Advance with MUSC Health

Seairyn's Story

Gary Logan
June 09, 2023
Seairyn with burn nurse Tiffany Smith, RN, BSN
Seairyn (left) with burn nurse Tiffany Smith, RN, BSN.

A team of pediatric burn specialists care for a teen who sustained serious burns not from a fire but from a golf cart crash.

“It was just a normal weekend,” says Seairyn Banning before she decided to take the family golf cart out on a “little trip on the IOP” with a friend. As her family had just moved into their new home on the coastal Isle of Palms just north of Charleston, South Carolina, the teenager was unfamiliar with the bumpy twists along the way. Then, turning toward her friend taking a picture of her and then sharply back to the driver’s side, the right side of the cart bounced and lifted up. It was airborne until seconds later it wasn’t as trees blended under a dark sky. She blacked out until she heard her friend saying “Seairyn, you have to get up, YOU HAVE TO GET UP.”

Seairyn, however, couldn’t move as she quickly realized her left leg was trapped under the flipped golf cart. Her friend, whose fall was cushioned by Seairyn, desperately tried to move the cart upright, but the four-passenger cart was too heavy. A neighbor ran over to help, but together they couldn’t lift the cart. Seairyn then took matters into her own hands. 

Every time they tried it would drop, so I ended up just ripping my leg out,” she says.

Seairyn emerged covered with gravel, leaves and blood, in her words, “everywhere.” Looking down she saw deep scrapes and blood oozing on her left hand and lower legs and exposed bone and tendons on her left ankle. Feeling no pain, she figured she must have been in shock. Among her first words: “Oh my gosh. Don’t tell my dad.”

“You fell off your bike and skinned your knee? These bike or golf cart injuries can be serious as well and need specialists to evaluate them. Seairyn had really deep third-degree burns that would not have had a good outcome had she not been with us in the burn center.”
-- Jenna Kelly, PT, DPT

They had to, of course, and Seairyn’s parents drove her to the closest walk-in clinic where staff found serious friction burns—not burns resulting from fire or hot fluids but burns that are caused by contact with hard surfaces such as artificial turfs and asphalt roads. Because they generate heat and may lead to extreme cases of chafing, they may result in genuine burning of the outer layers of skin. Minor friction burns can be treated with lukewarm water and pain-relieving antibacterial ointments, but Seairyn’s burns appeared severe and needed professional burn care.

The nurse first cleaned Seairyn’s wounds of road debris to decrease the risk of bacterial infection, more common in friction burns. She then pointed her to Charleston and the Pediatric Burn Center at the Medical University of South Carolina (MUSC). There she met pediatric burn surgeon Aaron Lesher, M.D.

A music major at Davidson College, Lesher, who still performs piano concerts to this day to raise money for the MUSC Shawn Jenkins Children’s Hospital, says he always wanted to be a doctor. His medical family in North Carolina apparently had more influence than the keyboard. After attending medical school at Duke University and training in thoracic and pediatric surgery, Lesher saw a lot of children with burns in both Memphis and Charleston.

“All through my training there was no adult burn unit, so the pediatric surgeons always treated all of the burns—big burns and small burns and hundreds of burns each year,” says Lesher. “Treating children is what I really loved doing.”

The reasons, Lesher explained, include more involvement with young patients’ care over generally longer periods of time than adults as burn scars don’t grow with the child and need periodic treatment until adulthood. Working with a diverse burn team also appealed to him; that large team encompasses burn nurses, child life specialists, clinical psychologists, pediatric anesthesiologists, critical care physicians, pharmacists, physical and occupational therapists, and social workers..

“The pediatric burn service is not just the burn surgeons,” says Lesher. “It’s a huge team and everybody is involved with every patient.”

Organizing and tracking that care is Tiffany Smith RN, BSN, who met Seairyn and her mom Danae Banning upon their arrival to the Pediatric Burn Clinic on Seairyn’s 16th birthday. A pediatric intensive care and burn care nurse for the past 10 years, Smith introduced herself as the go-to person for any questions related to Seairyn’s care and navigating the burn center system. She applauded the job of the walk-in clinic in cleaning and dressing Seairyn’s wounds but added she would have to repeat that task. That’s when Seairyn found herself facing more trauma from the trauma, arching her back in pain as Smith removed the dressings and started cleaning her wounds.

“I know you hate me right now,” Smith said before continuing but stopped quickly as tears ran down Seairyn's face. Better to have her wound debridement with sedation in the Pediatric Emergency Room, she felt, and coordinated her dressing change there. It was, of course, a surprise when she came off the sedation to find a ring of burn center staff, corralled by Smith, circling her bed, singing Happy Birthday and handing her presents. Business as usual for the team, but for Seairyn this medical chorus pushed her deeper into thinking about her accident, her care and who she was.
“It was a big moment for me in realizing the things you think can’t happen to you can,” says Seairyn. “You realize you’re not invincible—I know now I’m not. It also helped me to be grateful for what I have.”

The next step, notes Lesher, was the evaluation of Seairyn’s burns to determine whether they would heal on their own or require skin grafts. It’s not a decision made lightly, he adds, as it involves taking skin from a deceased organ donor or from another part of the patient’s body and transferring it to the wound, which itself creates a new scar.

“We push it as far as we can to avoid a skin graft,” says Lesher. “If we can only do that, however, the patient absolutely has to have it.”

