Inaugural Professorial Lecture in Wound Care
Progress in traumatic wound care: why the delay in closure?
by Lt Col Professor Steve Jeffery RAMC
WARNING: The following video contains graphic images of serious wounds.
All surgeons know that many acute trauma wounds cannot be safely closed on the day of injury.
To close wounds which have been contaminated or where the level of debridement is imperfect will result in wound infection, dehiscence or worse. Traumatic wounds including burns also 'progress', ie tissue which was initially alive dies in the hours or days following injury. The exact mechanism for this is not well understood. Closing wounds in these circumstances may risk dead tissue being left within the depths of the wound, again risking problems for the patient.
The delay required before closing these wounds causes prolonged hospital stay, and as long as the wounds remain open the patient is at risk of developing a wound infection, which may become systemic. This remains the commonest cause of death in patients with large burns.
It is therefore in the patient's best interest that the wound gets closed as soon as is safe. Not before, and not too long after. But how to judge when this critical window is open? Current methods of judging are highly subjective; when it 'looks good', when the patient is 'stable'.
Understanding of why wounds fail if closed too early has improved slightly over the past few years, but it is still a very inexact science. Increased protease activity is implicated as one of the reasons, and recently the ability to perform bedside testing for elevated protease activity in wounds has become available. Other diagnostic markers are also being developed.
Other factors are known to affect wound healing, such as moisture levels and bacterial colonisation. Sensing technology to allow the quantification of parameters such as these in real time are also being developed, and may facilitate the earlier closure of traumatic wounds.
About Professor Steven Jeffery
Steven Jeffery joined the Royal Army Medical Corps as a medical student in 1986. He qualified from the Universities of St Andrews and Manchester in 1989, and served as a Medical Officer with the Argyll and Sutherland Highlanders before completing his basic surgical training, becoming a Fellow of the Royal College of Surgeons of Edinburgh and of Glasgow. He completed three operational tours of duty in Northern Ireland during this time.
He developed an interest in burns and other soft tissue injuries, and soon realised that the best way to pursue this interest would be via plastic surgery. He completed his plastic surgical training in East Grinstead, Newcastle and Perth, Western Australia before getting his first consultant job in Newcastle in 2003.
In 2007 the numbers of casualties coming back from conflicts abroad rapidly rose, and Selly Oak Hospital struggled to cope with the large numbers of casualties. Steve moved to Birmingham to be the first military plastic surgeon in the city, as well as to be part of the burns team there. He also completed three tours of Afghanistan during this time.
In recognition of his contribution to developing the military plastic surgery medical and nursing teams, Steve was awarded the Military Civilian Partnership Award for 'Regular of the Year' in 2011, as well as receiving the Wounds UK ‘Key Contribution’ award and the Smith and Nephew 'Customer Pioneer of the Year' award the same year.
Steve is a Patron of the Restoration of Appearance and Function Trust Charity, and has been awarded Fellowship of the Royal College of Surgeons of England ad eundum. He is an expert adviser to NICE Medical Technologies Evaluation Programme. In 2011 he co-founded the Woundcare 4 Heroes charity, which is already making a big difference to the wound care of both serving and veteran personnel.