Papers by Matthew Wordsworth
BMJ Military Health, Nov 21, 2023
Understanding tissue loss following injury is important due to its prevalence among the war-wound... more Understanding tissue loss following injury is important due to its prevalence among the war-wounded and the impact it has on subsequent treatment and rehabilitation. Progressive tissue loss is a type of tissue loss that has complicated extremity injury in recent conflicts. It has resulted in more proximal residual limb lengths and has influenced rehabilitation. Quantifying wound burden in combat casualties remains a challenge due to poor quality of data sets that lack the capacity for detailed analysis. The aims of this article are to outline the current hurdles in attempting to quantify wound burden in combat casualties and to propose simple interventions to improve data capture for future analysis. ⇒ To understand future wounds in combat casualties, this paper postulates several simple measures to facilitate understanding of wound burden on the patient and its potential evolution.
Journal of Hand Surgery (European Volume), Jun 14, 2022
This is the second of a two-part review article on the management of conflict injuries, focused o... more This is the second of a two-part review article on the management of conflict injuries, focused on the reconstructive strategies for bone, nerve and soft tissue and to provide guidance on assessing and managing common complications associated with complex upper limb injuries. Following assessment and early surgical management, the conflict casualty will require further wound evaluation and planning prior to definitive reconstruction of limb injuries. Surgical management of the upper limb injury should aim, where possible, to preserve the limb and allow functional reconstruction. The principles of the second look procedure are to assess wound progression, further reduce the risk of infection and plan definitive reconstruction with adequate soft tissue cover. The prerequisites for successful surgical reconstruction are a stable patient, combined orthoplastic surgery expertise supported by physiotherapists and hand therapists.
Injury-international Journal of The Care of The Injured, 2017
The recent Afghanistan conflict caused a higher proportion of casualties with facial injuries due... more The recent Afghanistan conflict caused a higher proportion of casualties with facial injuries due to both the increasing effectiveness of combat body armour and the insurgent use of the improvised explosive device (IED). The aim of this study was to describe all injuries to the face sustained by UK service personnel from blast or gunshot wounds during the highest intensity period of combat operations in Afghanistan. Methods: Hospital records and Joint Theatre Trauma Registry data were collected for all UK service personnel killed or wounded by blast and gunshot wounds in Afghanistan between 01 April 2006 and 01 March 2013. Results: 566 casualties were identified, 504 from blast and 52 from gunshot injuries. 75% of blast injury casualties survived and the IED was the most common mechanism of injury with the mid-face the most commonly affected facial region. In blast injuries a facial fracture was a significant marker for increased total injury severity score. A facial gunshot wound was fatal in 53% of cases. The majority of survivors required a single surgical procedure for the facial injury but further reconstruction was required in 156 of the 375 of survivors aero medically evacuated to the UK. Conclusions: The presence and pattern of facial fractures was significantly different in survivors and fatalities, which may reflect the power of the blast that these cohorts were exposed to. The Anatomical Injury Scoring of the Injury Severity Scale was inadequate for determining the extent of soft tissue facial injuries and did not predict morbidity of the injury. 2016 Published by Elsevier Ltd.
Journal of the Royal Army Medical Corps, Feb 4, 2014
War and surgical advances are well-documented companions. The developments in resuscitation and a... more War and surgical advances are well-documented companions. The developments in resuscitation and acute surgical care over the last decade of conflict have meant UK military trauma patients are surviving increasingly severe injuries.[1][1] Unprecedented survival means a cohort of survivors with
Annals of Surgery, Apr 1, 2015
Objective: To develop and validate a robust, objective mobility assessment tool, Hamlyn Mobility ... more Objective: To develop and validate a robust, objective mobility assessment tool, Hamlyn Mobility Score (HMS), using a wearable motion sensor. Background: Advances in reconstructive techniques allow more limbs to be salvaged. However, evidence demonstrating superior long-term outcomes compared with amputation is unavailable. Lack of access to quality regular functional mobility status may be preventing patients and health care staff from optimizing rehabilitation programs and evaluating the reconstructive services. Methods: In this prospective cohort study, 20 patients undergoing lower limb reconstruction and 10 age-matched controls were recruited. All subjects completed the HMS activity protocol twice under different instructors at 3 months postoperatively, and again at 6 months, while wearing an ear-worn accelerometer. Demographic and clinical data were also collected including a short-form health survey (SF-36). HMS parameters included standard test metrics and additional kinematic features extracted from accelerometer data. A psychometric evaluation was conducted to ascertain reliability and validity. The HMS demonstrated excellent reliability (intraclass correlation coefficient >0.90, P < 0.001) and internal consistency (Cronbach α = 0.897). Concurrent validity was demonstrated by correlation between HMS and SF-36 scores (Spearman ρ = 0.666, P = 0.005). Significant HMS differences between healthy subjects and patients, stratified according to fracture severity, were shown (Kruskal-Wallis nonparametric 1-way analysis of variance, χ 2 = 21.5, P < 0.001). The HMS was 50% more responsive to change than SF-36 (effect size: 1.49 vs 0.99). The HMS shows satisfactory reliability and validity and may provide a platform to support adaptable, personalized rehabilitation and enhanced service evaluation to facilitate optimal patient outcomes.
