This three-year patient-focused research project, commissioned by the Healing Foundation, conducted by the Picker Institute, and funded by the GUS Charitable Trust studied the information needs of people with disfiguring conditions. The impact of a disfigurement can be enormous and life-changing, and alongside any accompanying physical obstacles, adapting psychologically and socially to a change in appearance is often one of the most difficult aspects of rehabilitation and recovery. The detailed findings of the study can be accessed below.

If you would like more information please click on the links below to download the full interim report and the fact sheet or visit The Picker Institute Website.

Potential Benefits of Research to Patients:
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.

Objectives of Research:
Cancer, trauma, degenerative disease and congenital craniofacial abnormalities can result in large cartilage tissue loss and severe disfigurement requiring plastic surgery. Current treatments include autologous tissue or prosthetic replacements but these are associated with their own limitations, risks and complications such as limited availability, donor site morbidity, infection, and psychosocial disability. The field of cartilage tissue regeneration aims to replace diseased tissue with new living tissue tailored to meet the individual needs of the patient.

Cartilage tissue lacks the innate ability to regenerate. Hence, current motivation in cartilage tissue engineering lies in the search of methods to direct cell behaviour and induce tissue growth. Our aim is to produce a nanofibrous scaffold which provides a mimic of real tissue extracellular matrix (ECM). Furthermore, we will design the scaffold to be bioactive, biocompatible and biodegradable for cartilage regeneration.

A major challenge in Tissue Engineering is being able to present the correct biochemical stimuli to cells. Transforming Growth Factor-1 (TGF-β1) has become a powerful tool in the induction of tissue regeneration. It modulates a broad range of biological processes including cell proliferation, differentiation, and maintenance of the ECM. Nevertheless, over accumulation of activated TGF-β1 results in pathological conditions. Engineering a cell-mediated TGF-β1 activation system would provide a real breakthrough in the field. Latent TGF-β1 is a form of the growth factor that possesses an RGD peptide sequence which when attached to a cell, activates the TGF-β1. In view of this cell-mediated activation, our proposed strategy is to utilise latent TGF-β1 to functionalise our scaffold system. This is a unique and novel strategy which intends to precisely guide and control cartilage tissue growth.

Potential Benefits of Research to Patients:
This project ultimately aims to produce the optimal cartilage tissue scaffold for plastic and reconstructive surgery. The intended outcome of this project will be highly beneficial to patients with visual disfigurements as a result of cancer, trauma and congenital anomalies.

The project will mean a breakthrough in the treatment of many diseases including in other fields of surgery such as orthopaedic surgery. It will also form an important part of the ever advancing multidisciplinary research in cartilage tissue engineering as well as a vital template for tissue engineering of other tissue types.

Educational History and Qualifications:
MRCS (Eng), 2004
MB ChB, 2000

Objectives of Research:
Keloid disease (KD) is one of the most aggressive forms of abnormal skin scarring in humans. Most forms of KD cause hugely disfiguring and symptomatic lesions in affected individuals with little hope of successful treatment as it is highly recurrent. The sufferers of KD face serious aesthetic, physical, psychological and social consequences that may culminate in substantial emotional and financial costs. Keloids comprise a diverse group of unsightly prominent scars that are persistent and chronically active. Keloid scars tend to recur following surgical excision and other treatment modalities making them a difficult medical challenge and a frustrating ailment for sufferers.

The rate of occurrence of keloid disease is reported to be higher in the Black population. 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 of keloid disease may provide future prognostic and diagnostic advice to patients and help to develop novel therapeutic regimes for treatment of skin fibrosis.

The objective of this study is to recruit patients with familial keloids and other affected and unaffected family members. This will allow us to determine the inheritance mode and to conduct genetic studies (linkage analysis). The genetic linkage analysis will help identify sequences on the human genome that may be responsible for keloid scarring. The potential benefits of identifying the sequences will be of great scientific and clinical importance.

Potential Benefits of Research to Patients:
The potential beneficial outcome of this study is to further our understanding of the pathogenesis of keloid disease. The scientific data collected if successfully analysed will potentially facilitate clinical applications that will benefit scarred patients.

