To coincide with Remembrance Sunday, Changing Faces spoke to Professor Steven Jeffery, Consultant Plastic Surgeon and member of the British Burn Association
Well, last weekend was bonfire night. This is always the worst night for a plastic surgeon to be on call! I took a call at two in the morning that there was a 14 year old boy who had had a firework go off in his hand. I drove to the Birmingham Children’s Hospital and spent the next twelve hours operating on him to try to salvage the hand as his index finger and thumb had been blown nearly completely off. At the end of the operation both digits were back on and were pink. I then had to do a full day’s work at the adult hospital looking after several other firework injuries. Luckily when I eventually got to bed on Sunday night I managed to get an undisturbed night’s sleep!
What made you want to become a plastic surgeon?
I was training to be a military surgeon, so I had to work in all the various specialties in order to be able to operate on any part of the body. The last such job I did was in plastic surgery. I was particularly amazed to see that the surgical practice was very broad. The first patient on the operating list might be an old lady with a big skin cancer on the top of their head, the next might be an electrical burn to the leg, and the next patient might have a huge pressure sore. The variety of he practice, together with the instantaneous results – which are on show for the whole world to see – make this a rewarding speciality for me.
What does a soldier’s treatment involve that makes it different from general plastic surgery?
The complex injuries sustained by military personnel demand a highly organised and structured multi-disciplinary team (MDT) and inter-disciplinary team approach. Over the last ten years the Queen Elizabeth Hospital has become adept at managing the multiple specialties and their individual requirements through enhanced communication and planning. Twice daily theatre planning meetings are held as well as a weekly MDT meetings to discuss and coordinate trauma services and surgical plans. This also permits prioritisation of work and appropriate theatre scheduling to include civilian cases needing surgical intervention.
Once they are discharged from hospital they go on through rehabilitation. With some of the more severe injuries it is sometimes hard to speak to them about future employment. Injury will often result in loss of either function, cosmesis, employment, self-esteem or all four. This loss is usually followed by a grief reaction. Part of a typical grief reaction is to undergo a period of denial, and this is often the stage at which they are at while they are in hospital. Hopefully they will come to accept their changed appearance while in rehabilitation.
Have you only done plastic surgery on military personnel?
I work at the Queen Elizabeth Hospital, Birmingham and Birmingham Children’s Hospital. The vast majority of the patients I treat at the moment are actually civilian, as luckily our soldiers are not being injured in large numbers at the moment.
We don’t hear enough about the way that plastic surgery evolved during the first and second world wars. Would you agree?
‘Modern’ plastic surgery is thought to have evolved as a result of World War One. Harold Gillies developed many techniques which form the basis of the specialty today. This expansion in the specialty continued in World War Two, when Archibald McIndoe further developed techniques to deal with the injured airmen he was treating. He also pioneered the need to rehabilitate casualties and reintegrate them back into normal life.
The specialty has again evolved over the past ten years, as we have developed techniques which allow us to deal with the huge wounds that are now ‘survivable’ following combat injury due to advances in immediate medical care.
What are the hardest aspects of your job?
I hate to see badly injured children. This is particularly bad if you have a child of a similar age to the patient in front of you. One cannot help thinking that it might be your child lying there.
What are the most rewarding aspects of your job?
I love it when I know that I have made a difference to a patient’s life, whether that be by keeping them alive following a major burn injury, or by allowing them to return to work after a limb injury, or by giving them the confidence to go out of the house following a facial injury.
What would you tell your 25 year old self?
I would tell myself not to accept the status quo and to always strive to do things better. This is how I have tried to live my life. I would like to think that in 20 years time people will laugh at how we treat wounds today, as there will be much better ways of doing things. Much in the same way that we laugh now at surgeons in the past who used to treat every condition with leeches!
A final word on disfigurement?
Disfigurement affects different people in different ways, but it can have devastating effects on the ability of the patient to reintegrate back into society. The reason many burns units were initially built in the countryside was to keep the patients out of the view of the population. Sadly our media is obsessed with having perfect looks, and any deviation from this can cause upset. If only people could realise that beauty is a lot more than skin deep!
Professor Jeffery, thank you for talking to Changing Faces!
Biography: Professor Steven Jeffery BSc, MB ChB, FRCS, EBOPRAS, FRCS (Plast) is a Consultant Plastic Surgeon who specialises in the assessment and treatment of scarring, traumatic wounds, burns and pressure sores. He is a member of the British Burn Association, the International Society for Burn Injury and is a Patron to the charity RAFT. In 2011 he was awarded the Wounds UK ‘Key Contribution Award’, the Military Civilian Health Partnership award ‘Regular of the year’, and the Smith and Nephew Pioneer of the Year award.
Changing Faces is grateful to the Ministry of Defence for their assistance in the preparation of this post.