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Doctors hope pioneering procedure helps tragically burned 3-year-old

By Errol Barnett, CNN
updated 8:11 AM EDT, Tue June 19, 2012
  • 3-year-old Isabella "Pippi" Kruger has third-degree burns over 80% of her body
  • A relatively new skin-graft procedure is being tried for the first time in South Africa
  • The only lab doing the procedure is in the United States
  • The new skin had to be flown quickly from the lab to South Africa

Johannesburg (CNN) -- Severely burned 3-year-old Isabella "Pippi" Kruger has experienced a level of horror and pain that would test the nerves of a soldier. Her survival alone is miraculous and the procedure being undertaken to save her is a first of its kind in South Africa.

Doctors will get a first look at how successful that procedure might be this week, when reconstructive surgeon Dr. Ridwan Mia will carefully peel away layers of bandages around Pippi's tiny torso.

Her ordeal began on New Year's Eve. Pippi played outside as her father, Erwin Kruger, prepared a barbeque using a highly flammable liquid gel. As he lit the gel, its container exploded and covered Pippi's small body. She screamed as her skin burned and "bubbled" according to her mother, Anice Kruger.

The toddler sustained third-degree burns on 80% of her body. Afterward, she was struck with four cardiac arrests, kidney failures, collapsed lungs and multiple infections.

Her critical condition eventually stabilized under the care of Mia and others at the Netcare Garden City Hopsital in Johannesburg. But the Krugers were uncomfortable with their options for healing her skin: temporarily use skin from a cadaver or from a pig, or take her small portion of undamaged skin and graft it elsewhere.

"Please don't take the perfect skin, just give me a week to find something else," begged Anice of Mia.

Pipi poses for a photo before the accident.
Pipi poses for a photo before the accident.

After days on the Internet and hours reaching out to reconstructive specialists in the United States, Pippi's mother discovered a company in Boston called Genzyme whose specialty is growing layers of human skin by cloning a 2-square-centimeter sample from a patient.

The process, called a cultured epidermal autograft, was done more than 100 times in the United States last year, according to Genzyme. However, because the "new" skin must be administered within 24 hours of leaving the lab, it hasn't been attempted much farther away -- never before in South Africa -- and it's not cheap.

"The only lab is in the U.S., it is extremely expensive to set up with special technicians and very specialized equipment. It took years to get the technology there, but I think the big problem is cost," Genzyme's Dr. Alan Barrett said. He explained that in Pippi's case, the price tag of new skin is $82,000. Only through local medical coverage and generous online donations have the Krugers been able to consider such a modern solution with no guarantee it will work.

Even when the skin does make it to the patient within 24 hours -- as it did for Pippi last Monday after a trans-Atlantic flight -- potential risks are many. The grafted skin could tear, and infection is possible from the trace amounts of murine cells, which come from lab rats or mice, used to aid skin growth.

In fact, Mia won't know if Pippi's new skin is attaching itself properly until he gently pulls back her bandages on Monday and each following day.

For Pippi's mother, the uncertainty is worth the cost and the risk even if it offers nothing more than further hope.

"I can't bear to see her like this again," she said. "I know it's for the best... she will heal in God's perfect time."

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