Fiona Wood has been on a search to find a better way to treat burns victims. Now she is connecting with other medical researchers to help complete the jigsaw.
Medicine is a time-consuming science for researchers and doctors seeking the often-elusive Holy Grail. For patients, however, time can be a luxury they don’t have, and this is particularly true for burns patients. The excruciating pain, permanent scars and associated functional difficulties usually deliver a life sentence for these victims.
Fiona Wood decided about 30 years ago that this life sentence was unacceptable. Since then, as a leading plastic surgeon, researcher and one of the world’s most highly regarded burns specialists, she’s made it her mission to find a solution.
Professor Wood came to prominence in the wake of the 2002 Bali bombings, which saw two explosions in the popular Kuta nightclub district kill 202 locals and tourists, and injure a similar number. Many of the survivors were airlifted to Royal Perth Hospital, where Wood and her burns team treated their horrific injuries.
Her experience in and commitment to treating burns garnered widespread attention, particularly for a world-first technique she and a colleague had developed nine years earlier: spray-on skin.
"We had this seminar ... out of that came a lot of pieces of this jigsaw. It was fascinating."
The technique, developed over four years of vigorous experimentation in a Perth laboratory, involves spraying skin cells directly onto a burn wound to expedite healing. Pertinacity is in Wood’s DNA, and she was determined to improve on her practice of sending healthy skin cells to a skin culture laboratory on the other side of the country, then waiting for three weeks for the new skin to be grown, sent back and used to treat the burn. Spraying healthy cells onto the wound within days was a vast step forward.
It’s been almost 15 years since the Bali bombings and Wood’s rise to prominence, including an Australian of the Year award in 2005. Still based in Perth, she continues her quest for the Holy Grail: to find an even better way to regenerate skin.
To this end, Wood has worked with scientists and practitioners from other disciplines to find the pieces to her puzzle. She says she likes to join the dots – sometimes she joins the wrong dots, but it’s a fascinating journey that inevitably reaps dividends.
In an interview for the INTHEBLACK magazine, Wood talks about the motivation to keep pushing the boundaries and explains how the nozzle of an Italian mouth freshener brought her dream of spray-on skin to life.
Alex Malley: Fiona Wood, you’re a person who has pushed the boundaries for as long as she can remember. So I need to start with mum and dad; Geoff and Elsie. Tell me about them.
Professor Fiona Wood: Two amazing individuals. I was number three of four. Mum and dad left school at 13 and 14 but were absolutely obsessed with education. Education will give you the choice where you get up in the morning to do something you enjoy. And so their drive was to make sure the four of us had the best education they could deliver.
Inspired to act
Malley: I want to take you to 1985, when you met a child who had terrible coffee burns on his chest. You made a series of observations that day, which ultimately changed your whole direction.
Wood: I’d seen a few people, certainly children, in Great Ormond Street [Hospital] with severe scarring, and that led me to think, “I’ve got to explore this; I’ve got to figure out what is going on here”. At Queen Victoria Hospital, one of the famous burns centres in the UK, I saw a number of things that came together, and one of which was a young boy whose picture I kept with me for a very long time because I figured we had to do better. We had to understand the processes behind that aggressive scarring that is life-changing.
Fast-forward 20 years … we’ve made progress; we’ve been able to explore the whole concept of an acute burn and the pain of that is extraordinary. Yes, we have to treat that [the pain]. But we shouldn’t take our attention away from the fact that it changes your life … we’ve got so much more work to do.
Malley: You ask people to think about when you burn yourself on the oven and consider that across 90 per cent of your body. It’s not imaginable, is it?
Wood: It’s suffering beyond what we can comprehend and we’ve got to reduce it.
Malley: In the early 1990s, a schoolteacher suffered 90 per cent burns from petrol. It was at that time you were building momentum around skin grafts and it was the early stages of developing spray-on skin. Take me through that time.
Wood: We had a patient … who was falling through our fingers; the waves of infection kept coming. We took the last piece of skin we had from her and sent it to [the skin culture laboratory] in Melbourne to grow. That was in 1990. The skin came back; it takes three weeks. It is a long three weeks. We did a few more cases with Monash [Medical Centre, Melbourne] and then I thought, “We’ve got to reduce the time here”.
In February 1993, we got a grant and I found somebody who was as crazy as myself and we started working together. The first cab off the rank was 10 days ... and we started building from there, faster, faster, faster, five days. By 1994, we were using the spray.
One day after theatre, we were talking about how we could deliver the cells in a suspension, in a fluid, onto the wounds. Skin is three dimensional, so how could we get it on a hand or a face – flat surfaces were easier – and one of us said, “We should just spray this stuff on”.
We got throat spray, hairspray, nose spray, you name it. We set up a series of experiments, where we put the cells in different sized syringes, because we found we could damage the cells in different syringes so the size of the syringe and the pressure generation is really important. An Italian mouth freshener fitted onto a standard syringe. “Oh that’s handy; no dead space, no wastage, 90 per cent viable.” And that’s when we ended up buying big time Italian mouthwash until we found we could communicate with them – we just needed the nozzles, not the bottles of mouth freshener!
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The 2002 Bali bombings
Let me take you to a Sunday morning in 2002, when a call comes through about the Bali bombings. Take us through that day as it unfolded.