1. The ability to identify individuals at risk of pathological keloid scarring pre-operatively with a blood test on the basis of the presence/absence of candidate susceptibility gene polymorphisms.

2. The ability to offer prophylactic therapy to those identified to be at risk of forming keloid scars.

3. The ability to develop effective treatment based on exact pathogenesis of disease in order to treat patients with existing keloid scars.

Educational History and Qualifications:
I am originally from the Sudan but underwent my primary education in London. I studied medicine at the University of Karachi in Pakistan. I completed my basic surgical training in Manchester. I have worked as a trainee in Plastic Surgery at the Booth hall Hospital for Children and Wythenshawe Hospital in Manchester. I have also worked as a Plastic Surgery Trainee at Frenchay Hospital in Bristol. I am a member of the Royal College of Surgeons of England. In October 2006 I was awarded the first Aesthetic Research Fellowship by the Healing Foundation at the Royal College of Surgeons of England. I am currently enrolled at the University of Manchester in a MD programme.

Whether present from birth or acquired later in life, a disfigurement, which is visible to others, can have a profound impact on those affected. Difficulties experienced can be pervasive and debilitating, and include negative experiences related to social encounters with others and adverse effects on self-esteem and quality of life.

This three-year research programme, co-ordinated by the Centre for Appearance Research at the University of West of England, is the largest of its kind in the world. The results will be used to develop support for those with disfigurement and visible loss of function in conjunction, with or as an alternative to, surgery.

To learn more about the project please click on the links below which includes the final report and summary.

Download the report summary [Adobe Acrobat format, 787k]

Download the report [Adobe Acrobat format, 2.5Mb]

Objectives of this Research:
This two year project examined the role of television in representing disfigurement and considered how representations might be improved. This was the first piece of research to systematically explore the ways in which disfigurement appears on terrestrial television, the motivations of television producers, and the responses of audiences. Over 8500 hours of television were analysed, along with 31 hours of focus group and interview material.

Potential Benefits of Research to Patients:
The primary outcome provides the first ever media analysis aimed at understanding how disfigurement and visible loss of function is represented on British primetime television. Further beneficial outcomes are:

1) discovering how the representation of disfigurement/visible loss of function impacts different members of the audience, depending on their own previous experience of disfigurement/visible loss of function;

2) exploring how audiences learn, and what they learn about people with disfigurement and visible loss of function through television;

3) recording the support and information needs of people with disfigurement and visible loss of function, and considering how to improve ways in which this information can be shared through television formats;

4) reporting the findings from different audience groups to programme-makers and commissioners at a variety of terrestrial television channels. Ultimately, this research enables the Healing Foundation and others to be more accurately informed about media coverage of issues related to disfigurement and visible loss of function, educates programme makers about the impact of their primetime output on different audience groups, and hopefully contributes to building an ongoing dialogue between the two groups.

Overall Recommendations include:
1) Using more people behind the camera. Ultimately, encouraging people with disfigurements to pursue careers in television, both as actors and presenters, as well as scriptwriters and producers, will be the most influential way to change content.

2) Give voices to people with disfigurement. One of the most striking findings from the research was the absence of people with disfigurement speaking with their own voice. This has a powerful effect on audiences who rarely 'see' disfigurement and hardly ever hear from someone about their own personal experience.

3) Television producers should find ways to challenge societal ignorance about disfigurement. Audiences without personal experience of disfigurement stated an interest in seeing more representations of disfigurement on television.

To learn more about the project please click on the link below which includes the final report and presentation of findings.

Objectives of Research:
The objectives are to develop skeletal muscle through 'culturing' of primary cells and optimise conditions to generate sufficient muscle tissue. Although tissue engineering techniques attempting regeneration of human tissues and organs have recently entered into clinical practice, the engineering of skeletal muscle tissue is still a scientific challenge.

