TUTOR IN PLASTIC SURGERY
North West Thames Regional Centre, Mount Vernon Hospital 1988 – 1996
FOUNDER MEMBER AND PAST TRUSTEE
Restoration of Appearance and Function Trust. (RAFT) National Plastic Surgical Charity.
PAST MEMBER
International Committee of the International Federation of Societies for Surgery of the Hand, investigating Classification of Congenital Hand Deformities.
International Committee of the International Federation of Societies for Surgery of the Hand. Committee for Developing an International Form for the Documentation of Trauma.
PREVIOUS APPOINTMENTS
PRE-REGISTRATION APPOINTMENTS
Medical and surgical, Sunderland Royal Infirmary with Dr R H Vasey and Mr H Jones (July 1968 – July 1969)
ASSISTANT LECTURER IN ANATOMY
Department of Anatomy, University of Glasgow, Professor G Wyburn
(July 1969 – August 1971)
During my tenure of this post, I commenced an investigation into the anatomical basis of the groin flap. Later, this was extended to an experimental investigation into physiological factors governing the design of axial pattern flaps, financed by the Scottish Home and Health Department on the recommendation of the Advisory Committee on Medical Research. This latter investigation was subsequently continued during the tenure of my clinical posts.
During this two year period I was able to maintain clinical contact through a part-time appointment in the Casualty Department, Glasgow Royal Infirmary.
GLASGOW ROTATING SURGICAL TRAINING PROGRAMME
Based at the Western Infirmary, Glasgow, initially as Senior House Officer, later at Registrar level (August 1971 – June 1974). This post included periods of training in general and vascular surgery with Sir Andrew Watt Kay, Professor P R F Bell and Professor D Roy. It also included experience in neurosurgery, orthopaedic surgery and casualty surgery with Professor B Jennett and Professor D Hamblen.
I had during this time maintained the contact with Plastic Surgery, begun during the research into flap design, and wished to experience the specialty at a clinical level, though at the time my ultimate wish was to train in orthopaedic surgery.
EDINBURGH, REGIONAL PLASTIC SURGICAL CENTRE, BANGOUR
ROYAL HOSPITAL FOR SICK CHILDREN, EDINBURGH
(June 1974 – June 1975) Senior House Officer and Locum Registrar
This Unit covered the whole spectrum of Plastic Surgery and had a particular interest in burns. There was a large separate Burns Unit. Part of the time was also spent at the Royal Hospital for Sick Children in Edinburgh where paediatric plastic surgical experience was gained. My time here served as an introduction to plastic surgery.
ORTHOPAEDIC HIGHER SURGICAL TRAINING SCHEME, WESTERN INFIRMARY, GLASGOW
HOSPITAL FOR SICK CHILDREN, YORKHILL
(August 1975 – June 1976) Registrar. Professor Roland Barnes and Professor D Hamblen.
During this year, I realised that of the range of orthopaedic surgery the part which interested me and which I wished to pursue was hand surgery – a subspeciality which combines the expertise of plastic surgery and orthopaedic surgery.
Athol Parkes was the prime mover of my interest in this field. I was also intrigued by the growing importance of microsurgery and the effect it would have on reconstructive surgery, and felt that both of these interests would be better pursued in the field of plastic surgery.
PLASTIC SURGERY CENTRE, WEXHAM PARK HOSPITAL, SLOUGH
(June 1976 – December 1977) Senior House Officer
This post, for local administrative reasons, is at Senior House Officer level, but the work corresponded to that of Registrar. The Senior Surgeon at Wexham Park Hospital, Mr S H Harrison, is a recognised authority in the field of Hand Surgery and in particular of rheumatic and congenital disease of the hand. The other consultant, Mr M Saad, has as one of his interests, cleft lip and palate surgery. The Unit covered the whole spectrum of plastic surgery.
One of the growing points, in plastic surgery is that of microsurgical techniques, and to be trained in this I obtained the post of Research Assistant in the Microsurgical Laboratory of Dr R D Acland in Louisville, Kentucky. This laboratory is run in association with the Hand Surgery Service in Louisville.
