Repairing burn wounds through skin regeneration: Fiona Wood at TEDxFlanders
-
0:13 - 0:16Thank you, that's right.
I'm Fiona Wood. -
0:16 - 0:18I'm a plastic and reconstructive
surgeon, -
0:18 - 0:20and for the last 30 years --
-
0:20 - 0:24I've spent my whole
professional life focused on -
0:24 - 0:28and trying to treat people
with burn injuries. -
0:28 - 0:32I think as a plastic surgeon
I see suffering on a daily basis. -
0:32 - 0:35I see people's lives
that have changed in an instant. -
0:35 - 0:39When I look back and sort of introspect,
I guess, over those 30 years, -
0:39 - 0:45where did I start ? Where did I start
to think that we could do better ? -
0:45 - 0:49And I've traced that back
to seeing a young child, -
0:49 - 0:52a young child in 1985.
-
0:52 - 0:55A cup of coffee had gone down
the front of that chest. -
0:55 - 0:59There had been a period
of time for painful dressings, -
0:59 - 1:04the cries that would probably
never leave the mother and father. -
1:04 - 1:07All those weeks for healing,
-
1:07 - 1:10and I was working
in a plastic surgery center -
1:10 - 1:12in the South of England
at that time -
1:12 - 1:16and this child turned up
at our plastic surgery center. -
1:16 - 1:21"The burns are healed now,
he needs plastic surgery." -
1:21 - 1:24It hit me straight between the eyes,
-
1:24 - 1:27that this boy would never move
properly again, -
1:27 - 1:30he would never move
his neck or his arm, -
1:30 - 1:34that the scars that had been left
from a very simple situation -
1:34 - 1:37would be with him for life.
-
1:37 - 1:41And so as I moved forward through
my education and my training as a surgeon, -
1:41 - 1:47I became increasingly focused
on how to make sure -
1:47 - 1:51that the quality of the outcome
was worth the pain of survival. -
1:51 - 1:54Many of you may have burnt
yourselves on the arm, -
1:54 - 1:57just done a bit of a splash of oil
when it's cooking. -
1:57 - 2:01Just bear one second,
a fraction of a second, -
2:01 - 2:04for half your body being burnt.
-
2:04 - 2:06Ten years ago,
this month, -
2:06 - 2:11was a tragedy that touched
many people across the world -
2:11 - 2:13but in particular touched Australia,
-
2:13 - 2:15it was the Bali bombings.
-
2:15 - 2:18It was at the ten year review,
-
2:18 - 2:21when I was talking to
one of these young men, -
2:21 - 2:24the captain of the football team,
-
2:24 - 2:27who found himself in
that nightclub that night, -
2:27 - 2:30and he described
how he fell into the flames, -
2:30 - 2:32he broke his back,
he lost all his teeth, -
2:32 - 2:36he had multiple fractures,
and 70% of his body was burnt. -
2:36 - 2:38He went on to survive
-
2:38 - 2:42and he described on this occasion
two weeks ago, -
2:42 - 2:45the pain of that injury.
-
2:45 - 2:50But he also went on to describe
the pain of the healing, -
2:50 - 2:51week in, week out,
-
2:51 - 2:53and the recovery,
the rehabilitation -
2:53 - 2:56and making sure
that when he first left, -
2:56 - 2:58and he couldn't clean his teeth
or brush his hair, -
2:58 - 3:01how he drove over
that first 3-4 years, -
3:01 - 3:05to the point where he had
a full range of movement. -
3:05 - 3:07The scars will never leave him.
-
3:07 - 3:10So, as a surgeon, when I say
I've come to talk to you today about -
3:10 - 3:12"How can we do it better?"
-
3:12 - 3:17You know that it is what we live,
what we breathe, on a daily basis. -
3:17 - 3:21We see sufferings, we see lives changed
in an instant, and it can happen to anyone. -
3:21 - 3:24So, what do we do?
-
3:24 - 3:26When someone has
a burnwound, the skin -- -
3:26 - 3:28I could talk about skin forever,
-
3:28 - 3:32it's a fascinating organ,
that's well and truly underrated. -
3:32 - 3:35Now, what a beautiful thing is skin.