The project is expected to give further crucial insight in the unknowns of skeletal muscle tissue engineering which would bring us much closer to a clinical setting. The possibility of creating new muscle to replace lost muscle function is very attractive as the newly build muscle could be 'tailored' to its intended site and function, resulting in better and more predictable results and would obviate the need to sacrifice another healthy muscle

Potential Benefits of Research to Patients:
Facial palsy is a devastating condition having functional and psychological consequences in addition to the more obvious aesthetic ones. In this condition, facial appearance is altered by reduced muscle tone causing drooping of facial features and, in the case of one-sided facial palsy, exaggerated facial contortions towards the working side. Functional problems include inadequate eye closure, which may threaten sight, oral incontinence causing drooling, speech problems and swallowing difficulties.

The face is a focal point for social interactions and those affected may become severely introverted and reclusive. Since human interaction occurs almost constantly in normal daily life, its avoidance can have a pervasive effect on a person's human experience.

Educational History and Qualifications:
After obtaining my degree of Medical Doctor at the Catholic University of Leuven in Belgium in 2002, I pursued my medical career in surgery. My first three years as a trainee on a general surgery rotation in Belgium allowed me to understand the different subspecialties in surgery. I soon realised the technical challenges encountered in reconstructive plastic surgery procedures were my main point of interest. I was very fortunate to be able to spend part of my Belgian plastic surgery training abroad and had the chance to work in the department of Plastic and Reconstructive Surgery of the Mount Vernon Hospital which has now merged with the Royal Free Hospital in Hampstead London. During this period I developed a specific interest in research in the broad field of reconstructive surgery and started a tissue engineering project which will be kindly supported by the BAPRAS/Healing Foundation Grant. I will finish my training in Plastic and Reconstructive Surgery in Belgium once my research project is completed and hope to stay involved in research during my future career as a plastic surgeon.

Objectives of Research:
In the UK it has been estimated that impaired wound healing costs in excess of £1 billion. It is typically associated with diabetic foot ulcers, venous leg ulcers and pressure sores. Impaired wound healing occurs due to a process of prolonged inflammation, and abnormal production of the matrix within which normal skin cells grow and migrate. Growth factors are proteins that can stimulate and control wound healing but are susceptible to degradation by enzymes in the chronic wound environment. Growth factors, such as epidermal growth factor (EGF), have well-documented actions on cells involved in the microscopic processes of wound healing. Polymer therapeutics as an umbrella term used to describe the use of nanometre-sized (1 billionth of a metre) polymer molecules as drugs. Most drugs on the market today are of a very small molecular weight (up to 1000x smaller than polymer therapeutic agents) and are excreted quickly from the body. This limits their efficacy, as they cannot target the areas of the body in which they are required, resulting in greater risks of toxicity and short duration of action. The development of novel growth factor-polymer drugs offers a potential growth factor delivery system for chronic wound therapy, allowing controlled and targeted growth factor delivery. It also increases their bioavailability, to induce healing responses, whilst protecting growth factors from the harsh wound environment.

Potential Benefits of Research to Patients:
The synthesis of a novel EGF polymer therapeutic may provide an effective medicine for the treatment of chronic wounds. Current therapies can involve long-term wound care which can be painful, expensive and, in some cases, ineffective. By providing an alternative topical therapy that can be combined with current wound treatments, wounds will heal quicker, and complications associated with chronic wounds, such as infection will be reduced. The quality of life of patients will be greatly improved.

Educational History:
2008 Post-Graduate Certificate in Medical Education (in progress); June 2004 MRCS (Edinburgh); June 2000 MBChB - Sheffield University; June 1995 4 A-levels at grade A - Wyggeston & Queen Elizabeth I College, Leicester; June 1993 10 G.C.S.E.s at grade A - Lancaster Boys School, Leicester.

Prizes:
Young Investigators' Oral Presentation Prizes: (1) 6th Cardiff Institute of Tissue Engineering and Repair (CITER) Annual Meeting 2007; (2) Metabolism, Regeneration and Repair Inter-Disciplinary Research Group Meeting, Wales College of Medicine, Cardiff University, 2007; (3) Annual Postgraduate Research Day, Wales College of Medicine, Cardiff University, 2006. Young Investigators' Poster Presentation Prizes: (1)International Symposium on Polymer Therapeutics, Berlin, 2007; (2) 5th Cardiff Institute of Tissue Engineering and Repair (CITER) Annual Meeting, Abergavenny, 2006.