Wood: I was at a wedding when the call came through. [Previously], we had spent a lot of time with Woodside Petroleum developing disaster response plans for Western Australia since the North West Shelf opening in the late 1990s. From there, we had planned around the Sydney Olympics with multi-disciplinary burns teams in all capital cities across Australia. Small teams, very focused, superb people, but how would we manage if we had to escalate our response? The biggest burns unit in Australia is Concord [Sydney], with 14 beds. That’s not a whole lot. But we had an element of understanding of how we fit with the [Australian] Defence Force retrieval systems, the other retrieval systems, with the non-burns emergency management systems. There is no substitute for planning.
Malley: How does one prepare for what was coming out of Bali, because there were some extraordinary injuries? How were the staff coping?
Wood: People were just incredible. The amount of energy and focus and drive was extraordinary. We did the surgery from Wednesday through to Sunday, running between two and four operating theatres, with 19 surgeons in rotation, supported by the nursing team; there was at least 60 of them. [There were] the nurses in the burns unit and the physios and the OTs [occupational therapists] and the psychologists, the social workers, the pharmacy, the supplies … it went on and on. It wasn’t until three weeks later that we actually realised what we had done. There was no time really to think, “Gosh, this is overwhelming”.
I’ve had plenty of time since and one of the most overwhelming for me personally was in Parliament House on the 10-year anniversary. That was … I can’t remember what I said.
Malley: Fiona, I watched that and you were breathless. You got up with extraordinary energy but you were breathless and it was the most moving thing I have ever heard.
Wood: I have no idea what I said. I’ve never seen it since, because I don’t know where it came from. It really struck me that these people don’t need a speech; they need to know that their pain is felt.
Malley: When someone has horrific burns and is still able to communicate, do you see a spirit that is only in the hands of people facing such trauma?
Wood: When you first … meet someone whose life has changed like that, all I can do is reassure that we will do our best. There’s no false hope framework. Burns is not a linear thing; it’s not like … tomorrow you’ll get better. It’s more like a roller-coaster ride. Some of those downs are really hard and sometimes we can’t turn it around. It is much harder to stop and those are the harder decisions when you know that what is in front of you is overwhelming and it is beyond our capacity.
Coping with those days is the question of “what can I learn from this? What can I do to make sure that somebody else down the track will actually survive because of what we have learnt here today, so no life is wasted?”
Burns meets brains
Malley: I want to take you to some really interesting aspects of your research, what you call visualisation. You’ve said if you have a burn on your right wrist, elements of the left side ofyour brain react and have an impact potentially on your left wrist. What can the brain do to help solve the problem?
Wood: What do we need to heal skin? Twenty years ago, I would just say we need the cells and we need the framework for the cells. But then about 2000 or 2003, we had a situation where we were saying, “Hang on, we know if a lizard loses its tail and the nerve is crushed, it never regrows. So what is happening to the nervous system in the skin at the time of burns?”
I thought, “Why don’t we measure the nerves in the scar and the non-injured equivalent side?” We were in a lab next door to the neurophysiologists. We looked at what they were doing, and they were doing amazing work on how to get the eye, the optic nerve, to regenerate by stroking the whiskers of the small animal.
So we had this seminar where burns meets brains and out of that came a whole lot of pieces of this jigsaw. It was fascinating.
Can we think ourselves whole? Maybe one day, but I’m not sure I’ll still be here. We are still chipping away at that and trying to connect with our colleagues who know much more about the brain and the nervous system than we do.
We know a lot about how the nerves react in that skin construct. The skin itself is just a giant receptor and so what we are trying to understand is how can we get it to regenerate? How can we use the information of the brain and drive the nerves into the newly forming skin, so it creates the same shape, not a scarred shape?
Taking off the blinkers
Malley: The history of medical research has been that it’s been very much about the blinkers; that you’re in your area of medicine so you stick to yours and someone else sticks to theirs.
Wood: I’m smiling because I’m here at the nano-bio conference and people are asking, “What is she doing here?” Well, because we work with guys in chemistry, in nano-chemistry and in bio-medical engineering.
I join dots. Sometimes those dots shouldn’t be joined; however, it’s been an absolutely fascinating journey for me to say, “I think you’ve got a piece of our jigsaw; come let’s see if we can work together”. We’ve worked with population health teams, with sub-biology … we’ve got a bit of street cred.
The ulitmate goal
So what is the Holy Grail for burns?
Wood: The Holy Grail for burns is to heal like you were the day before; regeneration, not repair.
We have learned that it is not just the acute pain and suffering ... that scarring impacts for life, functionally, and it’s related to a lot of other things. Why does it have an ongoing impact on your life, on the rest of your body systems?
So for me, it’s regeneration. If we could heal without scarring, would we change the life trajectory, so that you were back to what you were the day before and you didn’t have all the dominoes falling over for the rest of your life?
Creating an innovation culture
Malley: If you were giving advice to governments about how to create a frame for innovation and research from your learnings, is there anything you would like to see them do?
Wood: It’s a really complex area. One of the things about development of intellectual property, development of innovation, actually making a difference to people on the planet, is the whole commercial drive, and in order to make money you have to make a difference. If you need to make the difference to make the money, we need to keep it in perspective. There is an element of greed that I see in our society that is a little bit erosive, and so I think from a government perspective I’m not sure it’s the role of the government. I would actually put a call out to each and every one of us to be the best they could be.
So from a political point of view – and certainly I understand we have to have infrastructures to help us progress – I think abdicating responsibility into that system of politics is wrong and we all need to stand up and be counted.
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