Dupuytren’s disease is a common inheritable disorder, mainly affecting the hand. The digits develop progressive flexion contractures and hand function is significantly impaired. The current mainstay of treatment is surgical excision of the affected tissues but recurrence following excision is seen in approximately 40% of patients. Replacing the palmar skin with grafts obtained from a non-palmar site on the body virtually abolishes recurrence. Based on this well-established surgical observation, we have developed a novel in vitro model, which replicates these interactions between skin cells and the contractile cells responsible for Dupuytren’s disease. We have also identified a molecule (tenascin-C), which may control the signalling between these cell types.

This study is designed to elucidate the exact role of tenascin-C in Dupuytren’s disease and go on to work out how this molecule alters the interactions between skin cells and the cells in Dupuytren’s disease.

Previous attempts to understand the mechanisms involved in Dupuytren’s disease have not led to viable therapeutic interventions. Our aim is to understand the basis of a well-established surgical phenomenon and, based on this knowledge, develop modalities for controlling this common, disabling disorder of the hand.

Kindly supported by the Freemasons' Grand Charity.

Keloids are benign dermal collagenous lesions that arise in the dermis during a prolonged wound healing process in individuals with a genetic predisposition. Keloid disease causes hugely disfiguring and symptomatic lesions in affected individuals with little hope of successful treatment as it is highly recurrent. The sufferers face serious aesthetic, physical, psychological and social consequences that may culminate in substantial emotional and financial costs. Although the rate of occurrence of keloid disease is reported to be higher in the Black population it affects all races and managing the resulting disfigurement is a frustrating challenge. The increased familial clustering in keloid disease, its increased prevalence in certain races and in identical twins suggests a strong genetic predisposition to keloid formation. Understanding the genetic basis may provide future prognostic and diagnostic advice to patients and help to develop novel therapeutic regimes for treatment of skin fibrosis.

Generously supported by ICAP plc.

Breast Cancer is now the second commonest cancer in the UK and by far the most common cancer in women. For women, the lifetime risk of developing breast cancer is now 1 in 9. Over 41 000 women are diagnosed with breast cancer each year and more than 1000 women die from the disease every month in the UK alone. The current mainstay of treatment for such cancer is surgery with a combination of radiotherapy, chemotherapy and hormone therapy. Following surgical removal of the cancer, we are left with a defect that needs to be filled. Using reconstructive surgery techniques, we move tissue from an area of the body where it is expendable to the defect in order to aesthetically reconstruct the breast. Ordinarily, this tissue is used simply to fill the space of the cavity and provide the material to fashion a new breast. In this project we seek to modify the tissue after it has been removed from the donor area and before it has been placed into the cavity by introducing genes that will have an anti-cancer effect. This is achieved by using pieces of DNA (called plasmids) or viruses to make the free flap produce a protein that destroys cancer cells and, therefore, stops the cancer returning.

Generously supported by ICAP plc.

This research is aimed at understanding how people with disfigurements, their stories and their daily experiences are portrayed on primetime television. This research will explore whether television can help people with disfigurements, in terms of identifying with others in similar situations, learning about support outlets, or feeling accepted by the wider community. Does television fulfil those roles now? If not, are there ways that television programme makers could improve output which would consider possible recommendations suggested by people with disfigurements. One of the aims of the Healing Foundation is to understand ‘the processes of psychological adaptation and recovery’, and the media can potentially have a significant impact on these processes.

Impaired wound healing in the skin may occur after trauma or elective surgery and represents a huge clinical problem. Chronic skin wounds have been estimated to occur in 3% of the Welsh population and are increasing with the rising ageing population. Described as skin wounds that fail to heal, they represent a significant cause of disability and distress amongst the aged. Whilst the exact cause(s) of these wounds are unclear, the inability of cells within the wound to function properly is believed to be responsible for their failure to heal. Our attempts to treat these wounds are principally based around the applications of dressings or pharmaceutical treatment of the wound surface; such interventions have been largely unsuccessful, to date. Recently, the development of novel methods of delivering biological agents (using long chain polymers) may aid in the delivery of various biological molecules/pharmaceuticals to treat such wounds. We have identified one key molecule, called Hepatocyte Growth Factor (HGF), which may help the cells from chronic wounds regain their normal healing properties. The aim of this research is to investigate whether the development of polymers containing HGF can help cells from chronic wounds to regain their normal wound healing properties.