-
3:35 - 3:40It helps to keep your body in,
how amazing. (Laughter) -
3:40 - 3:43It does all sorts of things,
it's your interface to the world. -
3:43 - 3:46We look at a baby
and we smell that baby, -
3:46 - 3:51and we smell that skin,
and how exquisite it is. -
3:51 - 3:54How could we get back to
that when it's damaged ? -
3:54 - 3:55Only it takes very little,
-
3:55 - 3:57our skin is turning over
all the time, -
3:57 - 4:01it takes very little
to overwhelm that capacity, -
4:01 - 4:04so it can't repair itself.
-
4:04 - 4:05It can't return to the functions
-
4:05 - 4:10of temperature control,
bacterial control, etcetera. -
4:10 - 4:15So many functions I couldn't even begin
in 18 minutes to talk about. -
4:15 - 4:17So, what do we do then?
-
4:17 - 4:19Look around
and take your blinkers off. -
4:19 - 4:23I think anybody in science these days
has got to seriously have their blinkers off. -
4:23 - 4:27They've got to look and see where else
they can find information. -
4:27 - 4:29And certainly in embryology
and in biological sciences, -
4:29 - 4:33in genetics we can see
all sorts of things happening. -
4:33 - 4:35I can see a gecko can grow a tail,
-
4:35 - 4:39yet I can't repair
a wound without scarring. -
4:39 - 4:42Now we may step back
from this and think, -
4:42 - 4:44"Wow, what is it that we do? "
-
4:44 - 4:47So, I'd like to take you
to the last 20 years -
4:47 - 4:50of work in the area
of skin grafting. -
4:50 - 4:54When you treat somebody with burns
it's a massive juggling exercise. -
4:54 - 4:58We have the pain, we still have infection
as the biggest killer, -
4:58 - 5:02we have to seal the skin over as the waves
of infection relentlessly come -
5:02 - 5:05and weaken that body,
weaken it, -
5:05 - 5:08weaken the ability
of the bone marrow to respond. -
5:08 - 5:10And we try to seal that surface,
-
5:10 - 5:13so once we got that surface sealed,
we're safe. -
5:13 - 5:18And then the healing goes on,
as I've described. -
5:18 - 5:21But it gives us an opportunity for life,
if we can seal that surface, -
5:21 - 5:26we are safe and we can have
that opportunity to live again, -
5:26 - 5:28to then rebuild
the skin underneath. -
5:28 - 5:30So how do we create that surface,
-
5:30 - 5:34if 50% of your body surface is gone,
-
5:34 - 5:36there's only 50% to get skin from.
-
5:36 - 5:38And so traditionally,
many years ago -- -
5:38 - 5:42the first skin graft done
was in the 1800's, -
5:42 - 5:44that's a serious little time ago.
-
5:44 - 5:47And so traditionally, when I started,
over 30 years ago, -
5:47 - 5:51we would take the surface of the skin,
just skim that surface -
5:51 - 5:55with a very large tool,
very sharp knife, -
5:55 - 6:00and still skim that surface,
so we'd got a split thickness skin graft. -
6:00 - 6:02We can change that
split thickness skin graft -
6:02 - 6:05to mesh it and make it larger.
-
6:05 - 6:10So if I take a piece from a leg,
I can cover maybe 2/3 of an arm. -
6:10 - 6:13Maybe just less.
By meshing it out. -
6:13 - 6:17But that scar then look like a mesh.
-
6:17 - 6:20So how, when we get bigger
and bigger burns, -
6:20 - 6:22we're in a situation
where technologies are advancing, -
6:22 - 6:25we know the people
can survive major burns. -
6:25 - 6:29And I recently had coffee
with a patient I met in 1991, -
6:29 - 6:311st of October in 1991,
-
6:31 - 6:35as I'd not long been director
of the Burns Service in Western Australia. -
6:35 - 6:38He had 92% body surface area burns,
-
6:38 - 6:40and I was expected to walk away.
-
6:40 - 6:43And I said, "We don't walk away,
because we have now the technology -
6:43 - 6:47
to move forward
to ensure his survival." -
6:47 - 6:51And 20 years later
I was having coffee with him. -
6:51 - 6:53So, how did we achieve that?
