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Working for the wounded

Working for the wounded

ARTICLES

16 Oct, 2019

The Scar Free Foundation recently announced its conflict wound research priorities and launched a call for pilot studies to address these vital areas. If you or someone you know has been affected by this issue, read on to find out about the valuable work of this very special organisation – and some of those it has already helped

The Scar Free Foundation

Medical research charity, The Scar Free Foundation, recently announced its key research priorities to achieve scar-free healing within a generation for survivors of conflict wounds. These encompass three main themes:

1. acute wound care and diagnosis
2. the biology of scarring
3. life-long scar impact, revision and rehabilitation.

It is also launching a call for applications to conduct pilot studies to address these vital areas.

As part of the Foundation’s grant from the Chancellor using LIBOR funds to establish The Scar Free Foundation Centre for Conflict Wound Research – the world’s first specialist military and civilian conflict wound research centre – an initial £150,000 has been made available to support pilot or feasibility studies, which have the potential to be developed into larger-scale research programmes with higher awards from the Foundation and other funders. 

The effects of scarring

Scarring can have a significant long-term physical and psychological impact on survivors of conflict. More than 6,000 members of the British Armed Forces have been seriously injured or scarred in recent conflicts.* It is anticipated that future conflicts will be conducted in unpredictable, potentially austere and heavily contested spaces, and are expected to involve more lengthy evacuations than those experienced in Iraq and Afghanistan. In addition to gun shot and blast injuries seen in combat, it is likely that the emergence of new weapons, will result in far more burns casualties.

How research is helping

The research priorities are the result of the Foundation’s Conflict Wound Research Symposium, held at The Scar Free Foundation Centre for Conflict Wound Research, a ground-breaking national facility based at Queen Elizabeth Hospital in Birmingham. The symposium took place in May, and was attended by 84 researchers, clinicians, military veterans from the CASEVAC Club (see ‘Factfile’), as well as senior Armed Forces personnel from the UK and the USA, along with representatives from military support charities.

The centre’s main aim is to minimise the psychological and physical impact of scarring and limb loss among Armed Forces personnel injured in service and civilians wounded in terrorist attacks, and the work carried out is actively supported by senior Armed Forces personnel including the Chief of the Defence Staff, Chief of Defence People and the Surgeon General. The research undertaken at the Centre is part of the Foundation’s longer-term strategy to achieve scar-free healing within a generation.

Applicants will be asked to submit projects of up to 12 months in length. The Foundation’s intention is to fund up to three projects of up to £50,000, however if a larger project is submitted of sufficient merit which ‘cross cuts’ several of the priority areas, it is possible a larger funding request will be considered. Applicants will be asked to send project outlines (a one-page summary for discussion and recommendation), prior to submitting a full application.

Brendan Eley, chief executive of the Scar Free Foundation, comments: ‘To ensure our work is at the forefront of scarring research, it is crucial that we collaborate with a wide network of academic researchers, clinicians, military veterans and serving personnel to establish the future needs of those surviving conflict wounds – both in military and civilian scenarios. Scarring not only has a lasting physical effect, but can also have a serious impact on survivors’ mental health long after the wounds themselves have healed. We welcome applications for pilot studies to help us take the next step in our journey to deliver scar-free healing within a generation.’

Dave Henson, co-founder of the CASEVAC Club, says: ‘The membership of the CASEVAC Club comprises unexpected survivors – those that, by right, should have died on the battlefield. For many, surviving wounds of their severity is unheard of and new to medical science. We are actively engaging with this research because the knowledge that can be gained will provide insights that can increase the likelihood of more unexpected survivals in the future, and improve the outcome for survivors of traumatic injury in general.’

The research priorities in depth

Theme 1: Acute wound care and diagnosis

(Development of therapies and diagnostic tools that are appropriate for treating acute injuries sustained in austere conflict environments, where risks of contamination, extremes of temperature, and transportability are all factors.)

  • What tools or protocols could be developed to assist the objective assessment, rapid diagnosis and categorisation of conflict wounds?
  • What steps can be taken to mitigate secondary injury prior to casualty recovery from conflict zones – for example, tools to aid the detection of sepsis?
  • What treatments, such as ‘anti-scarring’ wound dressings, should be developed for use in austere conflict and humanitarian environments?
  • Considering the possible nature and environment of future conflicts, which models would best inform acute wound care research?

Theme 2: The biology of scarring

(To better inform new treatments by understanding how the body heals and protects itself following the types of trauma that are likely in future conflicts, including chemical, burn and complex blast injury.)

  • What is the best suite of models to investigate high-energy complex injuries?
  • What can we learn from other fields either for therapeutics or the understanding/monitoring of biology – for example, imaging and bioengineering?
  • What work should be undertaken to develop our understanding of the wound bio-membrane?
  • How can we understand the long-term effects of relevant injuries – for example, accelerated ageing and the influence of psychology on biology?

Theme 3: Life-long scar impact, revision and rehabilitation

(Improvement of therapies for seriously injured Armed Forces personnel and veterans to reduce and correct scars, and to promote resilience to the psychological impact of their disfiguring injuries.)

  • How do we ensure the best psychosocial outcomes for military personnel with conflict injuries that have altered their appearance, and for their families?
  • What is the physiological, life-long impact of limb amputation and prosthetic use?
  • What is the role of physiotherapy and other treatments such as laser therapy in breaking down disabling, internal scar tissue and supporting return to function?

