's a much easier course than having to travel three or four hours, five hours just to get routine care.

Erin Spain [00:01:39] Well, walk me through the center and the space and tell me about the special features and what you are all able to bring to the new center.

Steven Kahn. M.D. [00:01:48] Certainly. Well, the first part about building the burn center was recruiting a team. We were fortunate enough to be able to recruit a team of experts from around the country to build on the infrastructure that MUSC already had in place. The South Carolina Burn Center encompasses two hospitals. There's a unit for patients 15 and under Shawn Jenkins hospital, and there's a unit for patients 16 and up at the main university hospital.

Erin Spain [00:02:11] And when they were building this space, what were some things that were kept in mind to truly make this a state of the art experience?

Steven Kahn. M.D. [00:02:18] There is a special shower room where patients can go to have their wounds cleaned on a daily basis. The rooms are set up, especially at John Jenkins, to be able accommodate a family member so someone can stay with their injured loved one. And the rooms actually have special heating capabilities because someone who has a very large burn injury can't regulate their body temperatures so the rooms can heat up to over 90 degrees

Erin Spain [00:02:40] And tell me a little bit about you. Were you brought in to help build this team?

Steven Kahn. M.D. [00:02:44] I was. Yeah, I am by background, a general surgeon, I did a residency in general surgery, then I did fellowships in thermal injury research, trauma, surgical critical care and burns. I ran the burn center in Mobile for four or five years before I relocated here. My background is in comprehensive care of the burn patient, both pediatric and adults. I'm an academic surgeon who does a lot of research, some related to firefighter safety, some related to minimally invasive burn care. And I'm on the board of trustees of the American Burn Association and the upcoming American Burn Association Program Committee chair. So I'm in charge of the educational content for the burn community around North America.

Erin Spain [00:03:24] Let's talk about burns. Can you explain the different degrees of burns first, second, third and so on and how you treat these patients at the South Carolina Burn Center?

Steven Kahn. M.D. [00:03:33] So the most common burn depths that are treated here are second and third degree burns, second degree burns, the outer layer of the skin blisters off and the inner layer of the dermis is exposed and it tends to hurt. Third degree burns go all the way through the skin, and all of the good cells that your body normally needs to heal are unfortunately burned by the injury. So those patients often have to get skin grafts.

Erin Spain [00:03:58] How do most of these injuries occur?

Steven Kahn. M.D. [00:04:00] The majority of the injuries that we treat are accidents that happen in the home and children at scald burns adults. It's cooking with grease.

Erin Spain [00:04:09] Really, what beyond cooking? What are some of the other instances that you see other accidents?

Steven Kahn. M.D. [00:04:14] We see a lot of people who become injured when they're burning trash or waste in their yard. They put gasoline on the fire. We see injuries related to space heaters.

Erin Spain [00:04:25] You mentioned skin grafts, so a lot of people do think of burn treatments as being really invasive, massive skin grafts, many surgeries. The field is changing, though. So tell me what's happened in the past few decades and some of the new technology that you're using now to do more minimally invasive procedures on the skin?

Steven Kahn. M.D. [00:04:44] Certainly. Well, the vast majority of patients that we treat fortunately, do not need a skin graft. We have special dressings that can stay in place for a couple of days that cut down on any discomfort during wound care. We also have skin substitutes or what I like to refer to as artificial skin that one can put over the wound and that way, you're changing a dressing over the artificial skin as opposed to the painful burn wound. Skin graft is generally standard of care in the United States for a third degree burn. We have some very cool new minimally invasive technologies that can help eliminate skin grafts for some patients or dramatically cut down on the size.

Erin Spain [00:05:20] Tell me a little bit about those I know. The South Carolina Burn Center is one of the first in the nation to successfully use a couple of these combinations of these new technologies. Explain those to me.

Steven Kahn. M.D. [00:05:30] Yes. So instead of a normal surgical removal of a burn, we now have a very interesting new technology. It's an enzyme called bromelain that comes from pineapple stems that you can put on a burn wound, and it will remove the burn wound and preserve all of the healthy tissue, cutting down on the need for surgery. In the initial round of studies, we found that it made you less likely to need a skin graft. And if you had to have a skin graft, it was dramatically smaller compared to patients that did not receive the enzyme. They also got better about six days sooner.

Erin Spain [00:06:01] Because when you do have to get a skin graft, typically that skin comes from another part of your body, which makes a more difficult recovery. Sometimes tell me about that typical process for a traditional skin graft.

