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Dr Fiona Wood was interviewed in 2008 for the Interviews with Australian scientists series. By viewing the interviews in this series, or reading the transcripts and extracts, your students can begin to appreciate Australia's contribution to the growth of scientific knowledge.
The following summary of Wood's career sets the context for the extract chosen for these teachers’ notes. The extract discusses her search for a new ‘gold standard’ in the healing of skin after a burn. Use the focus questions that accompany the extract to promote discussion among your students.
Fiona Wood was born in Yorkshire, England, in 1958. She studied at St Thomas’ Hospital Medical School in London and received a BSc in 1978 and an MB BS in 1981. During her studies she became interested in surgery, particularly plastic and reconstructive surgery. She worked as a senior house officer and registrar in various surgery disciplines in hospitals in London and Sheffield and became a Fellow of the Royal College of Surgeons (London and Edinburgh) in 1985.
In 1987 Wood moved to Perth. She continued her medical training in surgery and plastic surgery at hospitals including the Sir Charles Gairdner Hospital, the Princess Margaret Hospital for Children, the Repatriation Hospital and Royal Perth Hospital. She became a Fellow of the Royal Australasian College of Surgeons in Plastic and Reconstructive Surgery in 1990.
Wood became a consultant plastic surgeon in 1991 and her interests focused on burns care and reconstruction. Also in 1991 she became the director of the Burn Service of Western Australia. In 1992, after treating a patient with burns to 90 per cent of his body using an emerging US-invented technology of cultured skin, Wood was inspired to research how to help heal burns more quickly as a means to reduce scarring. She and scientist Marie Stoner began exploring tissue engineering, starting with growing sheets of skin and then developing ‘spray on’ skin. Wood and Stoner co-founded the McComb Foundation in 1999 to research and develop innovative tissue engineering technologies. Clinical Cell Culture Pty Ltd (now Avita Medical) was established in 2000 to commercialise technologies emerging from the McComb Foundation. Ground-breaking technology developed by Wood and Stoner was used to treat the devastating burns suffered by people in the Bali bombings of 2002.
In addition to her work with the McComb Foundation, Wood currently holds positions as director of the West Australian Burns Service, consultant plastic surgeon of Royal Perth Hospital and Princess Margaret Hospital for Children and professor in the Burn Injury Research Unit at the University of Western Australia. She is also involved in a number of educational and disaster response programs.
Wood has received numerous awards including the Clunies Ross Award (with Stoner, 2005), the Australian Medical Association’s Contribution to Medicine Award (2003) and Doctor of Letters from the University of Western Australia (2004). In 2003 she was honoured with a Member the Order of Australia (AM) award for her work with the Bali bombing. She was Western Australia’s Australian of the Year in both 2004 and 2005 and was named Australian of the Year in 2005.
The search for a new ‘gold standard’ in healing
I talked earlier about a bifurcation [in plastic surgery specialists]: the major reconstruction people versus the bouffant-hair ones who’d like to do the noses and the breasts. But there’s also another kind of bifurcation, in that surgeons notoriously like to ‘do’ but not to find out ‘why’ or to research. The research tradition is not strong in surgery.
I’d have to say you’re right, unfortunately. But I’m doing my very best to engage the surgeons and get people interested. My colleague, Suzanne Rea – who is going to be submitting her PhD on the bone marrow work that she has done – has been a consultant with me now for four years. Also, we’ve got medical students coming through and I’m very keen that they understand that they can actually change the way we think and the way we practise. I don’t believe that we will be practising simple skin grafting into the future. We need to think beyond, ‘Is that as good as we can get?’ We have to get better, as skin grafts cannot be the universal gold standard. Every skin graft I have ever done, however nicely I’ve been able to do it, has left a scar. The gold standard has to be the skin of that area of that person at that time of their life. Anything less means we will jump the hurdle with relative ease. We’ve got to raise the bar. We’ve got to bring our med students into the understanding that they don’t have to believe all they are told. They can actually go out there and find out things that are new, that are novel, that can change people’s lives in an innovative way.
Did you have somebody who taught you that?
Piecing it together, yes. I have been really fortunate in some of the surgeons I have met along the way. In particular, Harold McComb, more latterly as I came to Australia, taught me that however mature one is in one’s career – and he’s well in his 80s now – one can always think of doing it better. And one should never think today is as good as it gets. I think he had that very clear in his mind, as he was a great cleft surgeon. (That is where I worked with him, in cleft lip and palate work.) He advocated the maintenance of that interest in the subject through to way, way into your career, to make sure that you’re learning how to do it better tomorrow, always better consolidating, doing a series of cases, investigating them and analysing them and coming back or working out how to do it better. That’s what I hope to instil in a few – in many, I don’t know, in one? [laugh] – because it’s really important not to believe that today’s treatment is good enough. If we do that, we just all sink into mediocrity.
What is the bone marrow work?
It is looking at where the cells come from that heal the wound. The traditional thoughts were that the healing came from the adnexal structures of the skin, and that when that was overwhelmed you had to reintroduce skin, in terms of skin grafting or of things like the skin cells that we spray. But we’ve demonstrated that there’s a significant introduction into the wounds not just of inflammatory cells but of mesenchymal cells from the bone marrow.
So, cells like stem cells?
Yes, maybe. Interestingly, however, in our animal work those are not maintained over the long term, not beyond 120 days. We are now looking at biopsy work in our burns patients to see if we can understand what is happening, to see if it is really maintained or not.
Some work has come from looking at when our patients don’t survive. Patients that don’t survive come in three groups – almost in equal thirds. We analyse that very intensively, trying to work out how we could do better.
The first group of people we can’t even start to treat. The injury is so overwhelming that it’s beyond technology as we have it here, right now. Then there’s a group where we try, but by the end of about five to seven days it’s very obvious that the injury is overwhelming and we’re not going to be able to ensure survival in that individual.
But then there’s a third group, who survive for about three months. Sometimes it’s a matter of nutrition, sometimes it’s infection, sometimes it’s a race against time to close the skin integrity while the waves of infection keep coming over. And in those people the question we raised was, ‘Is it bone marrow failure? Is it because the bone marrow cannot respond?’ We know patients are immunocompromised, but is it simply an immunocompromise or is the bone marrow being overwhelmed? So we’ve gone back, and we’re working with other groups as well, looking at the quality of the survival.
Is it regenerative collapse?
Yes. Is it that we’re just stressing this system too much? Might there be other workplaces we can learn from – people treating HIV, for instance – that support bone marrow in a different way?
An edited transcript of the full interview can be found at http://www.science.org.au/node/325814.
Focus questions
Select activities that are most appropriate for your lesson plan or add your own. You can also encourage students to identify key issues in the preceding extract and devise their own questions or topics for discussion.
burns
immunocompromised
scarring
skin graft
stem cells
wound healing
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