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The Ros Dodd Interview: Life changing plastic surgeon who gets under your skin.

Byline: Ros Dodd

Hanging above the desk in Remo Papini's office is a framed picture showing the dramatic scenery of the Australian desert.

'It reminds me of home,' he explains rather wistfully, although - as he then admits - Down Under isn't 'home' at all. London-born Remo spent just a year living and working in Perth.

But although his stay was brief, the skills and knowledge he acquired during those 12 months have had a major impact on his career as a consultant plastic surgeon and head of the burns unit at the University Hospital Birmingham Trust, based at Selly Oak.

For 41-year-old Remo - whose Italian looks and seemingly easy-going manner must make him a big favourite on the wards - has developed revolutionary 'cell transplant' surgery which can radically improve the appearance of burns victims.

The technique - pioneered in Australia - involves picking the pigment, or colour-producing cells, from the patient, mixing them with the best cells for skin growth, then 'harvesting' them a week later.

They are placed in a liquid solution and sprayed on to the affected area of the body.

Because the new skin cells are still growing, they quickly spread over a wider surface area to promote rapid healing as well as improved pigmentation.

Last autumn, Smethwick schoolgirl Becky Owen became the first patient in Britain to benefit from the surgery. Doctors at Selly Oak transferred a thumb-nail sized sample of cells from behind her ear to her face, which was badly burnt during an accident as a toddler.

The 12-year-old had already undergone eight skin grafts - the traditional way of treating burns patients - when skin was transferred from her leg to her face. But the skin on her leg was darker than her facial complexion and was thus very noticeable.

So how is Becky doing now?

'She came to the clinic last week and she's doing very well,' beams Remo.

With that, he jumps up to find 'before' and 'after' slides, which show a marked difference in the schoolgirl's appearance. Instead of raised darkish patches, the new skin is much smoother and blends in better with the rest of her face.

'It's something we can keep repeating if necessary. In fact, Becky will need a bit more of a touch-up on her neck.'

Since Becky's operation in November, Remo and his team have performed cell transplant surgery on six or seven patients.

'We've used it to resurface unsightly scars. There's one guy who went through a cable in the road. He had one of those mesh grafts on his arms and when the wound healed it looked like a duvet. He hated it.

'So we did both his arms and he's delighted with the result.'

Remo has been in Birmingham for two years - having worked long and hard clambering up the career ladder from modest beginnings.

'I suppose I'm a Cockney wop,' he says with a laugh.

'I was born at St Bart's Hospital, near to where my dad, who runs a snack bar, works.

'Both my grandfathers were first-generation immigrants; they came over here at the turn of the century, so I suppose they were economic migrants.'

How important to him are his Italian roots?

'I'm very proud of them. I speak Italian, but not fluently. My son is going to Italian classes at the moment and I'm trying to speak to him occasionally in the language. He was all chuffed the other day because he knew a word in Italian that I didn't!

'He has an Italian name, Elio; I was very insistent about that. It took us six weeks to name him because my wife wouldn't agree with any of the names I suggested.

'We have a house in Italy - on the Amalfi coast. It's nice for the kids and I like it because of the views and the food.'

Brought up in north London, Remo had a grammar school education.

'I've never been a swot, but I've always had to work reasonably hard to pass exams,' he admits.

'If you get in with a bunch of people who are not interested in working, you don't work either. But most of my friends were quite well-motivated, so it was enough for me to get my A-levels, although I retook them to get better grades.'

Did he know at that stage he wanted a career in medicine?

'I wasn't sure whether to do medicine, marine biology or archeology. I'd have loved to have been an archeologist, but I wouldn't have made a living out of it.

'So I went into medicine - for all the corny reasons: to use my knowledge to help others and because I'd be able to work with people.'

While he retook his A-levels, Remo worked as a hospital porter at St Bart's before enrolling at the Royal Free Medical School.

'I decided fairly early on I wanted to do surgery.

'I like the hands-on and physical aspects to it - you can get in there with your hands and put whatever is wrong right. I couldn't be a physician and stand at the end of a patient's bed saying, 'We'll change the dose and wait a couple of weeks to see if it makes a difference'. I haven't got the right temperament for that.'

What made him choose reconstructive plastic surgery?

'I worked for a guy who used to work at the Royal Free once a week, Mike Brough. I saw some of the work he was doing and it fascinated me. I love the blend of art and science that is plastic surgery.

'Also, the surgeon I was working for at the time said to me about plastic surgery: 'That's the future in speciality'. I didn't think he was right but it inspired me at the time. So I decided fairly early on that was what I wanted to do.'

After five years of general medical training, Remo spent another 12 months as a houseman, took two years out to conduct research into infection in burns, and then worked for three more years to get his surgical fellowship.

'It was a long, hard slog,' he admits. 'By the time I'd more or less finished my training I knew I wanted to find a job in a busy burns unit.'

The Birmingham job fitted the bill perfectly.

