Hydrogel Containing an Oxygen Carrier With Hemoglobin From the Marine Worm Arenicola marina (M101) in the Management of Deep Burns

Summary:

A 34-year-old patient with no medical history was admitted following severe thermal burns (>85% of the body surface area), including deep second- and third-degree injuries. Surgical management aimed to heal the entire upper body (thorax, abdomen, and back) using topical oxygen therapy (TOT) on the deep second-degree burns, without burn excision or skin grafting, while processing conventional management of the remaining burned areas alongside specialized intensive care. TOT was performed using an innovative oxygenating dressing (HEMHealing, Hemarina SA, Morlaix, France) combined with conventional excisional, allograft, and autograft management (4 surgical steps) on the hands, upper limbs, and lower limbs; the protocol enabled graft-free healing of the abdomen, thorax, and back within around 5 weeks. Despite a prolonged healing time (47 d, beyond the dogma of 2–3 wk), at 12 months follow-up, the scars showed very little inflammation and no hypertrophy on the trunk and the back. The patient did not require compression garments on TOT-treated sites. We report the use of this innovative dressing—in parallel with resuscitation and conventional surgery—and the very favorable evolution of this patient confirms this choice in retrospect. We now need to consider other cases and studies to validate our initial clinical results.

Superficial and first/second-degree burns typically heal within 2 weeks with appropriate wound care.^1,2 However, severe and deep second/third-degree burns do not heal within this timeframe and require skin autografting.² This can be challenging due to factors such as the wound bed being unsuitable for autografting in deep burns or limited areas for grafting in extensive burns. Advanced wound care products are vital for promoting healing and preventing complications.¹ This case report highlighted the successful use of topical oxygen therapy (TOT) with an oxygen carrier hydrogel, M101, in treating severe burns covering 85% of the body in a 34-year-old man.

In the present case, both the severity of the burn and the surface area exceeding 85% were of poor prognosis in terms of survival rate and functional outcome. This is a first-in-human application in case of severe and extended burns.

MATERIAL AND METHODS

A 34-year-old patient with no medical history or drug allergies was involved in an explosion while refueling his boat engine. Although he was not thrown by the blast, he sustained severe burns and immediately jumped into his swimming pool to cool the injuries.

He was transferred to our specialized burn unit for intensive care and initial surgical dressing. The burn assessment revealed 85% total body surface area involvement (face, neck, thorax, abdomen, upper and lower limbs with circular burns) (Fig. 1). His unit burn standard score was 184 (severe cases start at 60, and survival is exceptional above 150), and his Baux score was 119, indicating a critical prognosis.

Fig. 1.

Photography of trunk burns at day 0.

Due to the severity and location of the burns (face and neck), the patient was intubated to prevent respiratory compromise. An escharotomy was performed on the inner sides of both legs. Prophylactic antibiotic therapy was initiated, and wound dressings were applied with silver sulfadiazine (Flammazine, Alliance Pharma, France). On day 5, worsening burns on the thorax, abdomen, and back led to an adjustment in the surgical plan, combining conventional management with an innovative oxygenating dressing to promote autograft-free healing of the upper body and spare the rare donor sites for autografts of the hands, upper limbs, and lower limbs (Fig. 2).

Fig. 2.

Burn surface evaluation by e-Burn software (Lyon Burn Unit).

Given that HEMHealing (Hemarina SA, Morlaix, France) is not yet registered, we obtained compassionate use authorization from the French Health Authority (Agnece nationale de sécurité du médicament [ANSM]) as part of an expanded access program. This innovative dressing is a gel containing xanthan gum (texturizing agent), hyaluronic acid (healing agent), and M101, an oxygen carrier derived from the marine worm Arenicola marina.

The conventional surgical management included 4 key steps:

• Day 6: Excision and allografting of the lower limbs to reduce the burned surface and limit complications.

• Day 14: Early excision and autografting of both hands and upper limbs.

• Day 32: Additional excision and allografting of the lower limbs.