RESEARCH ASSISTANT, MICROSURGICAL LABORATORY – LOUISVILLE
(January 1978 – April 1978) Dr R D Acland
This allowed me to spend four months in the laboratory environment learning basic microsurgical skills. During this attachment I developed a technique for anastomosing small lymphatic vessels.
Clinical experience in reconstructive microsurgery as applied to head and neck malignancy was gained in association with Dr Acland.
I was invited by Dr Acland to act as the Director of his Microsurgical Laboratory for the period of three months in 1980 during his period of Sabbatical leave.
CHRISTINE KLEINERT FELLOWSHIP IN HAND SURGERY
(April 1978 – January 1979) Louisville, under Dr H E Kleinert and Dr G D Lister.
This service is very large by United Kingdom standards and carries out the entire range of Hand Surgery. It is regarded by many as the premier service in the United States. Both Dr Kleinert and Dr Lister had an interest in congenital hand surgery and Dr Deiter Buck-Gramcko was the visiting Professor to the Unit. During this year I had the opportunity to visit leading centres in the USA in Boston and San Francisco. Upon completion of my year’s Fellowship, Dr Kleinert invited me to join the Practice.
RESIDENT – DUKE UNIVERSITY PLASTIC SURGICAL CENTRE
(January 1979 – January 1980) Durham North Caroline, under Dr N Georgiade)
This service carried out a wide spectrum of general plastic surgery and is a highly respected training programme in the United States. Dr Georgiade has as his main interests, breast reconstruction and maxillo-facial surgery. Dr Pickrell had established a large cleft lip and palate service and Dr Serafin is known for his expertise in microsurgery. Many free tissue transfers were performed in this Centre.
SENIOR REGISTRAR – MOUNT VERNON HOSPITAL
Mr R Dawson, Mr S Harrison, Mr B Morgan, Mr R Sanders and Mr D H Harrison.
This Unit performs a wide spectrum of general Plastic Surgery, with an increasing interest in microsurgical techniques.
CONSULTANT PLASTIC SURGEON AND HAND SURGEON – MOUNT VERNON HOSPITAL
(March 1982)
Since commencing this appointment I have been able to extend my interest in hand surgery so that my workload now comprises 85% hand surgery and microsurgery and the remaining time is given to general plastic surgery. The peripheral hand clinic which I commenced at Luton & Dunstable Hospital has now been established and has been passed on to another Surgeon, but still provides a tremendous range of material for Mount Vernon Hospital. An on-going research programme with two Research Fellowes has been undertaken into both nerve injuries and Dupuytren’s contracture. Tendon grafting has become one of the main interests of both myself and the Physiotherapists and Hand Therapists at Mount Vernon.
Several years ago I was instrumental in helping to found RAFT, which is the Restoration of Appearance and Function Trust which funds much of the research undertaken at Mount Vernon Hospital. The current situation is that we have raised approximately £10 million and have established a research building in which the Professor is housed. the whole purpose of RAFT is to foster meaningful clinical research directed by Clinicians and geared
precisely at patient need. As a result of the presence of RAFT, I have been able to look into factors influencing poor prognosis in Dupuytren’s and we have highlighted the importance of the dorsal apparatus in Dupuytren’s. Another Fellow has been directed to look into the neurophysiological mechanism of electrical sensory threshold testing, a technique that was developed by myself and Godfrey Mott in 1986.
CONSULTANT PLASTIC SURGEON – GREAT ORMOND STREET
(June 1988)
I was specifically appointed here to undertake the establishment of a congenital hand surgery clinic. In the first five years approximately 70 pollicisations have been undertaken. Microsurgical toe to hand transfer has been commenced for the first time in the hospital and the world’s first symbiotic twin hand to hand transfer has been performed. There is a large supply of children with craniofacial deformities and their associated hand abnormalities are dealt with in the clinic. Free non-vascularised phalangeal transfers have been undertaken (approximately 70).