LOCATION:

Department of Plastic, Reconstructive and Hand Surgery, Level LG1, West Wing, John Radcliffe Hospital, Oxford OX3 9DU

Inaugural Florey clinical lecturer in Medicine at The Queen’s College, Oxford, 2000-5

Biography

I was brought up in Australia studying medicine at the University of Western Australia, did my Masters in Surgery at the University of Melbourne at the Bernard O’Brien Microsurgery Centre, and my surgical training at the teaching hospitals in Western Australia, completing my surgical training in 1995. I did my fellowships in Oxford and Paris before taking up a consultant plastic and hand surgeon post in Oxford at the Radcliffe Infirmary, John Radcliffe Hospital and the Nuffield Orthopaedic Centre (NOC).

I am a full-time clinical plastic reconstructive and hand surgeon with a special interest in microsurgery, peripheral neurosurgery, orthoplastic reconstruction. I developed with colleagues from other specialities; the Bone Infection Unit; and the Sarcoma unit at the NOC; the Paediatric/Congenital hand service and the Peripheral neurosurgical unit at the Radcliffe Infirmary/John Radcliffe Hospital. I am involved with the Neurofibromatosis two multi-disciplinary team.

MEMBERSHIPS

• British Association of Plastic, Reconstructive and Aesthetic Surgeons
• British Society for Surgeons of the Hand
• American Society for Surgery of the Hand
• The Transplantation Society 
• Intestinal rehabilitation and transplant society
• International Pancreas and islet transplantation society
• International Society for Vascularised Composite Allograft Transplantation
• American Society for Reconstructive Transplantation
• World Society for Reconstructive Microsurgery
• European Federation of Microsurgical Societies

AWARDS 

• Arris and Gale Lectureship, Royal College of Surgeons, 2019/20

I am interested in challenging the status quo in surgical solutions in plastic, hand and reconstructive surgery. We must not accept that what we are doing now is sufficient, but must seek better ways, by solving clinical problems at an individual level and by seeking to understand the mechanisms of disease and of how and why innovative operations work. 

My research involves trying to understand surgical observations, particularly if unexpected, and how they can be harnessed to make care better.  

For example, faced with the clinical problem of intestinal failure patients having no abdominal cavity in which to place their new intestinal transplant, I started performing abdominal wall transplants in order to increase the abdominal capacity such that they had enough space to receive an intestinal transplant. The transplanted intestine is not visible and the only method to determine if the organ is being rejected is by regular tests or biopsies, or if the intestine stops working.  We discovered that the skin component of the abdominal wall transplant could act as a visible monitor of the immunological status of the patient by showing a visible skin rash when transplant rejection was occurring, thus permitting early identification and treatment of rejection preventing organ injury and giving a visible feedback loop to permit immunosuppressive dose reduction.

This observation has led to us researching the skin’s ability to monitor for rejection in other organ types by using a smaller patch of skin on the forearm, trying to discover if it works for other organ transplants and why.

This research is essential, as it could provide for the first time, a method of continuous monitoring for rejection that avoids regular tests and biopsies; will allow individualised reduction of immunosuppression medication levels; and may result in longer lasting organ transplants.

We will do the clinical aspect of the research in collaboration with Oxford, Harefield and Papworth transplant units; the immunological aspects with the Transplantation Research Immunology Group (TRIG); and other laboratory aspects with others in NDS. 

One of the main transplanted organs that would benefit from monitoring is the pancreas. An alternative to whole pancreas transplant is to transplant just the active part of the pancreas involved in treating diabetes, the islets of Langerhans. These are very difficult to transplant as they are susceptible to attack from exposure to blood as well as rejection processes. I have devised a technique that is trying to optimise islet transplantation by first transplanting islets into a flap of skin that is kept alive in a laboratory on a heart/lung circuit that pumps oxygen and blood-like fluid around. Once the islets are happy and recovered from their isolation from the donor pancreas then they can be transplanted into the patient. This research will improve the method of islet transplantation and make it more accessible to more patients. I am doing this research in collaboration with Paul Johnson and the DWRF Islet lab and the BRC at the Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM).

Another example is the clinical problem of non-union of scaphoid fractures when one of the small bones of your wrist dies after breaking it in a fall. The current techniques involved removing three of the four bones or removing the broken bone and fusing the remaining bones. I devised a technique of replacing the dead bone by transplanting a small segment of bone with blood supply from the shoulder blade which preserves all the bones of your wrist and restores normal anatomy. I am researching how and why this works, and what else can this knowledge be used for?