Transplantation, Jul 1, 2018
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Sep 11, 2015
As the number of cyclists in Britain continues to grow [1], interest in cycle safety has increase... more As the number of cyclists in Britain continues to grow [1], interest in cycle safety has increased. The aim of this study was to identify patient characteristics, mechanisms of injury and injury patterns in cyclists with head injury admitted to a London Major Trauma Centre with a view to identifying factors which could increase cycle safety. Cyclists with any head injury requiring admission to hospital between January 1 st 2011 and December 31 st 2013 were identified from Intensive Care admissions, Emergency Department records, the Trauma Audit and Research Network and patient lists for the Trauma Ward. After identification of the patient group, data was collected from emergency department and pre-hospital documentation, imaging, toxicology and Intensive Care documentation where relevant.
Transplantation, Jul 1, 2018
INTRODUCTION: Skin scarring, though present in the adult, does not occur in fetal wounds. Rather,... more INTRODUCTION: Skin scarring, though present in the adult, does not occur in fetal wounds. Rather, fetal wounds heal by regeneration. Understanding the fetal wound healing mechanism could allow for scarless healing in human patients. Recently, our group showed that a group of fibroblasts in murine dorsal skin are responsible for all scar tissue deposition in adults, and they appear around the time of phenotypic change from scarless to scarring. These cells, known as engrailed positive fibroblasts (EPFs) are hypothesized to be responsible for the transition from scarless to scar-forming phenotype in the late gestational fetus, via numerous epigenetic changes. METHODS: Dorsal dermal fibroblasts from En1Cre, R26mTmG mice were isolated at gestational ages E10, E16, E18, P1, and P30. EPFs and ENFs (engrailed negative fibroblasts) from these time points were sorted using fluorescence-activated cell sorting (FACS) and were analyzed using assay for transposase-accessible chromatin using sequencing (ATAC-seq). This assay compared the accessibility of segments of genomic DNA. RESULTS: Preliminary ATAC-seq data reveals a strong association between epigenetic changes and time course between scar forming and other fibroblasts. Additionally, epigenetic changes are highly preserved among cells of the same time course. Also, ubiquitously expressed fibroblast genes have marked variation in genomic accessibility. CONCLUSIONS: ATAC-seq of EPFs and other fibroblasts proves they are functionally distinct, not only physiologically, but in their epigenetic regulation. In future experiments, we aim to achieve scarless skin healing using CRISPR-Cas9 editing to target genes identified using ATAC-seq.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Sep 11, 2015
Plastic and Reconstructive Surgery, Mar 1, 2019
Plastic and Reconstructive Surgery, Apr 1, 2019
kin is considered the most allogenic tissue in humans. This concept has been well accepted throug... more kin is considered the most allogenic tissue in humans. This concept has been well accepted throughout the history of vascularized composite allotransplantation. If one accepts that skin is the most allogenic tissue in a vascularized composite allotransplantation, on routine immunosuppression it is then logical to propose that skin will be the first tissue to demonstrate rejection. If skin is the first tissue to reject, it could ideally serve as the primary monitor. Skin is therefore widely accepted as an early warning system for rejection in the deeper tissues and therefore serves as a monitor of when to deliver immunosuppression. This concept is dogma. We question the validity of this dogma. Therefore, the hypothesis of this study is that skin Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article. No funding was received for this article.
Orthopaedic Proceedings, Feb 21, 2018
St Mary9s Hospital, the major trauma centre for West London, treated 168 patients with lower limb... more St Mary9s Hospital, the major trauma centre for West London, treated 168 patients with lower limb open fractures in 2011 & 2012. This audit compared antibiotic administration in the emergency department against the current BOAST IV guidelines. The choice, timing, dose, and documentation of antibiotic administration was collected from the casualty cards and the transfer documentation for any patient initially seen at another hospital. The severity of the injury (as the Gusitollo-Anderson classification) after the initial debridement and any infectious complications that presented before discharge were also recorded. The results showed a higher compliance with the BOAST IV guidelines for those patients directly admitted rather than transferred to the major trauma centre. In direct admissions the recommended antibiotics were either not given or not adequately documented in 7% of cases. In those patients transferred from another emergency department the documentation was inadequate in 27% of cases. The likely causes of these results are discussed alongside the unit9s bone infection rates.