-
6:53 - 6:56When he only had 8%
of his body left? -
6:56 - 6:58Where could we get
the skin from? -
6:58 - 7:01Well, clearly we can't.
-
7:01 - 7:04So many years ago,
in that famous institution -
7:04 - 7:09in Boston, the MIT,
they started growing skin cells -
7:09 - 7:12because we're into sheets,
we're into skin grafts, -
7:12 - 7:16we understand how the blood vessels
can come into that sheet -
7:16 - 7:18and establishes connections
with the surface. -
7:18 - 7:21We can change the skin from here to here,
-
7:21 - 7:26we understand that.
So we grew skin cells into sheets. -
7:26 - 7:29By this time, these skins cells
were 10 cells thick, -
7:29 - 7:31we knew which way was up
and which way was down, -
7:31 - 7:3510 cells thick, you can imagine,
that's quite challenging. -
7:35 - 7:39But certainly, back in 1992,
at that stage, -
7:39 - 7:43there were one place in Australia
that was growing skin, -
7:43 - 7:46there was one other place in the world
that was growing skin commercially, -
7:46 - 7:48and that was Boston.
-
7:48 - 7:54And so we could send a piece of skin from
-- I live in Western Australia. -
7:54 - 7:57We sent that skin
overnight to Melbourne -
7:57 - 7:59they grew it into sheets
that came back. -
7:59 - 8:04We put these sheets on
and we'd got an element of cure, -
8:04 - 8:05we'd got an element of closure,
-
8:05 - 8:08we were able to save a life.
-
8:08 - 8:13But that skin was over
in that laboratory for three weeks. -
8:13 - 8:16Every day in a burns unit
is a day too long. -
8:16 - 8:20How could we stop that?
How could we shorten that three weeks? -
8:20 - 8:22That's where my story started,
-
8:22 - 8:25engaging the whole concept
of tissue engineering, -
8:25 - 8:27tissue expansion.
-
8:27 - 8:30Myself and Marie Stone,
the scientist I worked with, -
8:30 - 8:34we raised money,
we started our own laboratory. -
8:34 - 8:38If you heal a burn within 10 days,
you get a 4% risk of scarring, -
8:38 - 8:42if you heal a burn within 21 days,
78% will have scarring. -
8:42 - 8:45Why wait 3 weeks?
Time matters. -
8:45 - 8:47People die waiting.
-
8:47 - 8:49And so we started
in the skin lab in 1993, -
8:49 - 8:52and our first sheets
we grew in 10 days. -
8:52 - 8:56But before long we realised,
by observation, -
8:56 - 8:58by taking basic signs
to the bed side, -
8:58 - 9:01we saw that the more immature
those skin cells were, -
9:01 - 9:04paradoxically,
the better they did. -
9:04 - 9:06And so we started doing
experiments around this. -
9:06 - 9:10Trying to understand
what was going on. -
9:10 - 9:14And then we started seeing that if we take
the cells after 5 days in the laboratory, -
9:14 - 9:18and remove them
from the flask into a soup, -
9:18 - 9:21that they did even better.
-
9:21 - 9:29And the operating theaters we work in,
are round about 44 degrees -- that's C[elsius], -
9:29 - 9:32because if a patient gets cold,
-
9:32 - 9:34they no longer clot their blood,
-
9:34 - 9:36and so we can't operate.
-
9:36 - 9:39So I came out of the sweat box,
-
9:39 - 9:43I walked into the lab to see Marie
in the beautiful air conditioned lab, -
9:43 - 9:44it was all clean,
-
9:44 - 9:46and in the operating room
we debride, -
9:46 - 9:50we remove the burn tissue until such point
that we get pin point bleeding -
9:50 - 9:53and then we know it's alive.
Somewhat less than subtle. -
9:53 - 9:58But our advances in that area are
another 18 minutes at another time. -
9:58 - 10:01And so there we were,
and I shook my head and said, -
10:01 - 10:04"Wow, we just should just
spread this stuff on." -
10:04 - 10:08The time taken to make sure
those cells were on the right way up, -
10:08 - 10:14fixing each patch onto the body
so they didn't sheer or move. -
10:14 - 10:19Taking it from there, putting in a soup,
trying to keep the soup under the dressings. -
10:19 - 10:23At that stage, you gain a whole raft
of more experiments to do. -
10:23 - 10:25How can we actually deliver cells
-
10:25 - 10:27to the surface
of this burned wound, such -
10:27 - 10:30that they are alive and functional?
