How medical heroes saved a burning boy part 2

13/09/2009

When little Tevita Tuiono strips off to reveal his shocking scars it's hard not to look away.

The mottled patchwork of skin grafts and puckered scarring on the left side of his torso, both legs, buttocks and one arm are so disfigured it is hard to recognise as a child's skin.

The injuries are a cruel legacy from the day the 6-year-old accidentally set himself on fire.

Even the parts of his body that escaped the flames are scarred, from surgeons repeatedly taking skin grafts in a desperate attempt to save his life and heal his wounds.

But according to burns specialist and reconstructive surgeon Richard Wong She, a state-of-the-art skin grafting treatment developed in the United States has given Tevita a chance of a normal life.

Wong She returned to New Zealand in 2006, after more than a year working with burns patients in Seattle.

Tevita had already endured 18 months of operations and treatment since the accident but, in Wong She's judgment, had little quality of life.

He was so badly scarred he could not stand up straight or straighten his left arm.

He suffered from constant skin infection; the pocks and ripples of the patchwork of grafts that had initially saved his life were a breeding ground for infections that would fill with pus.

In addition, the grafted skin was starting to break down.

During his first year at school, Tevita needed to visit the school nurse almost daily to have his dressings changed. He was permanently on antibiotics.

His mother, Rose Mahara, nursing her newborn son Sifa at their Auckland home this week, is still horrified by the accident less than a fortnight before Christmas 2004.

Home alone with her two young sons, Mahara left Tevita and his older brother Jerome, now 8, playing in the lounge while she had a quick shower.

Tevita, then a toddler, pushed a small table against the stove, climbed up and sat on one of the elements.

He reached across and fiddled with the knobs as he had seen his mother do. As the element became red hot, Tevita's pyjamas caught fire, his nappy initially shielding the heat.

The first thing Mahara knew was when her little boy ran to her screaming, his clothes on fire. She put him under the shower, called an ambulance.

For Mahara and Tevita's father, Viliami Tuiono, much of what happened after that is a blur. Mahara won't talk about it much, apart from saying it was "shocking".

At the National Burns Centre at Middlemore Hospital a team of specialists took over Tevita's care. They knew what to expect - the small body going into shock, shutting down.

Tevita was critically ill, kept in an induced coma on life support in intensive care as the burns team battled with crisis after crisis. He had a 50/50 chance of survival.

With more than 40 per cent of Tevita's body severely burned, surgeons used graft after graft from his unburned body parts and from "donated" skin.

When Tevita was discharged three months later, he was well enough to go home but his battle was far from over. His wounds were still raw and prone to infection.

Both legs and one arm were bandaged and in splints. More skin grafts were to come. Kidz First children's hospital, also at Middlemore, became the family's second home.

His parents were regularly up at night trying to stop their son scratching the unbearably itchy scar tissue until it bled. Tevita also had to constantly wear a pressure suit to reduce the scarring.

When Wong She first saw Tevita in mid-2006, the boy was alive but, in his opinion, "didn't have much of a life".

"I can only guess at how much misery this kid was in."

Wong She, now clinical leader for the Burns Centre, and his highly-trained burns team began "reconstructing" Tevita's badly-disfigured body.

They used a mixture of skin grafts and a skin substitute called Integra which Wong She had studied at the University of Washington Burns Center in Seattle's Harborview Medical Center.

Working on average 100 hours a week and on call 24/7, Wong She says he gained a decade's experience in just over a year. It changed the way he viewed burns treatment and he says if Tevita's accident happened today, his treatment would be different and the outcome substantially better.

"In the States, Integra would have been used on Tevita on day one."

Wong She and his team have spent the past three years gradually improving Tevita's scarring, cutting away puckered and pitted tissue and replacing it with fresh grafts.

The biggest improvement to his condition has come from using the artificial skin which "tricks" the body into growing a new layer of dermis (the lower layer of skin).

A new layer of epidermis (top skin) is then grafted on top of the healed dermis.

Wong She likens the epidermis to carpet, and the dermis to a good quality underlay.

The difference for Tevita has been remarkable.

He can stand straight, use his arm, and run about like any boy his age.

Glance at him in the school playground and he is hard to pick as a burns victim.

For now Wong She plans to "leave him alone", letting Tevita play, go to school, make friends, get his confidence back.

There is more work to be done on the scars but he will wait until Tevita wants them improved.

"And when he hits puberty and starts growing we may need to do some more work. I won't finally discharge him until he is an adult."