Steven Kahn. M.D. [00:06:14] Well, unfortunately, you have to make a wound to treat a wound, and this has really been standard of care in the United States since the 80s. This technique was first described in the 70s, actually in Eastern Europe, and there haven't really been too many major advances in burn care until some of these products. There's also a skin cell spray called Recell, where I can take a very small piece of skin about two by three centimeters, turn it into a spray and it over certain wounds and that two by three piece of skin, the spray will cover almost a whole sheet of printer paper, so you can get a dramatic expansion of the skin so your donor sites are much smaller. You're making fewer wounds to get people better, less recovery time and less pain.

Erin Spain [00:06:58] Some of the patients that you've been able to use this, really, it's still an experimental treatment on what has their reaction been?

Steven Kahn. M.D. [00:07:05] Patients have minimal pain. They're very satisfied with their care, and they generally have better cosmetic outcomes and then better functional outcomes over joints because you're spraying cells evenly over the wound as opposed to making a mesh, which is a normal skin graft pattern that has the scar in the wounds look much better in the heal, much faster.

Erin Spain [00:07:25] There's more to a comprehensive burn center than just treating the wounds. Tell me about the team of specialists from nutritionists, social workers that you have there, and how they support and care for your patients.

Steven Kahn. M.D. [00:07:36] So we're not only focused on physical scars, but also the emotional scars of an injury, not just for the patient but also their family. We're focused on recovery and reintegration back to doing what you were doing before you're injured, even in a very large, catastrophic burn injury. And we have a team of specialists who do nothing but take care of burns. We've got dedicated burn nurses. We've got a burn physical therapist, an occupational therapist. We have care managers. We have dietician pharmacists and we have a psychologist that only takes care of burn patients. We have specialized services for adults. And then it's Shawn Jenkins. We have all of these services for pediatric patients as well and all the other things that a child needs to recover during burn injury. But our goal is not just for someone to survive. But our goal was for them to thrive and get back to doing everything they did before they were injured.

Erin Spain [00:08:28] I do want to talk about survival rates. How has that changed in recent years and what are survival rates for, especially some of these more extreme burns?

Steven Kahn. M.D. [00:08:38] So as critical care, as advanced and some of our technologies have advanced burn survival, it's gotten better over time. If you were a young, healthy person 50 years ago, your burn size was basically your chance of dying. So if you were burned over 50 percent of your body, there was a 50 percent chance you would die. But now, a young person with 50 percent burn has pretty much 100 percent survival in the United States and in our hands. So patients are doing better, they're getting better, faster and they're getting back to doing what they used to do.

Erin Spain [00:09:07] You mentioned some of the causes of these burns. What can be done to prevent these injuries from happening in the first place? What is some public service announcement advice that you would like to share?

Steven Kahn. M.D. [00:09:20] Absolutely. Everyone should have working fire alarms and CO2 detectors in their house. I'd also recommend keeping a class ABC fire extinguisher in your kitchen. If a grease fire occurs, smother it with the lid or use the fire extinguisher. Never throw water on it. Or it will explode and never try to throw it outside because you have the chance of throwing it on yourself or on one of your loved ones. Be very careful and holidays when working with fireworks. Always wear eye protection. Never hold them in your hand. Don't mix flame and pyrotechnics with alcohol. As those result in all kinds of injuries.

Erin Spain [00:09:57] There's a trend that's happening on social media from time to time. These "fire" challenges as well. Have you seen some of these fire challenges end up in your burn center, some of these folks that are participating in these activities?

Steven Kahn. M.D. [00:10:10] Unfortunately, yes, and we've actually done some research on this and written some papers on the subject. It's very unfortunate and it's completely preventable.

Erin Spain [00:10:17] Well, tell me about that. What are these social media fire challenges that are out there?

Steven Kahn. M.D. [00:10:22] People tend to put things like alcohol or hand sanitizer on themselves and light themselves on fire, and then they jump into a pool or try to turn on a shower. And we've seen some catastrophic burn injuries from this, especially with hand sanitizer, because it's thicker and it tends to stick.

Erin Spain [00:10:36] Tell me about your research with firefighters. This is a group that's at very high risk of burns. You're very interested in the protocols in place to reduce firefighter burn injuries. Just tell me about some of your work in this area.

Steven Kahn. M.D. [00:10:49] Firefighters are heroes. They run into burning buildings when the rest of us are the opposite direction. They provide such an important public health service for us. My goal is to do what I can to help keep them as safe as possible. And if this career worth of research helps prevent one injury or one fatality, it was completely worth it. We have been working with various government and firefighting agencies to determine risks of fatality, particularly when preventable safety related things occur. And also looking at risks of injury, particularly related to gear use.

Erin Spain [00:11:22] So what can go wrong with gear that the firefighters wear, I know that a lot of that gear is special, very specialized, to protect them, but what can go wrong?

