Sept. 23, 2008 -- Three days after a plane crash left former Blink-182 drummer Travis Barker and celebrity disc jockey DJ AM with severe burns on their bodies, doctors say the musicians are likely to survive. But burn specialists say the stars will face a long, painful recovery.
Barker and DJ AM, or Adam Goldstein, escaped a runway Learjet crash in West Columbia, S.C., with second- and third-degree burns to their bodies. Goldstein suffered burns to his head and arm; Barker to his torso and lower body.
The two pilots, Barker's assistant Chris "Lil Chris" Baker and bodyguard and Charles "Che" Stills died in the crash.
Jennie Weinman, the representative for Goldstein and Barker, said the men are in stable but critical condition.
"It can take up to a year to heal," said Dr. Fred Mullins, medical director of the Joseph M. Still Burn Center, where the two stars are receiving treatment. "We expect them to have a full recovery, that's all I can say."
Barker's and Goldstein's families asked Mullins not to disclose to the press the percentage of their bodies burned. But with any third-degree burns, the term "full recovery" can be misleading.
Even after a third-degree burn heals, "You'll be sensitive to the sun, and on those areas, you won't be able to perspire," said Dr. Roger Yurt, director of the William Randolph Hearst Burn Center at the NewYork-Presbyterian Hospital/Weill Cornell Medical Center in New York City.
Further complications may include areas where hair will never grow again and tight scars contracted around joints that prohibit moving.
Burn trauma experts say Goldstein, 35, and Barker, 32, have their youth and the help of a burn trauma specialty center on their side. Still, medical advances have only changed the prognosis of a serious burn treatment from a deadly matter to a painfully slow treatment process.
"In years past we used to just add the percent burn of the body to the person's age and that would give you an idea of the percent chance that they will die," said Yurt.
That would mean a 30-year-old person who has third-degree burns on 30 percent of his or her body -- an area equivalent to the front torso and one arm -- would have a 60 percent chance of dying.
Doctors say without treatment, third-degree burns on just 15 percent of the body can become deadly.
Immediate Help for Deadly Burns
"Once you get a burn above 15 percent roughly of the body surface area, the whole body has to respond to that injury … so it affects the lungs, the heart, the liver, all sorts of organs," said David Greenhalgh, chief of burns at the Shriners Hospitals for Children in Northern California and a doctor in the U.C. Davis Medical Center.
"The first day or two is what we call burn shock," said Greenhalgh. "Your whole body swells in response."
Burn shock can be deadly without an IV to keep up bodily fluids, Greenhalgh said.
In addition to managing a whole-body blood flow response, Goldstein and Barker will also benefit from new surgery tactics that prevent once-common deadly infections. When it comes to infections, Greenhalgh said it's all a matter of degrees.
In a first-degree burn, patients are less susceptible to infection because they still have the epidermis, the layer that "keeps the water and everything else in, and keep the bugs out," explained Greenhalgh.
But infections can take their toll in widespread second-degree burns (down to the dermis skin layer where the hair follicles and sweat gland lie) or a third-degree burn (down to the fat layer) or a fourth-degree burn (down to the muscle, fat or bone).
Greenhalgh says key to changing the survival rate was research that showed removing the seriously burned tissue fast, no matter how painful for the patient, and doing a skin graft will keep deadly infections at bay.
"We have a much better track record of getting people well," said David Heimbach, a professor of surgery at the University of Washington in Seattle. "If you had 70 percent of body burned, now we have a 50 percent survival rate."
With the practice of a quick surgery and skin grafts, burn centers have made surviving burns the norm. Now, a top burn center such as the University of Washington Burn Center will lose only 4 percent of its patients.
While a skin graft saves lives, doctors say they do not prevent scarring or months of reconstructive surgery.
Burn Victims Face Scars On Skin
"Once you get a [serious] burn, the scars on their skin are there forever. There's always going to be a scar of some variety somewhere," said Dr. Paul Cederna, a plastic surgeon and associate chief of staff for the University of Michigan Hospitals.
Yet Cederna says plastic surgeons have various ways to narrow scars, expand areas of healthy skin and even hide the scars in aesthetically pleasing places.
"Once the skin graft is in place, a lot of times you can plan your operations so you can position the scar better," he said.
In a process called tissue expansion, the surgeon inserts a deflated balloon underneath a layer of skin and slowly expands it over three to four months to grow more skin. "Just like a pregnant woman's stomach grows skin," Cederna said.
Then in a procedure similar to a face-lift, the surgeon detaches a portion of the skin from the layer underneath and stretches it across other parts of the body.
"You can convert someone who has no hair on their head except for a little patch, to someone with a full head of growing hair," said Cederna. As the surgeon moves skin, the inevitable scar can be hidden in convenient areas such as below jaw lines as opposed to on the face, or in bathing suit areas as opposed to exposed ones.
But, the road to such recovery usually is a long one.
Cederna said, "It wouldn't be uncommon for someone with a big burn for me to operate on them eight to 10 times."