• Day 52: Final excision and autografting of the lower limbs using grafts harvested from the upper back, pubis, and thigh roots.

RESULTS

The TOT application began on day 7, using 50 mL syringes containing 25 mL to cover 100 cm². It was applied every 2 days with wound cleaning, mechanical debridement, thick gel application, and an oily dressing.

Healing progressed rapidly on the thorax and abdomen (Fig. 3), leading to treatment continuation and extension to the back on day 28. The treated burn area (trunk and back) decreased from 36% (day 0) to 32% (end of first week), 24% (week 2), 14% (week 3), 8% (week 5), and less than 2% (week 6), and treatment was stopped on day 47.

Fig. 3.

Trunk scar evaluation (front and back) at 12 months.

At 7 and 12 months, the treated skin appeared normal, with Vancouver scores of 6 and 1, respectively, compared with 9 and 10 on grafted limbs due to significant hypertrophic evolution. No adverse effects were reported.

DISCUSSION

Managing deep second- and third-degree burns covering 85% of the total body surface is highly challenging. Patients require specialized intensive care, precise surgical strategies, complex wound management, and multiple grafting procedures.^1,2

Hyperbaric oxygen therapy (HBOT) has been explored for severe burns,³ as burns cause local ischemia and impair oxygen supply, worsening injuries in the early postburn phase. HBOT accelerates healing,⁴ shortens hospital stays, improves graft viability, and reduces the need for additional surgery.⁴ However, HBOT is not widely available in France, and our patient could not benefit from a medical transfer due to the severity of his lesions. Furthermore, HBOT does not deliver physiological oxygen (bound oxygen to a carrier, such as hemoglobin) and may cause oxidative damage.

TOT enhances wound healing by delivering oxygen locally. Studies confirm that skin can absorb atmospheric oxygen, supporting the use of TOT.⁵ Hydrogels are promising dressings due to their biocompatibility, extracellular matrix-mimicking properties, and drug-loading capacity.^6,7

Hemarina (Morlaix, France) developed an advanced hydrogel-based dressing incorporating M101, an oxygen carrier. Extracted from A. marina, M101 carries 156 oxygen molecules; 40 times more than human hemoglobin. It possesses antioxidant properties while remaining nonimmunogenic and nonallergenic.⁸ Safe for use, this hydrogel enables passive O₂ diffusion, preventing oxidative damage⁹ and optimizing burn and wound treatment outcomes.

We already had used this hydrogel in the treatment of a deep burn on the fingertips with a surprisingly rapid healing process.¹

In our case, TOT facilitated the healing of 40% of the total body surface without grafting. This reduced the grafting requirement to 45% of the initial burn area, significantly improving aesthetic outcomes compared with grafted areas with similar burn depth (trunk/back versus upper limbs).

Burn management aims to limit secondary healing to 3 weeks to prevent retraction and sequelae. However, in this case, despite 47 days of healing, scars remained noninflammatory and nonhypertrophic after 12 months without compression therapy. A clinical trial needs now to be performed to confirm the effectiveness of HEMHealing in comparison with the standard of care and to reproduce this result presented in a unique single clinical case.

CONCLUSIONS

This is the first use of this innovative dressing for extensive deep burns alongside resuscitation and surgery. The patient’s favorable outcome supports this approach. Further research and clinical trials are needed to validate the potential benefit for wound healing and integrate the dressing into routine care.

DISCLOSURES

The authors have no financial interest to declare in relation to the content of this article. Dr. Leize-Zal holds shares in Hemarina, the company developing the medical device used in this study.

PATIENT CONSENT

The patient provided written consent for the use of his image.

ACKNOWLEDGMENT

The authors thank Dr. Franck Zal, CEO of Hemarina, and Pr. Benoit Barrou, Medical Director at Hemarina, for their support with the use of the product.

ETHICAL APPROVAL

Ethical approval was obtained from the ANSM (the French Agency for the Regulation of Medicinal and Health Products).