Wound Care campaign by Mediaplanet UK&IE

DECEMBER 2017

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Wound Care

HEALTHAWARENESS.CO.UK

SADIQ KHAN, MAYOR OF LONDON

“My rehab stay was a truly life changing experience” Danielle Branch, Patient Coordinator at The Katie Piper Foundation P6 PHOTO: KPF/NHS

on his zero tolerance approach to acid attacks in the capital P7 PROFESSOR KAYVAN SHOKROLLAHI

Innovations in laser treatments for scars and wound healing technologies P6

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IN THIS ISSUE

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Leg and foot wound care takes a step forward

Sadiq Khan “My call to government will clamp down on the sale of corrosive substances” P7

Inspiring patient stories from charitable stateof-the art scar and burns rehabilitation in the north of England ONLINE

UK experts highlight cutting edge techniques for wound care healing

The UK remains at the cutting-edge of managing a range of conditions, from burns and scars to more chronic wounds like pressure sores.

large wound technology industry has evolved in supporting clinicians in this area and research is at an all-time high. Advances including laser treatments and tissue engineering solutions continue to excite. Similarly, innovations in surgical reconstruction are also important for quickly healing wounds to avoid long-term dependence on expensive dressing care. The information age also heralds technologies within smart devices in a clinical setting. Recent, sobering events in the UK have brought the management of wounds and injuries from a variety of causes into sharp focus. Follow us

Acid attacks on the rise in the South East

of urgency to tackle this issue before it is too late. A number of antimicrobial wound healing technologies are showing promise in the fight against infection.

Assaults with corrosive substances appear to be on the rise in some areas especially in the South East, and this is an acute focus for prevention, as well as rehabilitation of survivors. Sadiq Khan provides his perspectives on this problem as Mayor of London.

We are running out of antibiotics Antibiotic resistance remains a real cause for concern prompting the World Health Organization to recently release a list of ‘critical’ bacteria, for which we will shortly have no antibiotics. While some progress is being made, there is now a sense

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Scar and burns rehabilitation

Professor Kayvan Shokrollahi Consultant Burns, Plastic and Laser Surgeon, Whiston Hospital, Merseyside Editor-in-Chief, Scars, Burns and Healing Journal

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However, excitingly, a great deal of progress has been made in the physical and psychological rehabilitation of survivors of major injury, with a buzz surrounding a scar and burns rehabilitation centre on the horizon. I have considerable optimism for the future of wound healing and scar management in the UK, underpinned by innovation and research and dedication of front line staff.

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Senior Project Manager: Leila Samadi E-mail: leila.samadi@mediaplanet.com Content and Production Manager: Kate Jarvis Business Development Manager: Ellie McGregor Managing Director: Alex Williams Content and Social Editor: Jenny Hyndman Designer: Juraj Prikopa Junior Designer: Mushada Raquib Mediaplanet contact information: Phone: +44 (0) 203 642 0737 E-mail: info.uk@mediaplanet.com

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Jemell Geraghty Lead Nurse, Tissue Viability Society, Royal Free London NHS Foundation Trust Trustee, Tissue Viability Society

Good news for people with foot and leg conditions Leg and foot conditions including ulcers are being overlooked. Now a new campaign urges patients and clinicians to stand up for legs.

Lower legs and feet, often with ulcers and associated oedemas are frequently left untreated– and thousands of people are suffering as a result. Two million people are treated annually for wounds, including over 700,000 leg ulcers. “Leg and foot ulcers and leg oedema are common, debilitating and costly conditions,” says Jemell Geraghty, Lead Nurse, Tissue Viability at the Royal Free London NHS Foundation Trust and Tissue Viability Society, UK (TVS) Trustee. “Leg ulcers are at least four times more prevalent than pressure ulcers, yet there is a lack of awareness among the public of lower leg and foot conditions and the importance of seeking out the right advice and treatment.” “Treatment for leg and foot ulcers is a service resulting in unquantifiable suffering. Many patients feel hopeless about their condition.” However, there is good news. The TVS is leading a coalition of organisations in the Legs Matter campaign, urging patients and clinicians to “Stand up for legs”. “We aim to promote good quality lower leg and foot care in the UK. Aided by funds from the Urgo Foundation, TVS and other coalition members we will be spreading awareness among patients, carers, clinicians, educational institutes, commissioners and politicians about the importance of seeking appropriate help for these conditions early on,” says Jemell. “Most leg and foot problems can be improved and indeed prevented given the right care, especially if addressed early.” The campaign will launch a website next April at the TVS Conference, Newcastle with advice for people with leg and foot problems, and for clinicians caring for them. Read more on healthawareness.co.uk

