My Scope of Practice: Research and Practice: Skin Tight

   Marcia Simon, PhD, Director, Living Skin Bank, sees her scope of practice as bridging the gap between basic research and clinical practice. The research she performs puts her at the forefront of developing new therapies for partial- and full-thickness burns and wounds. With a PhD in biochemistry, she became a cell and molecular biologist, working in the laboratories of Howard Green, MD, at Massachusetts Institute of Technology and Harvard University. In the early 1980s, while doing her post-doctoral fellowship, the laboratory received a call from Shriner's Burn Hospital. Two children had incurred burns over 80% of their bodies. Dr. Green's facility was needed to provide cultured epithelial autographs as tissue was insufficient for split-thickness grafting. All of the post-doctoral fellows were asked to help meet the OR start times. Dr. Simon's interest was piqued, seeing clinical practice and research perform side by side.

   "Serving as that liaison was serendipitous for me," Dr. Simon says. "From that position, I was recruited to establish the Living Skin Bank, a University Hospital unit located in the Department of Oral Biology and Pathology, School of Dental Medicine at SUNY (State University of New York), Stony Brook."

   The mandate of the Living Skin Bank has remained two-fold. Dr. Simon explains. "First, we supply cultured epithelial autografts and allografts either as permanent replacement for massive full-thickness burns or as biologic dressings for partial-thickness skin injury. We like to see a 40% to 60% decrease in time to wound closure. Second, we conduct research that continues to enable the development of new therapies for the treatment of burn wounds. The success in these areas is a direct reflection of the close academic and clinical ties between the Living Skin Bank and the Burn Center (Professor Harry S. Soroff, MD, Head)."

   The laboratory's activities are funded by industrial, federal, and state grants. Patients who receive the new therapies do so at no charge. In addition to these activities, Dr. Simon's laboratory carries out research on squamous cell carcinoma, stem cell biology, and epithelial cell biochemistry.

   However, during her first year with the Living Skin Bank (1990), Dr. Simon produced grafts and performed no research. Rather, under the guidance of Dr. Soroff, she became an observer of burn wound progression and management. In this manner, she gained a greater appreciation of burn wound complexity and the requisite perspective of the clinical staff. "Scientists who don?t get up close like that are missing information necessary to produce appropriate therapies and may be missing an opportunity to develop strong interactions between the laboratory and clinical staff," she says.

   Dr. Simon oversees 15 people. "As part of running a large operation, I head fund raising as well as research efforts," she says. "As a fundraiser, I must see that the projects are on track and well thought out and that the laboratory is well run, well stocked, and employs the right amount of people with appropriate talents. As a researcher, I must be mindful that our efforts translate into improved clinical outcomes," Dr. Simon explains.
The laboratory also provides training. Dr. Simon has instructed high school, undergraduate, and graduate students, residents, and clinical fellows. She has trained physicians and scientists from Israel, Spain, Yugoslavia, Venezuela, Brazil, and the Phillipines in order to facilitate establishment of similar facilities worldwide. She has lectured to nursing staff, Rotary Clubs, and firefighters about the mission, accomplishments, and potential of her facility. The teaching is technical, didactic, and a blend of both. While teaching is not a mandate of the Living Skin Bank, it is certainly part of its mission.

   The Burn Center and the Living Skin Bank are vital parts of the university community and of Suffolk County, with close interaction with the area firefighters. Because of the service to the community and the teaching efforts, they have been supported by Senator Kenneth P. LaValle, Chairman of the NY State Senate Higher Education Committee. He is pro education, pro medical care, and pro people. The Living Skin Bank is not a commercial enterprise, and although training is available for individuals from around the world, the Living Skin Bank is very local, providing care for the patients of University Hospital, SUNY at Stony Brook. It is not a laboratory off in an ivory tower.

   Dr. Simon advocates that a scientist who wants to develop theories and a physician willing to consider all available options can work together and learn from each other. 'We should listen to our physicians, nurses, and occupational and physical therapists and hear the issues and develop theories and products based on the patient as a whole," she says. 'When that cooperation occurs, there is a great chance of doing big things in our scope of practice."