-
10:30 - 10:36We took, became I guess,
amateur physicists, -
10:36 - 10:39looking at the vortex in,
and apertures, in various nozzles, -
10:39 - 10:43we found a nozzle,
in a chemist shop in Perth, -
10:43 - 10:46that was from an Italian
mouth freshener. -
10:46 - 10:51And when you put that nozzle
on a 5 ml standard hospital seringue, -
10:51 - 10:54the cells coming through that system
with no dead space, -
10:54 - 10:58were viable,
90% plus cells were viable. -
10:58 - 11:00It was a eureka moment.
-
11:00 - 11:06In the program you'll see
fine dots behind my name. -
11:06 - 11:10Just off screen is the seringue
as we're spraying those cells on. -
11:10 - 11:16So what we do, we take the skin cells
from you, to you. -
11:16 - 11:19It avoids all the issues of rejection,
-
11:19 - 11:21it allows tissue expansion.
-
11:21 - 11:24Each little cell can cover
much greater area -
11:24 - 11:27than when we coalesce them into a sheet,
and then grow them -
11:27 - 11:31and the next step in the whole process
was to look back, -
11:31 - 11:34and say, "We can do this in 5 days."
-
11:34 - 11:36But 5 days is a long time.
-
11:36 - 11:39I've said already one day in a burns unit
is a day too long. -
11:39 - 11:42How can we actually move quicker?
-
11:42 - 11:44We notice that our smaller burns
by this stage, -
11:44 - 11:47we were looking at these technologies
in our smaller wounds, -
11:47 - 11:51how where we were still doing
our traditional skin grafting, -
11:51 - 11:54they had scars that were worse
than larger burns -
11:54 - 11:56where we were doing
more advanced technology, -
11:56 - 11:57where we were mixing the technologies,
-
11:57 - 12:01where we were using this traditional,
and the cells spray. -
12:01 - 12:03And so we then moved to say,
-
12:03 - 12:06"How can we do it
in less than 5 days?" -
12:06 - 12:09So we took the absolutely
key essential components -
12:09 - 12:13of the laboratory,
we minutarised them. -
12:13 - 12:17We put them in a box,
a box just this big. -
12:17 - 12:20The box that heats the enzyme
up to the required temperature, -
12:20 - 12:22such that the skin
that we harvest, -
12:22 - 12:26we take a split thickness skin graft,
a small postage stamp. -
12:26 - 12:27We put that in the enzyme,
-
12:27 - 12:31takes few --
a matter of minutes, 10 to 15, -
12:31 - 12:3420 if the skin is a little thick.
-
12:34 - 12:37And we take that out,
it's like a bread and butter sandwich, -
12:37 - 12:40and we could peel those slices
of the skin apart, -
12:40 - 12:43like we'd peel the sandwich apart,
-
12:43 - 12:45and the butter is all those
actively growing cells. -
12:45 - 12:49Those cells under normal conditions
will keep us whole. -
12:49 - 12:51They will keep replenishing the surface
against the knocks -
12:51 - 12:54and the scrapes of everyday life.
-
12:54 - 12:57We harvest those cells,
filter them through, -
12:57 - 13:00make them into a suspension,
and deliver them to the wound. -
13:00 - 13:04The whole process now
takes 30 minutes. -
13:04 - 13:13(Applause)
-
13:13 - 13:17So, I'm a great believer in
learning from today's experience -
13:17 - 13:20to make tomorrow a better place.
-
13:20 - 13:22That tomorrow, every morning,
when you get up, -
13:22 - 13:24it's the start of a new journey.
-
13:24 - 13:26So, where to now?
-
13:26 - 13:30Where to when we stand back and look
at 20 years of our work -- -
13:30 - 13:32Where to next?
-
13:33 - 13:37I had this idea that when I was
chasing scar-less healing, -
13:37 - 13:39having seen that boy in 1985.