New methods bring burn treatment up to date From first aid to reducing scars, new knowledge and technology is helping medical staff to bring faster, easier, better treatment for burn patients. By Linda Whitney

Tackling burns and optimising wound care starts with prevention,” says Declan Collins, Plastic Surgery and Burns Consultant at Chelsea and Westminster Hospital. “The rise in acid attacks has fuelled calls for better burn prevention, and a new campaign to prevent firework burns launches in 2018.” At the same time, new knowledge and technology is improving treatment.

First aid Contrary to common misconceptions, we should run burns under lukewarm (rather than cold) water for 20 minutes. “Very cold or iced water, or

Declan Collins Consultant, Plastic Surgery and Burns

applying ice, reduces the flow of blood to the wound potentially further damaging the tissue and slowing healing,” says Collins. Accurate assessment of the extent of burns before treatment to replace the fluid lost as a result of the burn (called resuscitation) is administered is paramount. “Apps, which assess the extent of burns and calculate the resuscitation required in seconds, are now being used by health care practitioners,” says Collins.

Glue made from patient’s blood used in skin grafts Small burn wounds can be excised and closed, but larger

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PHOTO: THINKSTOCK

burns require skin grafts. Traditionally the graft was stitched or stapled over the burn wound, but now fibrin glue, made from one of the body’s clotting factors, can be used. Fibrin glue made using the patient’s own blood reduces the risk of and disease transmission and makes dressing changes more comfortable for the patient. Where large skin grafts are required, a meshed piece of skin is used to cover the wound, “This does not always lead to attractive scars but now we can make a cell suspension from the patient’s own epidermal cells. Made in theatre and sprayed over the meshed skin graft, it promotes healing and potentially better appearance,” says Collins. For very large areas, the patient’s

“The rise in acid attacks has fuelled calls for better burn prevention”

cells can be grown into a cultured epithelial autograft in a laboratory, but this takes around three weeks. Meanwhile, to temporise the wound until definitive closure can be achieved skin taken from a donor cadaver is used – a longproven technique. Synthetic dermal substitutes have been used for many years, Collins says: “Currently, research groups are taking this further by using 3D printing techniques to create skin substitutes with characteristics added to improve immune response and promote healing.” Technologies not yet in use but being investigated in the lab include injecting stem cells to change the environment of the wound and tissue engineering of stem cells.

Managing appearance of scars with laser drilling In the past, scar treatment was limited to moisturising creams, massage, steroids and surgery. Now, lasers are being used to create tiny holes in scar tissue so collagen can enter and remodel the scar. “Carefully-timed treatment can start as little as three months after the burn,” says Collins. Meanwhile specialist burns rehabilitation units – some offering patient accommodation – offer treatment by a multidisciplinary team, to speed patients’ return to everyday life.

Read more on healthawareness.co.uk

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Terror threats and acid violence has brought wound care into focus

With an increase in incidences of reported violence using corrosive substances, wound healing and scar management have come into sharp focus. Considerable progress has been made to improve the lives of trauma and injury survivors as well as those with more chronic conditions. PHOTO: KPF/NHS

PHOTO: KPF/NHS

Andreas Christopheros suffered an acid attack. He is a business owner and campaigns for perpetrators of acid attacks to be given life sentences with a minimum of 20 years. Danielle Branch before laser treatment and scar rehabilitation. She now works for The Katie Piper Foundation as Patient Coordinator. She suffered 85 per cent burns in a caravan fire. Catrin Pugh suffered 96 per cent burns in a coach crash when on a ski trip. She is a student, aspiring physiotherapist and motivational speaker.

ost exciting, is the potential to cater for rehabilitation and scar management of many survivors of severe injuries from burns and other sources of scarring. Catrin, Danielle and Andreas all underwent successful pilot rehabilitation with the Katie Piper Foundation.