Of the three predominant forms of skin cancer Melanoma is the most dangerous. There are around 5,600 new cases diagnosed each year in the UK of which around 1,600 will die of the disease. It is the spread of the disease, to other parts of the body, that causes patients to die. The rates for Melanoma have been rising for the last 30 years and are rising faster than any other cancer in the UK. This project aims to study certain chemicals in order to predict which cancers will spread. The next stage will be to block these chemicals to stop the cancer spreading. Predicting which cancers will spread would alleviate stress to patients and free up vital clinical time presently used in following patients. If we can stop the spread of cancer we can prevent a significant number of deaths from cancer. It would also reduce the amount of surgery patients now undergo, a significant amount of which fails to halt the progress of the disease. Furthermore the degree of surgery is also likely to be reduced if we can identify which cancers are not likely to spread. This will significantly reduce the disfigurement and subsequent reconstruction required, enabling healing to occur more quickly.”

Please click here to view Darryl's latest report.

Major burn injury produces inflammation that effects the entire body. This leads smaller blood vessels to leak fluid into the surrounding tissue causing organs to swell and stop working properly. This is a major factor in contributing to the mortality associated with extensive burns. Recently a control mechanism counteracting this has been hinted at, taking place within the vessel wall linings of cells and involving a protein called VE-PTP. We wish to understand more about VE-PTP and its instrumental part in preventing excessive fluid leak and to explore ways that drugs can enhance its effectiveness to resist inflammation caused by severe burns.

Annual Report now available – click here.

The project aims to develop a second generation synthetic dermal replacement that improves ‘skin take’ by actively promoting angiogenesis (the synthesis of new blood vessels), a crucial step in wound healing. On completion of the research, an effective new product should be ready to enter human clinical trials. If successful, this project will transform the outcome of chronic wounds, in particular burns, accelerating wound healing, reducing mortality and improving scarring and function.

Annual Report now available – click here.

A major burn injury leads to muscle wasting and severe weight loss. The body responds to the thermal injury by producing various chemicals that contribute to the healing of the damaged tissue. This project aims to understand the effects of the metabolic changes, in which these chemicals play a major part, on the wound healing process, this in turn will lead to a greater knowledge of how to prevent such dangerous weight loss in burn patients. The study involves comparing 50 control paediatric subjects with 50 paediatric burn patients from multi-centre locations across Scotland.

There is a need for laboratory-grown skin for patients who have suffered full-thickness skin loss such as follows burn injuries and also in cases where extensive reconstructive surgery is required, most commonly, in patients who have suffered contracture of wounds following burn injuries. Considerable progress has been made in developing laboratory-grown skin using the patients own skin cells (keratinocytes and fibroblasts) within a sterilised human donor skin from which all donor cells have been removed. However, these grafts often lose their blood supply which leads to loss of the grafts on the patients. This study aims to develop strategies to improve blood flow and blood vessel development (angiogenesis) in reconstructed human skin by establishing in vitro models.

Final Report now available click here.

Research indicates that a significant proportion of adult burn patients may still have psychological distress up to two years after discharge from hospital. This project aims to establish the psychosocial needs of burn-injured patients as they move from an in-patient to out-patient care environment and to develop support programmes based on the evidence attained.

Publications:
Considerations for the provision of psychosocial services for families following paediatric burn injury - a quantitative study.  Phillips C, Rumsey N.  Burns 2007 Jul 5.

Considerations for psychosocial support following burn injury - a family perspective.  Phillips C, Fussell A, Rumsey N. Burns 2007 Jul 10.

Phillips C (in press) Psychological and social aspects of burn injury. Cambridge Handbook of Psychology, Health, and Medicine (2nd Edition)

There is a real need for burns units to provide a holistic package of care to burns patients. The aim of this project is to study the role and need for an outreach nurse with links in both the hospital and community settings, in improving the continuity of care and support for burn-injured children. It will specifically look at how a nurse can help with the re-integration of a child into a school environment.