In 2002, a young girl from Afghanistan who was left horribly disfigured by burns she suffered in a tragic accident came to the U.S. for treatment. One year and 12 major surgeries later, Zubaida Hasan was able to resume something of a normal and happy life through the efforts of the team at the Grossman Burn Center.
Zubaidas ordeal attracted national media attention, from 20/20 to The Oprah Winfrey Show. Not only was it a heart-wrenching story about a little girl from a nomadic family in a poor country half a world away, but it also was a dramatic transformation that clearly demonstrated the need for plastic surgery intervention in the treatment of burns. While here in the U.S. burn care is available in almost every part of the country, it is not always easily accessible. Acute-burn care and reconstructive burn care are often delayed because patients sometimes have to travel hundreds of miles to receive treatment, or because of a lack of available burn beds even in communities where burn centers exist.
Furthermore, because burn care is about more than simply healing a patients wounds, helping burn survivors regain their personal and physical dignity through a longer-term, comprehensive approach to treatment is something both hospitals and doctors should aim to achieve. This is a mission that resonates among my entire family, and it is a generational duty I accept from my father. (My father founded the Grossman Burn Center over 30 years ago based on the single mission of restoring burn survivors functionally and cosmetically to as close to their pre-injury state as possible.) If the medical profession educates the public about the necessity of having a burn unitand patients are the greatest testimonial we have because these individuals depend on our experience and expertisethen we will improve the lives of the community as a whole.
Because the treatment of burns is a long process, often requiring reconstructive procedures for several years after the initial injury, patients families can be displaced for weeks at a time. It is hard to imagine having to travel several hundred miles to a burn center when we have the ability to establish burn units in proximity to areas that have a higher probability of burn incidents.
Too often, people associate burn centers with infrequent, catastrophic events such as fires and natural disasters. While these events make headlines, other types of burn injuries are far more common. From auto mechanics to welders, machinists to transportation workers, occupational burns are a constant hazard within every community, the seriousness of which is too often underestimated or overlooked. Additionally, a full one-third of our patients are children and they deserve the immediate attention that a burn center can provide.
By positioning resources in areas that require the dedication of a fully staffed burn centereven big cities lack these resources, which is a major problem when confronting a crisis like a terrorist attack or natural disaster or simply providing treatment resources for a concentrated workforcehospitals can provide a full range of services to burn patients, from treatment of the acute injury to cosmetic, rehabilitative and psychological care. This provides patients with the continuity of care that makes a difference in their outcome.
In our practice we subscribe to a two-stage surgical approach that I believe produces superior functional and cosmetic results. During the first surgery, the wound is debrided of all devitalized tissue and then grafted with a temporary biological dressing. Because burns are progressive in nature and typically continue to evolve and progress well after the initial event, in our experience, this two-step approach allows us to better treat the burn. Furthermore, by applying a temporary graft, we are stimulating the body to increase blood supply to the injured site, which increases the likelihood of a successful permanent graft and minimizes graft loss and scarring. In the second surgery, the temporary graft is replaced with the patients own skin.
Targeted population centers with easy access to interstate highways that serve rural and outlying areas are ideal places to locate a dedicated burn center. By considering additional factors such as the presence of heavy industry and existing low bed-to-population ratios, the site selection process for a center becomes a fairly simple exercise in plotting points on a map. I know from personal experience that our model not only serves the community, but also adds to our hospital partners profitability; its a symbiotic relationship.
The challenge that confronts us as physicians is to educate the public and the hospital community about the need for quality medical resources. There is always a concern about the bottom line, but to me success is measured by the number of lives I can help and it doesnt have to be a challenge or a matter of choosing economic cost/benefit rations. We can make the most effective burn-care options available to all Americans in a manner that makes surgical, clinical and financial sense, and it is clearly incumbent on us to do so.
Peter Grossman, M.D.PresidentGrossman Burn CentersSherman Oaks/Santa Ana, Calif.