Journal of Hand Surgery (European Volume), May 17, 2022
Upper limb injuries are common in conflict zones. The functions of the upper limb are impossible ... more Upper limb injuries are common in conflict zones. The functions of the upper limb are impossible to replicate with prosthetic replacement and wherever possible attempts should be made to preserve the limb with further secondary reconstruction aimed at restoration of function. Casualty assessment, haemorrhage control and resuscitation are simultaneously undertaken at the receiving medical facility. Primary surgical management involves decontamination and debridement, skeletal stabilization, restoration of vascularity, compartment fasciotomy where indicated and wound temporization with dressings. Operative findings and interventions should be documented and if evacuation of the casualty is possible, copies should be provided in the medical records to facilitate communication in the chain of care. Secondary procedures are required for further assessment and debridement prior to planning reconstruction and definitive fracture stabilization, nerve repair, wound cover or closure.
Journal of The American College of Surgeons, Oct 1, 2017
INTRODUCTION: Skin scarring, though present in the adult, does not occur in fetal wounds. Rather,... more INTRODUCTION: Skin scarring, though present in the adult, does not occur in fetal wounds. Rather, fetal wounds heal by regeneration. Understanding the fetal wound healing mechanism could allow for scarless healing in human patients. Recently, our group showed that a group of fibroblasts in murine dorsal skin are responsible for all scar tissue deposition in adults, and they appear around the time of phenotypic change from scarless to scarring. These cells, known as engrailed positive fibroblasts (EPFs) are hypothesized to be responsible for the transition from scarless to scar-forming phenotype in the late gestational fetus, via numerous epigenetic changes. METHODS: Dorsal dermal fibroblasts from En1Cre, R26mTmG mice were isolated at gestational ages E10, E16, E18, P1, and P30. EPFs and ENFs (engrailed negative fibroblasts) from these time points were sorted using fluorescence-activated cell sorting (FACS) and were analyzed using assay for transposase-accessible chromatin using sequencing (ATAC-seq). This assay compared the accessibility of segments of genomic DNA. RESULTS: Preliminary ATAC-seq data reveals a strong association between epigenetic changes and time course between scar forming and other fibroblasts. Additionally, epigenetic changes are highly preserved among cells of the same time course. Also, ubiquitously expressed fibroblast genes have marked variation in genomic accessibility. CONCLUSIONS: ATAC-seq of EPFs and other fibroblasts proves they are functionally distinct, not only physiologically, but in their epigenetic regulation. In future experiments, we aim to achieve scarless skin healing using CRISPR-Cas9 editing to target genes identified using ATAC-seq.
As the number of cyclists in Britain continues to grow [1], interest in cycle safety has increase... more As the number of cyclists in Britain continues to grow [1], interest in cycle safety has increased. The aim of this study was to identify patient characteristics, mechanisms of injury and injury patterns in cyclists with head injury admitted to a London Major Trauma Centre with a view to identifying factors which could increase cycle safety.
BMJ Military Health
BackgroundTension pneumothorax following trauma is a life-threatening emergency and radiological ... more BackgroundTension pneumothorax following trauma is a life-threatening emergency and radiological investigation is normally discouraged prior to treatment in traditional trauma doctrines such as ATLS. Some trauma patients may be physiologically stable enough for diagnostic imaging and occult tension pneumothorax is discovered radiologically. We assessed the outcomes of these patients and compared them with those with clinical diagnosis of tension pneumothorax prior to imaging.MethodsA multicentre civilian–military collaborative network of six major trauma centres in the UK collected observational data from adult patients who had a diagnosis of traumatic tension pneumothorax during a 33-month period. Patients were divided into ‘radiological’ (diagnosis following CT/CXR) or ‘clinical’ (no prior CT/CXR) groups. The effect of radiological diagnosis on survival was analysed using multivariable logistic regression that included the covariates of age, gender, comorbidities and Injury Severi...
The Journal of Pain, 2018
The results also support that for those patients who receive SCS in our local population, that it... more The results also support that for those patients who receive SCS in our local population, that it is likely to be a beneficial treatment. However, future projects should look at outcomes from a larger sample size and at up to two years post SCS implant. (288) Intrathecal administration of AIBP prevents and reverses pain states
Plastic and Reconstructive Surgery, 2018
Core Techniques in Flap Reconstructive Microsurgery
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Papers by Matthew Wordsworth