Feature Story

Medical Team and Family Help Fire Victim Recover One Step at a Time

Boyd Smith is a fighter at least that's how his wife, D.D., described him when Smith arrived at the Arizona Burn Center last May after suffering burns over a significant portion of his body.

Born without arms and one leg as a result of a birth defect, Smith awoke one morning in May 2012 in his Black Canyon City, Ariz. home to see flames overtaking the back porch. Smith, 57, woke his wife, stepdaughter and three young grandchildren and helped rush them and the family dog to safety. But when he returned to the house for one final check, not having his prosthetic arms on, he fell through the floor as it collapsed and his wife and stepdaughter had to pull him to safety. He managed to tell D.D., "Turn out the horses"their barn that housed their horses was only 20 feet away from the housebefore losing consciousness. He was put into a medically induced coma for nearly five months while the Arizona Burn Center team worked to repair his extensive wounds.

"His burns were very serious," says his physician, Kevin Foster, MD. "It can be very difficult to resuscitate folks that are that badly injured."

But since that first harrowing day and the months of medical care that followed, Smith is now focused on getting the physical therapy he needs to walk again, Foster says. Smith credits his tight-knit family, his strong faith, and his experience with health issues in his early life as preparing him for the challenges that have come with this recovery process. "Most of us that were involved with his care truly believe that his faith and the faith of his family really participated in his outcome," Foster says. "He's kind of an inspiration for everyone around here."

"I've spent a lot of time in hospitals as a result of my birth defect, and one thing I've learned is that you just have to keep fighting," Smith says. Those who know Smith aren't surprised by his progress he's always lived an active and accomplished life, despite his disability. As a young man, Smith was a champion team-roping cowboy, and for the last 35 years, he has been a successful and well-respected landscaper. 

Smith's Multi-Faceted Recovery
Smith's injuries required more than 30 surgeries to treat, several extended stays and months in a rehabilitation center. Due to the severity of his injuries, his treatment involved skin grafting which helped replace damaged areas.  When a burn is of significant depth, skin cells are completely destroyed, so the skin is unable to re-grow. In Smith's case, his burn involved a large surface area that most patients would have little hope of surviving without a skin graft.

As the first step in a skin grafting procedure, a medical team had to surgically remove all of Smith's skin that had been damaged by the fire. This was done over several days in Smith's case due to the extent of his injuries.

The second step in Smith's skin grafting procedure involved replacing the areas in need with healthy skin. Dr. Foster manipulated, trimmed and carefully fitted the graft (which is like wet non-tearing tissue paper) to the recipient site. When he was pleased with the "fit", he "fixed" the healthy skin to the burn area and applied the graft by using a variety of methods, including staples, sutures and ARTISS [Fibrin Sealant (Human)], a spray adherent that allows coverage over the entire graft.1 ARTISS is a fibrin sealant that provides full surface adherence of the graft to the wound bed.1 ARTISS can help reduce or eliminate the usage of staple application and removal.2

"Staples have a way of getting buried and disappearing, and if you do a chest
x-ray on some of our patients from 15 years ago when we weren't using fibrin sealants to the degree that we do now, you'll find sometimes up to a couple dozen staples that are buried and are still a source of infection and pain," says Foster, who co-authored a 2008 study on the efficacy of ARTISS versus staples for skin graft adherence. "If you can limit the number of staples, it's really a good thing."

In Smith's case, he underwent six months of one surgery every five to seven days-during which the team painstakingly worked on smaller sections of his skin at a time. The procedure can be quite painful. Smith was placed in a medically induced coma for much of this time.

His surgeons used several techniques to obtain enough skin tissue for Smith's multiple surgeries, including growing tissue in a laboratory in Boston-a process done only a few times each year, Foster says. The final step of a skin grafting procedure involved heavily and carefully bandaging the area, to allow as little movement of the graft as possible for the first few days (movement of the graft on the area on which it has been placed can result in failure of the graft to "take"). 

Smith has been released from the rehab center near Phoenix where he had been undergoing intensive physical therapy sessions and is back with his family again, living in a rental house while they decide on a long-term housing solution. He continues to require regular outpatient physical therapy and frequent physician check-ups. When asked what advice he has for other burn victims just starting out on their road to recovery, Smith says, "Just don't ever quit. I'm living proof that if you just keep on fighting, you can succeed. I'm really looking forward to getting back to my life, getting back to my landscaping work and just enjoying my four grandkids." For more information, please click here.

ARTISS [Fibrin Sealant (Human)] Indication

ARTISS is indicated to adhere autologous skin grafts to surgically prepared wound beds resulting from burns in adult and pediatric populations greater than or equal to 1 year of age.

ARTISS is not indicated as an adjunct to hemostasis.

Detailed Important Risk Information for ARTISS
For Topical Use Only. Do not inject ARTISS directly into blood vessels. Intravascular application of ARTISS may result in life-threatening thromboembolic events.

Do not use ARTISS in individuals with a known hypersensitivity to aprotinin and/or hypersensitivity to any of the active substance or excipients.

Hypersensitivity or allergic/anaphylactoid reactions may occur with the use of ARTISS. In specific cases, these reactions have progressed to become life-threatening.  Such reactions may especially be seen if ARTISS is applied repeatedly over time or in the same setting, or if systemic aprotinin has been administered previously; however, these reactions may also occur in patients receiving ARTISS for the first time. Symptoms associated with allergic anaphylactic reactions include: flush, urticaria, pruritus, nausea, drop in blood pressure, tachycardia or bradycardia, dyspnea, severe hypotension and anaphylactic shock. Such reactions may also occur in patients receiving ARTISS for the first time.

Discontinue administration of ARTISS in the event of anaphylactic/-oid  or hypersensitivity reactions.

Air or gas embolism has occurred with the use of spray devices employing a pressure regulator to administer fibrin sealants. This event appears to be related to the use of the spray device at higher than recommended pressures and in close proximity to the tissue surface.

Apply only as a thin layer. Excessive clot thickness may negatively interfere with the product's efficacy and the wound healing process.

Exposure to solutions containing alcohol, iodine or heavy metals may cause ARTISS to be denatured.

ARTISS is made from human plasma. It may carry a risk of transmitting infectious agents, e.g., viruses, and theoretically, the Creutzfeldt-Jakob disease (CJD) agent.

Adverse reactions in the burn studies occurring in greater than 1% of subjects treated with ARTISS were skin graft failure (3%), hematoma (1%) and pruritus (1%).

Please see the full Prescribing Information by clicking the following link: http://www.baxter.com/downloads/healthcare_professionals/products/
ARTISS_PI.pdf


1
ARTISS [Fibrin Sealant (Human)] full Prescribing Information, 08/2011. 
2Foster K, Greenhalgh D, Gamelli RL, et al.; FS4IU VH S/D Clinical Study Group. Efficacy and safety of a fibrin sealant for adherence of autologous skin grafts to burn wounds; results of a phase 3 clinical study. J Burn Care Res. 2008;29(20):293-303.