Lesher shares the team’s perspective, including the need for such procedures and the likely length of hospitalization and future care, with all patients and the parents. Initially, patients with severe burns may need to be in the hospital for weeks or longer and may experience physical discomfort and pain. On the positive side, he notes, children tend to do better from a wound healing standpoint and generally need less grafting than the adults. For young patients, however, the social impact is often more worrisome with concerns about scarring evolving into anxiety and depression, which can become chronic without treatment.

“With burn injuries, it’s important to set expectations very early,” says Lesher. “It’s not like taking out an appendix and you’re done with it. This requires a lot of counseling, discussion and experience.”

Lesher informed Seairyn and her mom that she had sustained extensive soft tissue injuries, some of which were full-thickness wounds that would require grafts. In Seairyn’s case, he added, most concerning was the deeply injured left ankle that was not amenable to grafting right away.

“You just can’t graft over the top of exposed tendon and bone,” Lesher explained. “You have to do a series of intermediate steps to grow tissue and then apply a small skin graft to cover it.”

There likely would be some scarring, but minimal, and scar revision options are available, Lesher added. He cited advances in grafting, including a spray-on-skin system for treating skin loss from intermediate scarring after a burn. The work of fellow burn surgeon Rohit Mittal, M.D., he added, has helped advance laser modeling and surgical reconstruction of scars in the past decade. A double board-certified surgeon, Mittal recently joined MUSC’s pediatric burn center as the Shriners Children’s Endowed Professor to create a comprehensive burn center and to achieve The American Burn Association (ABA) program certification.

“Dr. Mittal is very well versed in that area,” Lesher says. “His expertise was particularly needed on the reconstruction side.”

With the family’s green light to move ahead, Seairyn immediately began physical therapy with Jenna Kelly, PT, DPT, whose goal is to retain patients’ function prior to the burn injury. As the burn starts to evolve, she explains, the skin tightens and loses elasticity, resulting in hardening ligaments and contractures that limit patients’ range of motion.
Their ability to move and perform normal activities of daily living, like getting dressed, bathing, feeding and walking, is compromised. Working closely with occupational therapists, Kelly focuses on stretching the patient out of a jam.

“Seairyn had deep friction burns to her leg, which involved her knee and ankle,” Kelly says. “We did a lot of exercises to stretch that skin in the leg.”

Kelly also encourages frequent walks to generate healthy blood flow and circulation to help wounds heal faster and prevent complications such as blood clots. She and other physical and occupational therapists also make splinting devices to keep patients in a good position for healing during the acute period, which is most active during the first six to nine months.

As both contractures and physical therapy can be uncomfortable and painful for patients with burns, Kelly works immediately on building a rapport and foundation with patients for discussing pharmacologic controls and relaxation distraction techniques. Seairyn’s care needs, she adds, illuminate the potential seriousness of friction burns, which are often overlooked. “You fell off your bike and skinned your knee? These bike or golf cart injuries can be serious, as well, and need specialists to evaluate them,” says Kelly. “Seairyn had really deep third-degree burns that would not have had a good outcome had she not been with us in the burn center.”

Child Life Specialist Amelia Brackett, MS, CCLS is another pain reliever of sorts. She meets with patients and their parents on their first day of admission to assess their coping skills. For young children she uses a hospital playroom and age-appropriate toys to help them work through fears that might be associated with the cause of the burn and issues like going back to school.

“We use medical play to play out different emotions and normalize the experience,” says Brackett. “The child, for example, can mimic dressing changes to gain confidence and a sense of control.”
Reflecting on her own experience, Seairyn says the burn team made her “feel at ease” while facing significant and at times painful care. “The nurses were so gentle and always helped me with whatever I needed, to make sure I was comfortable and mentally okay.”

Seairyn has improved physically, as well. After two rounds of reconstructive laser therapy, her mom says her injuries have stopped burning in the shower and the treated skin is already smoother to the touch: “Seairyn is looking forward to it lightening the red pigment and increasing her range of motion where the skin has tightened after healing.”

Smiling teen with a multi-layered strawberry cakeLooking back to that “normal day” in November 2022, Seairyn’s mom says she thought her daughter would just walk into the burn clinic and get cleaned up. “The next thing I know she’s spending nights in the hospital and being knocked out for procedures. What’s going on? Can she handle this? What is she going to look like, feel like. Emotionally is she going to be able to handle this?”
Their “very tight family” and the burn team, along with Seairyn’s self-growth, she adds, made all the difference in healing mentally and physically.

“I’m not invincible? As a parent of a teenager, that’s something you want to hear,” says her mom, who describes her daughter as quiet and shy. “I’m so happy she’s okay and has grown from this. I can’t tell you how many doctors and nurses came to us and said, ‘Seairyn is amazing,’ and they fight over who is going to take care of her. It makes me so proud.”

Lesher, says Seairyn, usually wins those fights, which is fine with her: “Dr. Lesher seems like such a big mean guy, but he’s just so nice. He’s like Santa Clause and gentle as a teddy bear. He does ham it up—he’s a big jokester.”

Looking back, Seairyn acknowledges how challenging this experience has been. In addition to the physical consequences of serious burns, the dressing changes and procedures, the painful showers and mobility struggles, being traumatized by nightmares the first two months after the accident. Concerned about the appearance of her legs, she avoided wearing skirts for a while, but made her mother proud by wearing a dress at church on Christmas Eve. Being “stuck in” at home while her friends lived their lives was also hard, but she says she tried to “stay strong” through it. A student who hates to miss just one day of school, she was happy to return but faced friends asking about her hands and, she adds with a laugh, the “embarrassing farting noises” her wound vac made.

“I had a lot of marks on me, but I didn’t want anything to change inside of me because it would just make it harder.”

Seairyn’s mother, of course, would argue that she had changed.