annual report - O'Brien Institute

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L-R Dr Kevin Cronin, Research Fellow from Ireland working under the operating microscope with the assistance of Sue McKay and Liliana Pepe L-R Rosalind Romeo, Laboratory Manager, working in the Histopathology Laboratory with Dr Bruce Dowsing, Senior Research Officer, watched by Chantelle Sauza, work experience student from St Columba’s College, Essendon. We are indebted to: Mr Barry O’Callaghan and staff from Corrs Chambers Westgarth and Mr Michael Gainger and staff from KPMG for their advice on the affairs of the Foundation. Bernard O’Brien Institute of Microsurgery is supported by Microsurgery Foundation. Public appreciation of the work of the Institute and its plastic and reconstructive surgery and hand surgery team at St. Vincent’s Hospital is mainly through the reattachment of amputated body parts. Less well known is its sophisticated and expert microsurgical reconstruction of patients after the surgical removal of cancers from breasts, head and neck, skin and bone. Surgeons from around the world train at the Institute then return to their own countries to adapt these new techniques for use. Affiliations Affiliated with The University of Melbourne and Monash University, Bernard O’Brien Institute of Microsurgery is a recognised body in education, laboratory teaching and research. Our students are enrolled for Honours in Bachelor of Science, Master of Surgery, Master of Science and PhD in fields such as nerve repair, wound and tendon healing, tissue engineering. Barbara Walker Centre for Pain Management This unit had a pleasing year of progress and success, conducting medical research to improve clinical outcomes for persons currently experiencing acute and chronic pain and the development of early rehabilitation programs for the prevention of pain, together with educational programs for medical practitioners. An agreement was signed with the Commonwealth Department of Health and Aged Care to treat public patients who have exhausted all other options in their pain management treatment. Promotion of the Centre’s activities to medical practitioners saw a rapid increase in the level of clinical activity. We have treated over 1,000 patients, with more than half being seen for the first time. The innovative START program has so far involved 65 graduates. The program provides profound and lasting improvements to pain sufferers. Our success has been recognised by the Federal Government. Scientific Research, Technology and Innovation Major areas of activity this year were in Tissue Engineering, Extracorporeal Circulation, Nerve Regeneration, Scar Formation, Skin, Tendon and Nerve Healing, Basic Science Mechanism, Stem Cell Growth Development A generous grant funded the appointment of a Development Manager to generate new funding opportunities and enable the organisation to sustain momentum in its research programs. MICROSURGERY FOUNDATION Inspiring Progress To continue microsurgery research and develop new surgical procedures and management programs, we seek your continued participation and financial support. Please assist us in achieving the mission of the Microsurgery Foundation. Ronald J Walker AO CBE CHAIRMAN Alan Skurrie The Microsurgery Foundation and Bernard O’Brien Institute of Microsurgery owe an enormous debt to Mr Alan Skurrie who retired from the Board in June. As a Board member with 20 years of service Alan Skurrie’s contribution to the affairs of the Foundation has been outstanding. His thoughtful and wise counsel, particularly on financial matters has been of great benefit to the organisation. As Chairman of the Microsurgery Foundation between 1985 -1992 Alan provided incisive leadership and support to the late Bernard O’Brien and Professor Wayne Morrison as they built the Institute into what has become the world’s pre-eminent centre of microsurgery training and research. He provided wise and strategic leadership and forged new relationships that enhanced microsurgery research and training. As a leading Australian businessman Alan was instrumental in fundraising on behalf of the Foundation, particularly from the corporate sector. The secure flow of funds into the Foundation enabled the pioneering research and training activities to continue unrestricted. The Microsurgery Foundation and Bernard O’Brien Institute of Microsurgery sincerely thank Alan Skurrie for the contribution that he has made to advance the cause of medical research through microsurgery. We are indeed in his debt. 28 13
Overview Bernard O’Brien Institute of Microsurgery What is Microsurgery Research Microsurgery literally means operating through a microscope. In our field of Plastic and Reconstructive Surgery we use the microscope to connect small blood vessels (microsurgery) for the purpose of restoring circulation to amputated parts (replantation), or to tissues or parts that have been transferred from some other parts of the body (transplantation) such as skin, muscle, bones, joints, toes, etc. This experimental research is widely applied to clinical reconstructive microsurgery in trauma, cancer, burns and congenital abnormalities. This spectrum of activity covers all ages from infancy to the elderly and illustrates one of the most important developments in modern surgery. Currently we can join 0.5 mm diameter blood vessels using stitches one half the thickness of a human hair but there is still a risk that these vessels will clot off. When the circulation to a tissue is reduced or ceases a condition known as ischaemia, that tissue will atrophy or die occurs. The most familiar example of this is an ischaemic heart attack, but the same process occurs in strokes and gangrene of the limbs. At the Bernard O’Brien Institute of Microsurgery we are involved in research to understand the normal process of blood flow and factors which decrease it (ischaemia) or enhance it (angiogenesis). This will lead to new ways of reducing the effect of injury to tissues and to safer and more effective techniques of replantation, tissue