Publications:
Hardwicke J, Clarkson J, Park A. J Plast Reconstr Aesthet Surg. 2007; 60: 61-3; Hardwicke J, Jagadeesan J, Shariff Z, Paterson P. Plast Reconstr Surg. 2007; 119: 1131; Hardwicke J, Lam W, Paterson P.J Plast Reconstr Aesthet Surg. 2007; 60: 955-972; Hardwicke J, Gaze NR, Laitung J. J Plast Reconstr Aesthet Surg. 2007; 60: 1313-1316; Lam W, Hardwicke J, Laitung J. Scand J Plast Reconstr Surg Hand Surg (In Press); Hardwicke J, Azad S. Burns. 2006; 32: 1064-1065; Hardwicke J, Paterson P. Int J Low Extrem Wounds. 2006; 5: 101-104; Hardwicke J, Paterson P. Dermatol Surg. 2006; 32: 1219;Hardwicke J, Azad S, Laitung J. Injury Extra. 2006; 37: 34-35; Hardwicke J, Satti U. Injury Extra. 2006; 37: 133-134; Jagadeesan J, Oudit D.

Objectives of Research:
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.

Objectives of Research:
With advances in burn care therapy and the benefits of early burn excision, there remains a pressing need for a new artificial skin. Many approaches currently available, including skin grafting and cultured skin, have limitations. Despite reported integration rates of above 80%, in practice, the use of Integra™, currently regarded as the gold standard synthetic dermal replacement, is hampered by poor reliability and steep learning curve.

Central to integration is angiogenesis. We aim to develop a novel pro-angiogenic second generation 'smart matrix'. The non-viable matrix, like Integra™, will be used as a biological scaffold to provide mechanical support and act as a template for cellular regeneration promoting rapid capillary ingress. It would eventually be reabsorbed as the wound heals over several of weeks.

Our group has identified fibrin, the main constituent of blood clot, as the suitable biological protein. This project aims to harness its pro-angiogenic properties in a surgically useable dermal equivalent that provides a mechanical framework long enough to prevent early infection and late hypertrophic scarring.

Potential Benefits of Research to Patients:
14,000 patients a year are admitted to hospital with significant burn injuries, 600 die. Countless more are left with lifelong, restrictive scarring and are often forced to endure many more revision surgical procedures. Despite many advances in care of these patients, there remains a pressing need for an immediately available, limitless artificial skin. A reliable artificial skin would not only save lives by allowing the immediate reconstruction of large burns but also provide a realistic treatment option to those with prominent burns scarring and chronic wounds. Current options including skin grafting have many limitations including limited supply and high risk of thick scars.

The key to the survival of any artificial skin is the growth of new blood vessels into it. We believe this is why many, currently available, materials fail. This project has identified a naturally occurring building block of the body that encourages new blood vessel growth. It aims to harness its growth potential properties into a useable, reliable artificial skin that provides a template for the patient's own wound healing mechanisms and then be broken down naturally.

If successful, it will save lives, improve healing of problematic chronic wounds and reduce lifelong scarring.

Educational History and Qualifications:
I obtained my medical degree at St Mary's Hospital Medical School in London. Gaining an additional degree in infectious disease, a Medical Research Council scholarship, allowed me to undertake research into neonatal infections. During a medical student elective at Baragwaneth Hospital in Soweto, South Africa, I first met the problems of thermal injuries where many were burnt with open oil heaters. I undertook my basic surgical training at St James' University Hospital in Leeds. Whilst working at the regional burns unit, despite many medical advances, I became increasingly frustrated by the limitations of available burns reconstruction. The Healing Foundation allowed me to take my clinical experience to the laboratory and undertake a two year MD research program at RAFT Institute of Plastic Surgery in London developing a new artificial skin. Following completion of my research, I have returned to higher surgical training and am currently based at the Manchester children's burns unit.

