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Today there is a man on a flight from Boston to Joburg with a suitcase handcuffed to his arm. Inside is three-year-old Isabella “Pippie” Kruger’s new skin. The man doesn’t have much time. From leaving the lab in Boston, he has 24 hours to get his cargo to an operating table at Garden City Clinic, otherwise the artificially grown skin will be useless.
For Pippie, the nightmare that lead to her family attempting to make the young girl the first SA recipient of this experimental skin technology started on New Year’s Eve. Her father was lighting the second fire for a family braai when his bottle of gel fire-lighter exploded. Pippie was 3m away.
“It actually sounded like a gunshot went off,” says mother Anice Kruger. She took off her shirt to try kill the flames engulfing her daughter. “With the gel firelighter, when you try to douse it here, it just moves there.”
It was only when Pippie’s grandfather grabbed a floor mat that they put the flames out. By then, 80 percent of Pippie’s little body had been burnt.
When plastic surgeon Dr Ridwaan Mia saw her a few hours after the accident, she was three times her normal size because of swelling, and her face was barely visible beneath the black soot. Her skin looked like a leather shell.
In the past six months, Mia has taken her into theatre a few times a week to remove burnt skin and clean her wounds. But the skin removal (sloughectomy) made her fragile. She’s gone into cardiac arrest five times, swelled so large the blood supply was cut off to her hands, had pneumonia and her kidneys have failed.
“It was a balance between keeping her alive and removing dead tissue that would have killed her anyway,” says Mia. He laughs uncertainly. “There have been many dramatic nights.”
Kruger has spent so much time next to her daughter’s bedside she is known as “matron” to the night staff at the paediatric ICU because she answers the phones when they are busy. Kruger hasn’t see her daughter smile during the five months since the accident. It was a lot of praying and Googling that lead her to the solution of having skin grown in America, from Pippie’s own skin.
“(Pippie’s) mom didn’t want her to have any more scarring,” says Mia. “Mom did all the research and pushed us … because Pippie is such a fighter, we took our cue from her.”
Because of the hospital’s frequent cleaning of Pippie’s wounds, her burnt areas have shrunk to 40 percent of her body, and she is stable and on very little medication.
This progress meant that three weeks ago, it was possible to remove two 2cm x 6cm pieces of Pippie’s healthy skin and send them to Genzyme labs in Boston.
To create the skin product, Epicel, stem cell grafts from the skin, were laid on mouse cells. These cells are essentially dead and simply act as a scaffolding for the skin to grow on. Spurred on by growth agents, Pippie’s own cells multiplied and grew into sheets of skin. Today 50cm x 50cm of skin has been removed from its growth medium and is on its way to SA.
The skin is only about 10 cells thick, and will look like clear plastic when it’s first put on. It’s an experimental therapy whose long-term effects have not been conclusively shown by trials. But Mia believes Pippie’s got a good shot. He says the two key advantages of Epicel is that the scarring is significantly less, and there are no donor sites the grafted skin needs to be harvested from.
But there are danger factors. Pippie will be sedated for five days after the operations and will be placed in splints to prevent her from moving. If she moves, the skin could be disrupted and will not be able to develop a blood supply. The other factor is infection. After two weeks, Mia will have a good idea of how successful the procedure has been.
Then it’s another long road of rehabilitation. She has developed pressure sores from being in bed for so long. Her muscles have deteriorated and she needs to learn how to speak again.
Kruger remembers when she and her husband found out their unborn baby was a girl. Her sister commented on the ultrasound pictures saying, “she looks like a real Pippie”, meaning she would be strong like fictional character Pippi Longstocking.
“She has proven to be the strongest girl in the world,” says Kruger proudly. Photos of Pippie before the accident hang on the walls of her hospital room – big blue eyes, blonde curls and impossibly cheerful. If all goes well, the little fighter will make it back there.
The Kruger family have opened a trust to raise money to pay for Pippie’s expensive new skin.
They also hope to run the trust as an NGO after Pippie’s recovery to help other child burn victims get Epicel treatment.
Donate money to help pay for Pippie’s medical costs
Account holder name: CA Kruger
Account type: Savings
Account number: 1478169228
Branch code: 144547
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