'I must admit, Birmingham isn't the place we decided to end up in, but I'm not unhappy to be here. It has apparently changed an awful lot in the last ten years and there's a great deal going on.

'There's an awful lot of potential here, which is one of the things that attracted me to the place.'

Remo's wife Karen is also enjoying being in the Midlands - if only because the family is no longer having to up sticks on a regular basis.

'As well as Australia, I have worked in Newcastle, London and Liverpool, so my wife was quite glad to settle down.'

The couple met in Newcastle, where Karen was an intensive care nurse.

'Now, three pregnancies later, she doesn't work. Our youngest child, Francesca, is three-months-old.'

Before landing the Birmingham post, however, Remo went out to Australia.

'I arranged a post-graduate fellowship for a year in Perth and went to work for a lady called Fiona Wood, who's is one of the most dynamic people I've ever met.

'She's originally from South Yorkshire, but while she was a trainee over here she met her Australian husband Tony, who's now a transplant surgeon, and went back to Perth with him.

'She has six kids, runs two burns units - adult and paediatric - and also partly runs the cell culture laboratory. And she still picks the kids up from school three days out of five. She's absolutely incredible and completely inspired me. We hit it off and worked very well together.'

It was Fiona who pioneered skin cell transplantation surgery and who convinced Remo - who was initially unconvinced of its merits - that it was the way forward in treating people scarred by burns.

'Fiona also used cultured cells to resurface the wounds. She had her own skin laboratory and used to grow patients' cells.

'I wasn't convinced at first, but I did think the cosmetic results were better, as well as the whole approach to patient care - and that's what I'm trying to create here in Birmingham.

'With the big injuries, you've got to go for survival rather than cosmetics, but with smaller injuries Fiona's philosophy is to basically cover them with what's missing. In other words, replace like with like. Sometimes that's something people forget.

'There's a tendency in some quarters to think about burns as general trauma: getting the wound to heal by taking the burn off and covering the wound in some way is viewed as the end point. Then you say to a patient, 'You've got a very ugly scar now, but it was a burn after all'. I don't think that's right. I believe you should look at how to give patients the best result possible.

'You're not going to return the skin exactly to how it was before, but if you can give patients a result that's reasonably good, why not do that instead of just slapping on a skin graft?'

So how exactly does cell transplantation differ from traditional skin grafting?

'With mesh grafts - which are used when you have a large area to cover - skin is passed through a mangle to make it go further and to produce holes in it to help the graft take. The problem is, the mesh pattern often persists and so is noticeable.

'You can also see the join because the graft can become very raised and lumpy. And it is often a different colour.

'Fiona used to use mesh grafts and then spray the patients' own cells over the top so the holes in the mesh would get seeded with the patients' own cells and fill in very quickly.

'People have been using cultured cells for years, but what Fiona did was to harvest them after a week instead of three weeks, which was the traditional method because it gives you a sheet of skin.

'After only a week, the new skin is still clumps of cells. But Fiona found that spraying those cells on to the wound meant you could use a patient's own body as a culture dish. And it works. If you have only clumps of cells they start moving on the surface of the wound and migrate more.'

Another reason it works is that the sooner a burn is treated, the better the wound will heal.

Although a cultured skin laboratory was set up in Birmingham in 1975, by the time Remo arrived at Selly Oak, it was 'covered in mothballs'.

'The lab was set up by Paul Levick, initially at the accident hospital. It moved to the general and then to here, getting smaller and smaller each time. My predecessor closed the thing down because he didn't believe in cultured cells.

'But I wanted to start it up again, both to help patients and to do research. And that's what I've been doing.

'So far it's not being used to its full potential because we're running it on Trust funds, and the money we have in the pot would disappear within a year if we used it for all the patients I'd like to use it for.

'But I'm hoping after a couple of years to go to the chief executive and say, 'We're seeing the benefit', and that the bill can then be picked up by the Trust.'

Remo spends about 70 per cent of his time running the burns unit and the rest doing aesthetic and reconstructive plastic surgery.

Working with patients who have been seriously burned must be incredibly difficult. Has Remo become immune to the horror?

'I don't think you ever get immune to it, that's why it's quite important to not just do the burns work and to do the aesthetic surgery. I think if you were only dealing with major trauma and burns you'd probably go mad.'

Reconstructive surgery can, he says, be very satisfying 'if you get it right'.

'But it can also be hugely disappointing if things don't go as you planned, particularly when you start to run out of reconstructive options.

'I think there's an important link between cosmetic and reconstructive plastic surgery. The techniques you use for reconstructive surgery you take with you to cosmetic surgery, and the aesthetics of cosmetic surgery help you to do reconstructive work.

'In cosmetic procedures, most people want to be average - they want conformity. That's the same with burns patients; they want their features restored to the norm so that people don't turn to them in the street and stare.'


Remo Papini, of the University Hospital Birmingham Trust, has developed revolutionary 'cell transplant' surgeryPicture/NEIL PUGH
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Publication:The Birmingham Post (England)
Date:Apr 7, 2001
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