-
13:39 - 13:40I would get to the top of the mountain,
-
13:40 - 13:4220 years more no trouble,
-
13:42 - 13:44we plant the flag
at the top of the mountain, -
13:44 - 13:47but my goodness,
I was wrong. -
13:47 - 13:48Because as we've changed
the goalpost, -
13:48 - 13:51people survive more and more
and more massive injuries. -
13:51 - 13:56And we're chasing that illusive goal
for more complex situations. -
13:56 - 14:00And so I put it to you:
yes, we've got the cells in the right place, -
14:00 - 14:02but where to next?
-
14:02 - 14:08What create, what self-organizing
systems makes me this shape? -
14:08 - 14:09Recognizable through life,
-
14:09 - 14:11a little bit bigger,
a little bit smaller. -
14:11 - 14:14But essentially recognizable
through life. -
14:14 - 14:16From the embryo to death?
-
14:16 - 14:20What self-organizes this systems?
Well, we started looking. -
14:20 - 14:24We understand
that if you are burnt here, -
14:24 - 14:28the nerve density
in the nerves of the scar -
14:28 - 14:31and on the non-scarred
matched area are the same. -
14:31 - 14:33They're both decreased.
-
14:33 - 14:35I know that if you have a burn,
-
14:35 - 14:42in your right upper limb, the patterning
of your left brain has changed. -
14:42 - 14:43So where to next?
-
14:43 - 14:45We've got the cells in the place.
-
14:45 - 14:47We've got the architectural frameworks,
-
14:47 - 14:51as I work with colleagues in nanotechnology
looking at self-assembly, -
14:51 - 14:54a framework such that the cells
can express themselves -
14:54 - 14:56through an appropriate phenotype.
-
14:56 - 15:00Such as not only can we seal
the surface, giving life, -
15:00 - 15:05but that we can develop
the underlayers of the skin, -
15:05 - 15:08which give the quality of life.
-
15:08 - 15:10Then we can organize,
-
15:10 - 15:14we can self-organize
back to the original shape -
15:14 - 15:17And is the 3-dimensional spacial information
for that original shape -
15:17 - 15:21actually housed in
the homunculus in the brain? -
15:21 - 15:24I know also,
from personal experience, -
15:24 - 15:28when I was being scanned,
the day after I had a tooth out -
15:28 - 15:32that the pain blunts
and changes the neuro-plasticity -
15:32 - 15:35such that the patterning
is lost temporarily. -
15:35 - 15:38How can we with visualization,
-
15:38 - 15:41with active stimulation,
-
15:41 - 15:43think ourselves whole?
-
15:43 - 15:45We put the cells in place,
-
15:45 - 15:47the framework in place,
-
15:47 - 15:50but there are so many things
we need to do. -
15:50 - 15:52But that's an 18-minutes in the future.
-
15:52 - 15:54Thank you very much indeed.
-
15:54 - 15:57(Applause)
- Title:
- Repairing burn wounds through skin regeneration: Fiona Wood at TEDxFlanders
- Description:
-
Fiona Wood's journey of 3 decades treating burn injury, bringing basic science to the bedside focusing on helping people whose lives have changed in an instant, making sure the quality of the outcome is worth the pain of survival.
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDxTalks
- Duration:
- 15:58
Els De Keyser approved English subtitles for Repairing burn wounds through skin regeneration: Fiona Wood at TEDxFlanders | ||
Els De Keyser edited English subtitles for Repairing burn wounds through skin regeneration: Fiona Wood at TEDxFlanders | ||
Els De Keyser edited English subtitles for Repairing burn wounds through skin regeneration: Fiona Wood at TEDxFlanders | ||
Lena Capa accepted English subtitles for Repairing burn wounds through skin regeneration: Fiona Wood at TEDxFlanders | ||
Lena Capa edited English subtitles for Repairing burn wounds through skin regeneration: Fiona Wood at TEDxFlanders | ||
Lena Capa edited English subtitles for Repairing burn wounds through skin regeneration: Fiona Wood at TEDxFlanders | ||
Lena Capa edited English subtitles for Repairing burn wounds through skin regeneration: Fiona Wood at TEDxFlanders | ||
Lena Capa edited English subtitles for Repairing burn wounds through skin regeneration: Fiona Wood at TEDxFlanders |