"Right.  David suffered severe burns on his back due to being caught in an explosion; the scars will never heal given our state of medicine and split open and bleed if he bends or moves too much."

"That's a challenge. I see three real options, I could teach you enough about skin graft surgeries that you could potentially implement the treatment yourself or with the aid of a skilled surgeon. Second, I could supply you with topical drug which would over the course of about five years of regular application be likely to ameliorate the issue. Third I could supply you with a custom organism that would eat scar tissue and keep the area sterile until fresh skin has grown in."

"Could you give more detail about the course of each treatment? Would there be particular risks of interruption or infection? What would be the odds of success in each case? Would there be restrictions to his activities during the course of treatment?"

"Skin grafts involve removing skin layers from some other part of the body, removing scar tissue from the affected area and then layering the skin from the donor area onto the area where the scar tissue used to be. This naturally has a significant infection risk though with the right medicines and care it can be minimized.

It's a very delicate surgery though and if it's done incorrectly the patient can wind up worse off even without infection if the skin graft doesn't bond correctly to the underlying tissue. As for odds of success it depends so much on the skill of the people doing it that I wouldn't want to estimate the chances with any confidence.

If it's done correctly in well sterilized facilities then it has a quite high success rate but like all skills it takes practice to get it right consistently. It also has a recovery period of several days of immobilization followed by several weeks where the patient needs to be careful not to overly stretch the skin at the joining lines or there can be scarring, though the scarring would be much less severe than what was there before."

"I'm familiar with skin grafting, though I'm not a surgeon.  Certainly at our technology level infection is a serious concern and I am not certain of the other requirements, but I would be fascinated to learn.  What about the other techniques?"

"The topical drug is a mix of signaling molecules and growth factors. It would need to be kept refrigerated to remain effective over the entire course of treatment. In effect it would stimulate your friend's body to heal itself by discarding and replacing the damaged skin. As I said though it would be a very long process. The risk would be very low though and even an incomplete course of treatment should yield some improvement. The other downside is that depending on the severity of the damage even a complete course of treatment might not fully resolve the issue. Drugs are inflexible tools."

RC pauses for a moment before resuming. "The third option would be as I said to make a custom symbiotic organism. The main risk here is that it would be a living creature and it would need to be kept healthy. I can try to make it as resilient as possible but there would be some tradeoff between resilience and effectiveness. There's also a lot of options for exactly how it works.

The version of the organism I would tend to recommend, would physically attach itself to the patient for the duration of the treatment and effectively become a part of the patient's circulatory system to get the nutrients it needs. The patient might have to be careful about what chairs they sit on but otherwise shouldn't be too inconvenienced. I'd expect treatment in that case to last a couple months. The main risks would be if the organism was removed mid treatment there would be an infection risk and subsequent to the treatment the patient would be at increased risk of skin cancer, perhaps a 5% increase in risk."

"Would the drug still work after trying the organism if that failed for some reason?  What about combining the drug with skin grafting techniques?"

"I'm not sure what would cause the organism to fail, Perhaps if it died for some reason then you could go ahead and use the drug. As for combining the drug with surgery, you should wait approximately two weeks as it might interfere with the initial parts of the healing process but after that it should result in a more complete recovery than would occur with surgery alone."

"How long will it take to learn the surgical procedures? Are there more advanced methods for preventing infection?"

"I am not reading your mind nor am I aware of the state of medical knowledge on your world. Without more information both of those questions are very difficult to answer. There are two categories of ways to prevent infections, ensure that infectious microbes are kept away from the body and removing or neutralizing infectious microbes in the body. I'm not certain which methods your world is aware of in either category."

We understand the importance of preventing physical contamination by frequent handwashing and cleaning, and the use of masks to prevent spread by droplets.  There is a new medication becoming available called penicillin that is an antibiotic and can cure many bacterial infections.  

"Ah yes, antibacterials are a very useful class of drug as long as you don't misuse them. Bacteria can evolve to resist them if you give them the chance."