transplants and even storage of tissue in tissue banks. By a better understanding of the process of blood flow and new blood vessel formation we will be able to help wounds heal, especially chronic ulcers, and be able to promote and manipulate the growth of tissues so that new parts can be manufactured in the body. This process has been termed “tissue engineering” and we have recently used this technique in humans to grow new ears and noses. Cancer growth and spread is dependent on new blood vessels and by understanding how this process works we can potentially inhibit new blood vessel formation. In breast cancer and melanoma models in mice we have been able to manipulate the cancer growth by using drugs which have shown to be important in switching on and off the angiogenic process. Following trauma nerves as well as blood vessels are commonly injured and microsurgery is used to repair them. Nerves which function in a very similar way to electric cables are composed of long fibres which are direct extensions from the nerve cells housed in the spinal cord. When a nerve is cut in the same way that tadpoles’ tails regrow, so too the nerve will grow out again from its point of injury. We are experimenting with ways to enhance the outgrowth of nerves following injury, particularly using a special growth factor “Leukaemia inhibitory Factor”. The work undertaken at Bernard O’Brien Institute Microsurgery is broadly based and links many surgical disciplines and areas of applied science. Much collaborative work is in progress with other research institutes, both in Australia and overseas. Plastic and Reconstructive Surgery Unit The Plastic and Reconstructive Surgery Unit at St Vincent’s continues to be a leader in its field with 1,483 patients having been admitted for treatment. The majority of these patients required surgery and of these, 479 were emergency patients with 429 requiring surgery from injuries caused by accidents. There were 31 replantation cases, the majority being fingers but also including a whole arm. 77 vascularised free tissue transfers were used for the reconstruction of major deformities, 30 of which were for head and neck cancer, 20 breast reconstructions and 17 for trauma. In all, 53% of cases involved the hand or an upper limb, 31% general plastic surgery and the balance including facial, head and neck and burns reconstruction. The Research Fellows from the Bernard O’Brien Institute of Microsurgery continue to be an integral part of our surgical teams and play an important role in the many difficult procedures that are undertaken by the Plastic and Reconstructive Unit at St Vincent’s. We are indeed indebted to the staff of the Plastic Surgery Unit at St Vincent’s Hospital for their help throughout the year. Professor Allan MacLeod many ‘genetically engineered’ mice available worldwide to answer crucial questions as to the molecules involved in angiogenesis. In the tissue culture laboratory we are currently investigating how nitric oxide (NO) regulates angiogenesis. We have recently established another model of angiogenesis in our laboratory. Pieces of vascular tissue are placed in a special gel in cell culture plates, and new blood vessel growth is observed over a 2 week period. We are now about to test NO donors and inhibitors to observe their effect on vessel growth. In addition, we will test tissue from iNOS-/- mice to see if lack of NO via a genetic alteration confers different rates of vessel growth. Haemangioma Research We have begun examining the causes of haemangiomas, which occur when blood vessels spontaneously grow out of control. They are known to contain high levels of inflammatory cells such as mast cells. We have found that when these haemangiomas are placed in culture and exposed to FDA-approved. Lodoxamide, a mast cell stabiliser, there is regression of blood vessel growth. Mirna Boujaoude, PhD student, has recently joined our group and is involved in these studies, together with surgical fellows Drs. Tony Penington and Robert Donato. Engineering new blood vessels Another problem encountered by reconstructive surgeons is a lack of healthy blood vessels for use in repairing damaged tissues in trauma and cancer related reconstruction. We are trying to create a ‘bank’ of ready-to-use blood vessels that can be stored and taken “off the shelf” when required for reconstructive surgery. We have found that during storage blood vessels lose their internal lining of cells, which are essential for proper blood vessel function, particularly to stop blood clotting within the blood vessel. Therefore another tissue engineering project currently underway is investigating ways to restore these internal lining cells in stored blood vessels. Rabbit Stent Model Every year millions of Australians undergo heart bypass surgery. This involves replacing the blood vessels that supply the heart itself with new vessels taken either from the leg or the arm. The short-term success of this procedure is well documented however 10 years later 50% of these patients need to have the MICROSURGERY FOUNDATION procedure repeated because the new vessels themselves become narrowed and occlude. We have developed a model in a rabbit where a polyester stent is wrapped around an implanted vessel in the groin and shown that the narrowing of the blood vessel over time is reduced. Further studies are needed but clinical implications are significant. 14 27
Page 1 and 2: For the betterment of humanity MICR
Page 3 and 4: Restoring people’s confidence, ho
Page 5 and 6: 2000 Microsurgery Annual Report Cli
Page 7 and 8: CASE 2 John McKinnon Hope Fatherhoo
Page 9 and 10: CASE 3 Martin Turner Identity Commu
Page 11 and 12: Collaborators Bernard O’Brien Ins
Page 13 and 14: Patrons Microsurgery Foundation Pat
Page 15: Chairman’s Report Microsurgery Fo
Page 19 and 20: Many other research topics are bein
Page 21 and 22: Barbara Walker Centre for Pain Mana
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annual report - O'Brien Institute

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