Acid attacks Earlier this year, Katie Piper – author, TV presenter and acid attack survivor – wrote an open letter in a medical journal calling for action on corrosive substances. While these attacks remain rare, there is clearly cause for concern. A recent article in Scars, Burns & Healing journal provides the best snapshot of evidence on such injuries reaching burns services, highlighting our current lack of understanding of this problem. For instance, twice as many men were assaulted in this way as women. Furthermore, the figures for the cultural and ethnic backgrounds of the victims was described in that paper as being “from various cultural backgrounds such as Caucasian (16), African (3), Oriental (1) and South Asian Subcontinent (1).”

Hence, corrosive assaults in the UK appear to be a phenomenon that may be on the rise in certain geographic areas but not others, and appear to be something that is most commonly perpetrated by white men against white men but with a significant mix of other victims, both female and from a range of ethnic backgrounds. There is always more that can be done, but a good starting point is that action has been taken to reduce access to some corrosive substances, and to increase powers for the police and the courts to deal with perpetrators. My view is that future well-targeted research, for which there is a great need, will be the key moving forwards, including psychosocial aspects.

What to do in the event of an acid attack: Remove clothing Rinse with water Ring 999 (The three Rs) Burns Hands-on burn care and surgery for massive injuries continues to allow greater survival potential for major

Professor Kayvan Shokrollahi Consultant Burns and Plastic Surgeon, Whiston Hospital Merseyside, Comms Chair: British Burn Association

burns, as well as improved quality of life for survivors. The digital age has also heralded a series of innovations, such as smart devices being used more in healthcare. The award-winning Mersey Burns App was the first app approved as a medical device in the NHS and allows healthcare professionals to estimate the severity of burns and calculate the initial resuscitation fluid prescription.

Wound healing Progress continues to be made in wound technology, including smart dressings and tissue engineering ‘artificial skin’. Innovations in reconstructive surgery techniques are also key – two recent patients of

mine with Pilonidal sinus disease (abscesses from ingrown hairs) who were having daily dressings for many years healed within 3 weeks of innovative ‘flap reconstruction’ techniques and have not needed dressings since. The British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) is a good patient resource.

Infection Resistant ‘bugs’ remain a major challenge and the focus is not just on finding new antibiotics. ‘Phage therapy’ uses viruses that eat bacteria as well as vaccination could be key but are still some way off.

Patient stories and photographs Patient stories - A successful pilot of three patients with very different injuries from burns units around the UK, including a survivor of an horrific acid attack and two patients with almost full-body flame burns, created the platform and infrastructure to fundraise towards launching a comprehensive rehabilitation centre for scars and burns. Read their stories on healthawareness.co.uk

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“Acid attacks are abhorrent and have no place in our capital” After any assault or attack, it’s easy to focus on the physical scars - and from acid attacks, these can be particularly horrific and life-changing. But attention also needs to be paid to the mental trauma that often remains with the victim long after the incident. By raising awareness about this issue, we can help to ensure that victims get the long-term help and support they need, whether it’s through counselling or access to other vital health services. By Sadiq Khan

s Mayor, I’m clear that acid attacks are abhorrent and have absolutely no place in our capital. London is one of the safest global cities in the world, but in recent years we have seen an increase in these vile attacks, often linked to moped crime. In July, I called on the government to introduce a zero-tolerance approach, including a clampdown on the sale of corrosive substances, tougher sentences and more support for victims. It was encouraging to hear the

Home Secretary’s announcement last month that the sale of dangerous acids to under-18s will be banned - but the government can and must go further. Every Londoner deserves to feel safe in our city, whether they’re out in a bar or travelling around on a scooter. The Metropolitan Police share my concerns, and take these attacks very seriously. They are cracking down on perpetrators through targeted operations, building intelligence on offenders, and increasing prevention work. We are

Sadiq Khan Mayor of London

also calling on the motorcycle manufacturers to help design vehicles that are far harder to steal. We have met with motorcyclists and delivery drivers to hear their concerns and experiences alongside the Metropolitan Police, and we’ll be sharing these views with partners as – together – we seek to rid London’s streets of these appalling crimes.