In this interview, RegMedNet talks to Mr Paul Hayes, Consultant Vascular Surgeon at Addenbrooke’s Hospital (Cambridge, UK) about the need for multidisciplinary working in chronic wound management, and the potential for regenerative therapies to improve patient outcomes.
Paul Hayes is a Lecturer in Surgery at the University of Cambridge, with an honorary contract at Addenbrooke’s Hospital. He trained in Aberdeen, and then Leicester before moving to Cambridge 10 years ago. Since his arrival in Cambridge he has led the leg ulcer service there, which now receives tertiary referrals from a wide geography. He has instituted a number of innovations and novel therapies, with the aim of using modern techniques and technology to benefit the patients under his care. The service has been featured on both BBC radio and television programs.
Consultant Vascular Surgeon at Addenbrooke’s Hospital (Cambridge, UK)
The challenge of chronic wounds
When he first arrived at Addenbrooke’s Hospital more than a decade ago, following a stint as a lecturer at Leicester University, he expected to be carrying out complex aortic surgeries, but was quickly brought to heel by being placed in the leg ulcer clinic. He was surprised to find that it is incredibly rewarding to treat patients with chronic, difficult-to-heal wounds: ‘They are the most grateful patients I treat as they’ve often lived with their condition for years.’
Venous leg ulcers are a common occurrence and Mr Hayes estimates that in vascular surgery they consume 10—20% of clinic time. The incidence accounts for approximately 1% of the US population as a whole , but this is increasing owing to an aging population and an increasing incidence of obesity . By the age of 80 years the incidence is approximately 8%. Ulcers have a huge impact on the quality of life of patients, but perhaps don’t receive the same attention as other health conditions.
‘I think they’re not always managed in an ideal setting,’ he said. ‘Unfortunately because of current economic constraints in the UK — and I suspect it holds true in other places — patients are held in the community where it’s perceived to be cheaper to treat them rather than send them to hospital where surgeons like myself use some expensive, novel therapy to heal the wound. But of course, that’s not actually true because being treated for 2 years in the community is far more expensive than a few trips to the hospital out-patient clinic, and get the wound healed in a couple of months. If acute wounds are referred into secondary care earlier, we could actually stop them becoming difficult to treat.’
While this earlier intervention, coupled with intervention by a multi-disciplinary team is imperative to prevent the progression of many patients to having large, difficult-to-heal wounds, it is also one of the main barriers to effective treatment coupled with a seeming lack of interest by those outside of the tissue viability setting.
‘Diabetes and diabetic foot ulcers have become a headline-grabbing condition, but other chronic wounds have not; we need to have a group of interested individuals who can be dedicated to the cause,’ argued Mr Hayes.
‘I think the diabetic foot setting has shown the benefit of multi-disciplinary teams and effective assessments. I also think that earlier use of advanced therapies to prevent the progression from an acute wound with a good chance of early healing to a chronic wound is imperative.’
Advanced therapies for improved healing
In his own research, Mr Hayes has been using just such an advanced therapy to treat venous leg ulcers, having evaluated the performance of ReGenerCellâ„¢ (Avita Medical) in healing compared with compression therapy, which is the mainstay of treatment.
‘ReGenerCellâ„¢ potentially changes the wound environment and kick-starts the healing process, through the use of a very minor surgical procedure that can be done in the out-patient setting,’ he said. ‘I think cell-based therapies are good, but I think a combination of some of these advanced therapies might be what we’re really looking for. Certainly for our chronic wound patients the blood supply to the limbs is often poor — if we can improve oxygenation I think that will also be important to improve healing trajectories.’
The main challenge with uptake of such therapies, however, goes back to the issue of multi-disciplinary working: ‘I perceive that the problem is that patients aren’t always getting access to those advanced therapies and that’s a big challenge — it’s breaking the cycle of weekly compression bandaging in the community and getting them referred in for a few weeks of specialist care.’
Indeed, Mr Hayes told us that something they are attempting at Addenbrooke’s Hospital is to build better relationships with community colleagues, by showcasing some of the research they have been doing in an attempt to show that there is something over and above a standard dressing. However, there remains a long way to go and there remains a need for follow-up studies of ReGenerCellâ„¢ in the treatment of chronic wounds.
1. Bergan JJ, Schmid-SchÃ¶nbein GW, Smith PD, Nicolaides AN, Boisseau MR, Eklof B. Chronic venous disease. N Engl J Med. 355(5),488—498 (2006)
2. Moffatt CJ, Franks PJ, Doherty DC, Martin R, Blewett R, Ross F. Prevalence of leg ulceration in a London population. QJM. 97(7):431—437 (2004)
Want to learn more? Read the report on the Skin Regeneration Symposium, or our interview on translating research to improve outcomes in wound care and oncology with Dr Nik Georgopoulos.
This interview is supported by Avita Medical.