EUROPEAN  TISSUE  REPAIR  SOCIETY

AN INTRODUCTION TO THE BLOND MCINDOE CENTRE
Queen Victoria Hospital, East Grimstead, and the Blond McIndoe Laboratories at the Royal Free
and University College Medical School, London
Dr Robin Martin

The Blond McIndoe Centre, based at the Queen Victoria Hospital East Grinstead was opened in 1961. In 1999 it expanded to include the Blond McIndoe Laboratories at the Royal Free and University College Medical School, London.
A medical research charitable trust (The East Grinstead Medical Research Trust) dependent entirely on research grants and donations from the public, with emphasis in plastic and reconstructive surgery. The Centre has pioneered many new surgical techniques, including the first toe to thumb operation. Today, Blond McIndoe's research covers treatments for burns, wound healing, nerve injury and neuropathy, corneal restoration and cartilage repair.

The Blond McIndoe Centre is the legacy of Sir Archi-bald McIndoe Ð the famous plastic surgeon remembered for his epic work on burned aircrew during World War II at the Queen Victoria Hospital. The celebrated 'Guinea Pig' Club, formed by McIndoe's patients at East Grinstead in 1941, still actively supports the laboratories at East Grinstead and the Royal Free Hospital in London.

The combination of the research focus and the environment of Blond McIndoe is believed to be unique in the UK. The partnership between scientists and surgeons ensures that there is a high degree of professional research expertise available to clinicians searching for better treatments for their patients. The Centre is administered independently from the hospital and its objective is a research programme that will lead ultimately to improvements in the treatments available to patients who have suffered through accident or disease.

Wound Healing Group:
     Dr Robin Martin PhD Group Leader
     Dr Liz James PhD Senior Scientist
     Dr Justin Sharpe PhD Senior Scientist
     Miss Dawn Mann BSc
     MPhil Scientist
     Mr Keith Wood BA Senior Research Officer

Introduction
When Sir Archibald McIndoe and his colleagues at East Grinstead originally conceived the concept for the Blond McIndoe Centre the idea was to facilitate the closest collaboration between scientists and plastic surgeons in developing new treatments for serious burns. This goal to foster the collaboration between science and surgery is one that we constantly strive to fulfil. All our experimental work is carried out with the clear aim of moving to patient trials and treatments as soon as it is safe and ethical to do so. We believe that only by making new treatments available for surgeons to try can we hope to efficiently discover the potential and the limitations of each method.

We continue to work closely with consultant surgeons in the Burns Centre and Department of Plastic Surgery at East Grinstead. In recent years the Wound Healing Group have also developed an interest in two further areas of reconstructive surgery. These are the repair of damage to the cartilage surface within the knee, and repair to the surface of the cornea. Currently, our principal strategy is to learn how to capitalise on the technology that enables cells to be grown in the laboratory in large numbers from a small sample of a patient's own tissue. Sometimes we can also use donor tissue from other individuals. If cells can be grown in the laboratory and delivered back to the patient in a suitable form so that they regenerate the original skin, cartilage or corneal surface, this will open up tremendous opportunities for new treatments. Our aim is to make a significant contribution to rebuilding the quality of life that can be enjoyed by patients who have damage to these structures. This new technology is the field of 'Tissue Engineering' and we feel sure that if Sir Archibald McIndoe was alive today he would have been fascinated by the prospect.

Cultured cells to reconstruct skin
Skin replacement for burns
The normal function of the skin is to provide a barrier. Skin has to form an effective barrier to prevent fluid loss from the body and to stop infection from getting in from the outside. When skin is burned, the barrier is lost and the patient is susceptible to both fluid loss and infection. The surgeon's main objective is to replace the barrier function. If the burn is not too extensive, then grafts of skin from unburnt areas are taken. This is the standard treatment and it works well. However, if larger areas of skin have been burnt, there will be insufficient areas from which grafts can be harvested. A barrier can be achieved temporarily with artificial materials, but ultimately this must be replaced with the patient's own cells and tissues.

The Blond McIndoe Centre is actively researching ways in which a patient's own cultured skin cells (keratinocytes) can be combined with commercially produced temporary artificial skin substitutes that are already in clinical use, such as Integra™ artificial skin. This skin substitute consists of a collagen sponge-like matrix covered with a silicone sheet. The silicone sheet performs the barrier function of the skin substitute. The patient's blood vessels grow into the collagen matrix beneath the protection of the silicone. After four to six weeks the silicone has to be removed and a skin graft applied. Our research is taking a number of directions.

Surface application of skin cell sheets
In one approach we are researching ways in which thin sheets of cultured skin keratinocytes, grown from tiny samples of normal skin can be grafted on to the surface of the Integra™ after the silicone has been removed. Experimental work has been carried out and some trials have taken place on patients. We are now back in the experimental phase of this work seeing if we can improve the quality of the cultured skin cell sheets so that they perform more efficiently and can be grown into more robust tissues in the laboratory. This is important, as the areas where the cultures do not establish new skin are prone to scar formation.

Seeding artificial skin substitutes with skin cells
In a second area of research we are exploring whether it is possible to seed Integra™ artificial skim with a patient's own skin cells before the material is grafted. In this case we apply a suspension of skin cells in fluid to the underside of the collagen matrix. The fluid is absorbed into the sponge-like material seeding the cells into the lower half of the Integraª. The question is: will the cells know which way to grow? Experimental studies initiated by Liz James and Isabel Jones and now continued by Dawn Mann, have demonstrated the feasibility of this approach and that cells do have the ability to migrate upwards to the surface and form a skin barrier. We are currently conducting trials with our third patient using skin seeding with consultant surgeon Mr John Boorman to see whether this works in the clinical arena. If this proves successful then it will enable plastic surgeons to offer repair of skin defects using a single operation and patients will not need to have so many skin grafts. In recent work, plastic surgical research fellow Lachlan Currie has been experimenting with the combined use of fibrin glue and cell seeding of Integra™ artifical skin.

The above text is reprinted from the Blond McIndoe website, by kind permission of Dr Robin Martin.
For further information go to:
http:/www.blondmcindoe.demon.co.uk