Dr. John F. Burke, Dies at 89; Created Synthetic Skin
Artificial skin had been the holy grail in treating burn victims for a century when Dr. John F. Burke began wrestling with some of the perennial obstacles to making it: finding a flexible material that would protect against infection and dehydration, that could be made from ordinary substances, that would not be rejected by a patient’s immune system and that would look like normal skin.
In 1969, Dr. Burke, a Harvard Medical School professor and a surgeon at Massachusetts General Hospital in Boston, took those specifications to Dr. Ioannis V. Yannas, a professor of fibers and polymers in M.I.T.’s department of mechanical engineering.
Eleven years later, a team led by the two men developed a material — an amalgam of plastics, cow tissue and shark cartilage — that became the first commercially reproducible, synthetic human skin. It would save the lives of innumerable severely burned people worldwide.
Dr. Burke died of pancreatic cancer on Wednesday in Lexington, Mass., said his wife, Agnes. He was 89.
The Yannas-Burke team announced its first successful experiments with the skin in 1981, having used it on 10 severely burned patients, including a woman who had been burned over more than 50 percent of her body.
Dr. Burke told The New York Times at the time that neither Harvard professors of surgery nor M.I.T. mechanical engineers could have solved the puzzle on their own. The project, he said, required a command of two different spheres of knowledge: the biology of the skin, and the engineering of polymers.
“We needed their engineering know-how, and they needed our expertise,” he said.
Polymers are compounds with repeating molecular structures, either synthetic (as in plastics) or natural (like DNA cells). The artificial skin the team devised had two layers of polymers — one synthetic, the other organic.
The top layer was made of a thin, synthetic silicone sheet that protected the patient from infection and dehydration, the two most common causes of death in severely burned people. The bottom layer was a kind of scaffolding made from the molecular material in cow tendons and shark cartilage. It acted as a seed bed for healthy skin cells taken from other parts of the patient’s body.
Healthy skin cells grew into the scaffolding in about a month. The cow and shark cells were absorbed by the body. After the silicone layer was peeled off with tweezers, the area that had been severely burned healed “like a sunburn,” Dr. Burke said.
The skin-growing method unveiled by Dr. Burke and his partner made moot a number of longstanding problems. It could cover far larger areas than were possible with grafts from the patient’s own body. And it avoided the increased risk of infection from the use of immune-suppressing drugs, which were administered to prevent rejection when donated skin or pig skin was grafted on.
Patented and now manufactured as “Integra,” the artificial skin is widely used on patients with severe and extensive burns; for treatment of chronic skin wounds commonly suffered by people with diabetes, and for some types of plastic surgery. The product is one of several artificial skin materials that have since been developed.
“It is not perfect,” Dr. Yannas said in a telephone interview on Thursday. The new skin grows in without sweat glands, for example, requiring patients to forgo vigorous exercise and exposure to the sun, he said. “But it has greatly increased the survival rate.”
Dr. Basil A. Pruitt Jr., a professor of surgery at the University of Texas Health Science Center at San Antonio and former commander of the United States Army Burn Center, characterized the benefits of the artificial skin developed by Dr. Burke and Dr. Yannas as “protean — innumerable and ongoing.”
John Francis Burke was born July 22, 1922, in Peoria, Ill., the first of three children of Frank A. and Mary Biaggi Burke. He grew up in Chicago.
He was studying chemical engineering at the University of Illinois when World War II broke out. He volunteered the day after Pearl Harbor was attacked, his wife said, and while serving in the Army Air Forces decided to become a psychiatrist instead of an engineer when he saw how little the military could do “for men with emotional trouble.”
After receiving his bachelor’s degree at Illinois in 1947, he graduated from Harvard Medical School. “Along the way, Jack decided to become a surgeon,” Mrs. Burke said.
Dr. Burke was noted for several innovations before his collaboration in developing artificial skin. He pioneered a system of infection control in hospitals by establishing dedicated bacterial-control nursing units, now widely adopted. His research showed that giving antibiotics to certain patients before surgery lowered the risk of post-operative infections, another practice now in wide use.
During his years of collaboration with Dr. Yannas, Dr. Burke was chief of staff at the Shriners Burns Institute of Massachusetts General. From 1980 to 1990, he was chief of trauma services at the hospital. He was a professor of surgery at Harvard from 1966 to 1996.
Besides his wife, he is survived by two sons, John S. Burke and Dr. Peter A. Burke; a daughter, Ann Campbell Burke; and eight grandchildren. A third son, Andrew T. Burke, died 1987.
In the 1981 interview in The Times, Dr. Burke described his process of creating artificial skin in terms that prefigured later advances in bioengineering like stem cell therapies.
“An important biological fact is that every part of us talks to every other part — all of our self interacts with all other parts,” Dr. Burke said. “We have a material now that does, in fact, interact with the patient so that the correct types of cells do the correct things as they grow.”