Objectives of Research:
This 2 year research project set out to investigate a novel anti-inflammatory treatment that promises to be of great benefit to patients with organ damage secondary to major burns. Whilst major burn injury has obvious effects through scarring, it also triggers widespread and uncontrolled inflammation within the body, frequently disturbing internal organ function and possibly leading to organ failure and even death. This inflammatory response is strongly promoted by the widespread 'activation' of the blood vessel lining (known as the endothelium), and recent international research has identified the endothelium as a valuable target for new anti-inflammatory strategies. One potential drug known to work on the endothelium is Angiopoietin-1, and this Healing Foundation funded research project studied this drug in a variety of experimental studies into inflammatory responses involving the endothelium. As part of this work a clinical trial was developed to test the efficacy of Angiopoietin-1 using blood samples from critically ill patients in test tube models of inflammation. Results from this research have now identified the specific endothelial receptor mechanism that produces the anti-inflammatory effects associated with Angiopoietin-1. The work has also demonstrated provisional anti-inflammatory effects of Angiopoietin-1 when using the drug in conjunction with blood samples from seriously ill patients with sepsis.

Potential Benefits of Research to Patients:
Angiopoietin-1 is a natural substance already found in small quantities in the body, and by administering it in larger quantities during excessive inflammatory responses, it promises to suppress some of the disease processes that damage the internal organs and threaten survival. Indeed existing pre-clinical experiments indicate that Angiopoietin-1 has few unwanted side effects when used at high doses together with other major benefits such as accelerated wound healing. If the beneficial effects of Angiopoietin-1 continue to be evident in future clinical trials using the drug, this could potentially offer a great improvement in the medical care of patients with major burns. Specific goals include reduced duration of ITU care with reduced need for organ support and an ultimate reduction in mortality rates.

Educational History and Qualifications:
BSc (Anat. Sci.) University of Manchester
1997 MBChB University of Manchester 2000

Postgraduate qualifications:
MRCS (Eng) 2004 : Thesis submitted for the degree of PhD March 2008, following this 2 year Healing Foundation / Royal College of Surgeons of England funded research project.

Current Position:
Higher surgical trainee (ST3) in Plastic, Burns and Reconstructive Surgery at the Royal Victoria Infirmary, Newcastle.

Objectives of Research:
Cancer patients die only because the disease is able to spread around the body. At present it is not known how cancers can spread around the body. In Malignant melanoma once the cancer has spread there is at present no effective treatment to cure the patient. As a result the surgery that is offered is often extensive, leads to severe scars and has little guarantee of success. My research has been to investigate a group of proteins (chemokines) that normally direct healthy infection fighting cells to sites of infection and back to the lymph glands. I have found that malignant melanoma cells are using these proteins abnormally to allow the cancer to spread around the body. In conjunction with a French research group we have also found a way of stopping the chemokines to prevent the spread of malignant melanoma.

Potential Benefits of Research to Patients:
This research will allow doctors to accurately diagnose those melanomas that are able to spread around the body. Initially this will lead to a decrease in the amount of surgery performed in low risk patients and allow doctors to identify those patients most at risk. These patients will be offered the surgery they need earlier.

A pharmaceutical therapy, directed at blocking chemokines, has been developed that will prevent the spread of the disease. Thereby allowing patients to live with their cancer and not die from it. Importantly it is not only malignant melanoma patients that this will be of benefit to. This therapy is likely to also work in patients with breast, lung, stomach and ovarian cancers to name a few.

Educational History and Qualifications:
I qualified from the University of Liverpool medical school in 1999 with the degree MB ChB. After undertaking my basic surgical training at North Bristol NHS trust I became a member of the Royal College of Surgeons of England in 2003. After a further year of Plastic surgery training I started my research as the Skin Cancer Research foundation Research Fellow in 2004. In November 2005 I was awarded the Michael Brough Healing Foundation research Fellowship that I took up in January 2006. The 2-year fellowship has allowed me to complete my research and the work for my PhD at the University of Bristol.

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)