Find out more

Web: https://scarfree.org.uk
Twitter: @scarfreeworld, @CASEVAC_club

FACTFILE

The Scar Free Foundation – www.scarfree.org.uk

The Scar Free Foundation is a medical research charity, chaired by Professor Sir Bruce Keogh (former national medical director of NHS England), whose mission is to achieve scar-free healing within a generation and transform the lives of those affected by disfiguring conditions. Founded in 1999 as the Healing Foundation, it has supported more than £20 million of life-changing research into wound healing and reconstructive surgery.

The Scar Free Foundation Centre for Conflict Wound Research

The Scar Free Foundation Centre for Conflict Wound Research forms part of the Foundation’s national Scar Free Strategy aimed at delivering new scar-free treatments within a generation. The Centre has been established in partnership with the University of Birmingham, University Hospitals Birmingham NHS Foundation Trust, the Centre for Appearance Research at the University of the West of England, and the CASEVAC Club. Crucially, the centre is closely integrated with a wider network of academic and clinical institutions in the UK and beyond to ensure that the work is inclusive and at the forefront of scarring research.

Research undertaken at The Scar Free Foundation Centre will cost £4.8 million over three years. This is being funded by the Chancellor using LIBOR funds of £3 million – the largest grant announced in the final round of LIBOR funding – alongside an additional £1.8 million from the Foundation’s partners, including the Ana Leaf Foundation and JP Moulton Charitable Foundation. 

The CASEVAC Club

The CASEVAC Club is an organisation set up by and for Armed Forces personnel wounded in recent conflicts. The Club, based on WW2’s the Guinea Pig Club, aims to assist in the advancement of medical science and treatments for all, help others experiencing traumatic injury and provide wounded personnel with a close-knit community. Members of the CASEVAC Club are working closely with The Scar Free Foundation Centre for Conflict Wound Research.

Members of the CASEVAC Club
(including Josh Boggi, third left, and Karl Hinett, second right)

CASE STUDIES

Jaco Van Gass 

South African-born Jaco van Gass was a member of the British Armed Forces Parachute Regiment. During his second tour of Afghanistan in 2009 he was hit by a rocket-propelled grenade and sustained severe life-changing injuries: the loss of his left hand and lower arm, a collapsed lung, shrapnel wounds to his left side, punctured internal organs, blast wounds to upper thigh, a broken tibia and a fractured knee. Jaco had 11 operations and underwent intense rehabilitation.

The injuries also caused complications further down the line. Jaco became ill while on an expedition in Chile, with severe pain when he ate. His first suspicion was trapped wind, then a pulled muscled or a bruised rib. On returning to the UK it was identified as an abdominal cyst due to a piece of shrapnel that had remained in his body, and treated accordingly. ‘I then had to deal with an open wound for five or six weeks.’ The shrapnel came from the blast wound to his thigh.

Since then, Jaco has overcome the physical and mental trauma to become a professional sportsperson. He is a mountaineer, cyclist, downhill skier and marathon runner. More recently, he has been a member of the GB Para-Cycling team, competing internationally at the World Championships in 2013, 2014 and 2015. He has become a national champion cyclist on the road multiple times.

‘Scarring is something you’ve always got to look after. I’ve got quite a bit of scarring and skin grafts, and I do quite a bit to take care of them. When I’m away on an expedition I can see the skin slightly deteriorating because I can’t look after it as well as I can at home. Moisturising it keeps it soft and supple. So I would welcome research to improve treatments for scarred skin and skin grafts – anything to make the skin heal better.’

Karl Hinett

Karl Hinett, from Dudley, was a 19-year-old soldier serving in Iraq with the Staffordshire Regiment when his life changed for ever on 19 September 2005. Supporting an operation to rescue two British soldiers in a Basra police station, a riot broke out and his Warrior tank’s viewing sights were shattered by insurgents throwing bricks. This forced the crew to open their hatches to see outside and one of the mob then threw a Molotov cocktail, drenching Karl in burning petrol.

Karl suffered burns affecting 37% of his body. His recovery included 50 operations over five years. Following another major operation in 2010, he began running marathons as part of his recovery. This soon became much more than a hobby when he decided to dedicate the next few years of his life to fundraising for fellow wounded Service personnel and Queen Elizabeth Hospital. He has since completed more than 100 marathons and raised in excess of £30,000. As well as being a motivational speaker, Karl is a trained gym instructor and hopes to teach geography in the future.

‘I am so much more appreciative of my life. I take chances and want to experience more. I have truly found out the human body has almost no limits when being pushed. I hope that my challenge might just encourage others to take a step outside that comfort zone and see what they can achieve.’ 

Josh Boggi

On New Year’s Eve 2010, two months into his third tour of Afghanistan, Corporal Josh Boggi stepped on an IED. When he woke up seven days later in intensive care at the Queen Elizabeth Hospital, Birmingham, he learned he had broken his back, both his legs were gone and his right arm would have to be amputated. ‘I had to accept that my life had changed for good immediately, and that wasn’t easy.’

A few weeks later, Josh met a wounded man on prosthetic legs in the hospital. While Josh had been told about prosthetics and what they could help him achieve, it made a huge difference to see someone walking around with them.

Nowadays Josh doesn’t wish to be seen as different from anyone else – he wants to be able to get on with life as normal and to be the best father he can be to his little boy. Josh loves being able to take his son to the zoo, or take him out in the garden to play on his climbing frame. He has always been passionate about football and misses being able to play. However since being injured he has obtained coaching qualifications and now helps to manage the local team he used to play for.

 

* There were 838 seriously or very seriously injured or wounded battlefield casualties recorded by NOTICAS from 2001–2014 across Operations TELIC (Iraq) and Herrick (Afghanistan), and 6,326 veterans received compensation between 6 April 2005 and 31 March 2017 through the Armed Forces Compensation Scheme, due to injury, wounds and scarring.

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