How Fiona Wood Changed the Way We Treat Severe Burn Victims
A look at how Perth's Dr Fiona Wood treated Bali Bombing victims with her then-experimental "spray on skin" and saved nearly all.
As part of International Women's Day we're celebrating women around Australia. This article is part of that series.
The medical profession has long regarded severe burns as a mostly irreversible injury. Until recently, many burn victims wouldn't even survive. Those who did would be left with horrific scarring. But that all changed when, in the early 1990s, one woman came up with an experimental technique that would save the lives of those who had had their skin burned off. She called it spray-on skin.
Today, Fiona Wood is the only person I know who, by sheer force of character, can compel exhausted medical students like myself to put down our phones and listen.
As I'm ushered into her office at Fiona Stanley Hospital in Perth, Wood greets me with a wry English joke. Born in a Yorkshire mining village in 1958, the power of education was instilled in her from a young age. Learning was something her parents (a coal miner and a teacher) valued highly, and in high school she was encouraged to question everything "not as a criticism, but as an opportunity to nudge things forward." She originally wanted to be an Olympic runner but after that didn't work out, she was drawn towards medicine.
It was at the Queen Victoria Hospital in West Sussex, where Wood (then a junior surgeon in training) first came into contact with burns patients. "I was looking at the scarring and the devastation in people's lives and thinking, 'Could I actually change that? Could I change that person's life trajectory?'"
What I'm going to do is learn as much as I can right here, right now so I can change as much as I can going forward.
The first part of her journey from novice to pioneer was not easy, and the catalyst was a case that almost made her give up. In 1992, she was confronted by a high school teacher who had been burned in an explosion. "A 29-year-old with 90 percent burns," she says, her voice becoming much quieter. "I thought I'd done a good job and then he got polyneuropathy (nerve deterioration) and became critically ill. He was paralysed and had to spend nine months in rehabilitation. I thought 'I'm not cut out for this. I can't do it.'"
After a few days, she had a change of heart and decided to use the experience as an opportunity to learn. At that time the treatment options for burns victims included using swaths of unburned skin grafts from the patient (which is a fast and reliable technique but it also requires a lot of skin and causes scarring) or to artificially grow skin—either from a donor or from a patient's own cells. The latter option took two weeks and could leave the patient at risk of infection as their exposed tissue cultivated bacteria.
This is why in 1993, Wood and her colleague, Marie Stoner, began to work on an idea that would eventually become spray-on skin. Instead of growing the skin tissue in a culture flask, they decided to grow the skin directly on the patient, cutting the healing time down from weeks to days. But after failed efforts to line gloves with skin or to attach cells under an adhesive dressing, one exasperated researcher said to the other, "Jeez you know, we should just spray this stuff on." It was a throwaway suggestion, but in that moment they knew it was the way forward.
They called their product ReCell, and it worked by taking a small amount of healthy skin from a patient, dissolving the structures holding the cells together with an enzyme and spraying the resultant solution over the affected area. It soon became a standard part of Wood's practice, but it wasn't until a terrorist attack in 2002 that anyone outside the medical community really took notice.
On October 12, the Islamic extremist group Jemaah Islamiyah detonated two bombs in the Bali tourist area of Kuta, resulting in 202 deaths and countless injuries. Twenty-eight of the most gravely injured victims, some with burns covering 90 percent of their bodies, were airlifted to Royal Perth Hospital for urgent treatment. As head of the hospital's burns unit, it was Wood's job to coordinate four operating theatres—19 surgeons and 140 medical staff—as well as using her own skills to help save the lives of 25 people.
When I ask her about incident, her reply catches me off guard. "I sense that you ask me the question because you think that incident might have been different from normal. Yes, the hospital was full. Yes, there was a level of intensity and there were burn patients who needed treatment but there was also an element of that's what we do and business as usual."
At that time spray-on skin hadn't been exposed to the full gamut of clinical trials, and as some critics would later point out, was still in an "experimental" stage. Despite this, Wood decided to use ReCell on the most severely burned. "You have to be pragmatic," she says. "There's no mileage in being churlish and saying 'I'm not doing this because it's on the back of a devastating event. Instead what I'm going to do is learn as much as I can right here right now so I can change as much as I can going forward.'"
Royal Perth Hospital was the only one that used the treatment and Wood was later lauded for their reduced incidence of scarring. Three people died under her watch, which was tragic but also impressive considering the scale of carnage. Yet, post-Bali, there was some discussion from Wood's peers about the lack of clinical trials confirming ReCell's efficacy. Concord Hospital burns unit medical director Peter Maitz later told The Age, "Patients who come from a terrorist attack like Bali should not be subjected to an experimental procedure."
Ask her about this and Wood is quick to describe the body of evidence that existed in 2002 for her "logical" and "very low-risk" technology. These included tests on animal models, work using the skin graft donor site as a control wound and a comparison of treatments in randomised scald injuries—all of which demonstrated positive effects. But this wasn't the only source of controversy.
In the same year as the bombings, Wood and Stoner decided to commercialise their research, forming Clinical Cell Culture [it's since become Avita Medical]. What originally started out as a "splendid idea" soon got them into hot water over perceived profiteering from horrific injuries. While Avita Medical runs as a not-for-profit organisation in Western Australia, the cost of ReCell does vary worldwide. When I ask Wood about the ethics of making money from technology that could, if free, help thousands more, she acknowledges that it's a dilemma but argues it's difficult to make a difference without money.
Engaging in positivity and dismissing negativity appears to be Wood central philosophy. It takes her a long while to think of the worst part of her job. "The thing that irritates me is when people criticise without offering solutions to the problem," she says eventually. Not letting the "bastards get you down" as apparently her dad would say is also advice she would give her younger self. "I think I may have lost a bit of energy worrying about what people said. As you get more mature, criticism is less impactful. You kind of shrug it off."
Do I think I live in an environment where we have the capacity for genius? Yes. Do I think it's realised often enough? No.
Interestingly, it's this attitude that's influenced her current work. Her work revolves around harnessing positivity to aid recovery, she explains. With this premise in mind she's begun researching ways the brain responds to injury, in order to compliment or borrow certain mechanisms. Her research title even has a snappy title: "Can we think ourselves whole?"
Despite her zealous faith in science and evidence, her belief in positive thinking comes up more than once. It might go some distance to explain her energy (she has six children and still manages to plays sport), as well as her ability to solve problems. I ask her if she considers herself a genius.
"Do I think I'm a genius?" she contemplates. "No. Do I think I live in an environment where we have the capacity for genius? Yes. Do I think it's realised often enough? No. I think part of that is our belief. We need to believe we live in an environment with a capacity for genius. To drive innovation. To change lives."
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