Steven Kahn. M.D. [00:11:30] All gear has inherent limitations, so it's important for firefighters to understand what the limitations of their gear are and to make sure everyone has good education and standard operating procedures and protocols, and how to properly use the gear.

Erin Spain [00:11:42] And as far as getting treatment quickly, is that ever a problem as well that some firefighters, maybe they don't go to the burn center when they need to?

Steven Kahn. M.D. [00:11:50] We see that not only with firefighters, but also with regular civilians and people in other industrial accidents that involve high risk, high temperature situations. In general, people tend to recover more quickly when they come to a burn center. Because this is what we do all day, every day we eat, sleep and breathe burns. An analogy, if you had a heart attack, you'd want to go to a heart specialist and maybe not a generalist. Same thing goes with burns. It's best to seek care from a specialist. We're currently working with some of their governing bodies to determine and characterize injury rates and self-report of factors that went into injury, so we can get a better sense of how people are actually getting hurt from them as opposed to databases, things that are reported in statistics.

Erin Spain [00:12:33] We've talked a lot about the care that you do for folks who are burned, but you all also have expertise and caring and treating scars. So tell me about that work. And what are you able to do for people who have some severe scarring from injuries outside of burns?

Steven Kahn. M.D. [00:12:49] We not only treat burn injuries here at the South Carolina Burn Center, we treat wounds of all types, whether they occur from trauma or whether they're chronic wounds or wounds of another type or circumstance. And one thing that wounds all have in common is that they leave scars. So we have become scar experts over the years. We have a laser scar revision program where we use a laser to deliver drugs into the scar that helps thin the scar out. And the laser itself helps than the scar and helps it remodel over time. So it has a better functional outcome. Better cosmetic outcome tends to be less red. Scars that are itchy tend to itch less, and using the laser improves people's quality of life. Whether it's from an injury or whether it's a surgical scar, we can treat scars of any type you have.

Erin Spain [00:13:35] You could elaborate on that a little bit sort of the life changing experience this can be for someone who does have a severe scar to have it reduced to have it be less inflamed. What what does that mean to them and their and their quality of life, as you mentioned,

Steven Kahn. M.D. [00:13:49] It can be really tough for someone who has a scar on, let's say, on their face to go to the grocery store and have a look at them. It can be tough on their kids. It's just a big strain on the family. The skin not only helps you interact with your environment, you know where your nerve endings are in it, it protects you from trauma, protects you from infection, but it's also your identity. And some folks that have severe scars, it interferes with their identity and sense of self. And by treating these scars and making the skin look more normal, people feel more like themselves. Some scars are very tight and can occur over joints and can actually impair motion and movement. And by treating the scars with laser, we can often get them to thin out to the point where patients get their motion back.

Erin Spain [00:14:31] Can you share a specific success story that since the South Carolina Burn Center opened, that has really been a good example of the great work that can take place here.

Steven Kahn. M.D. [00:14:41] A few months after opening. We were the first burn center in the country to report treating someone with both the enzyme and the skin cells spray that I previously mentioned. They were not previously available together because they were only available via studies, and one patient can participate in one study at a time. So after the skin cell spray became FDA approved. And the enzyme became available again through another study. We're able to treat someone who had burns over 17 percent of their body with the enzyme, and instead of doing conventional skin grafts to get them better, we're able to use the skin cell spray. Think about that only almost one fifth of their body was injured, and we were able to treat their injuries with 24 square centimeters of skin. So basically a six by four area. By using the skin cell spray, the donor site was approximately tenth the size it would have been had we done regular skin grafting. He was able to leave the hospital in about half the time expected. He regained full function, got back to what he was doing incredibly quickly. Furthermore, his scars are barely visible.

Erin Spain [00:15:43] Have you been able to do this sort of dual procedure again? Or is that just the first time?

Steven Kahn. M.D. [00:15:49] We have now treated 11 patients with a dual procedure.

Erin Spain [00:15:52] So this is the question that we ask all of our physicians who come on the podcast. What do you do to optimize your health and live well?

Steven Kahn. M.D. [00:16:00] I love to spend time with my wife and daughter. I like to cook, particularly barbecue. I like to fish and I like to run.

Erin Spain [00:16:05] Thank you so much, Dr. Stephen Kahn, for coming on the show, telling us more about the burn center, and we will put some links up on the website in the show notes that people can find out more.

Steven Kahn. M.D. [00:16:16] Thank you so much, Erin. I appreciate being included. And thank you for your time.

Erin Spain [00:16:23] For more information on this podcast, check out advance.muschealth.org.