Plastic surgery and burns

The St Andrew's Centre is home to the world reknowned specialist burns and plastic surgery service. In 2014, St Andrew's celebrated its 40th year as a leading specialist centre.

The regional plastic surgery service now covers a population of 3.2 million and the regional burns service services a population of 9.8 million.

Children's Burns Service 

Mid Essex Hospital is home to the internationally-renowned St Andrews Burns Centre which provides care to children with the most complex burn injuries from across London and the South East of England and serves a population of 21million.

The St. Andrews Burn Centre includes the Burns Intensive Care Unit, Children’s Burns Ward, Adult Burn Ward, and Burns Outpatients.

Luckily, serious burn injuries affect only a small number of children, and to ensure staff caring for them have the knowledge and experience to do so the children are treated in supra regional centre’s such as St. Andrews, where a children’s burns specialist multi-disciplinary team can take care of the child.

Burns Intensive Care is designed to provide advanced treatment for the child with a burn injury. Children who need highly skilled medical attention, including close observation and the use of sophisticated monitoring equipment and comprehensive skin treatments are admitted to Burns ITU.

In each room, there is a monitor that records the child’s heart rate, blood pressure, respirations and pressure in the heart. Other specialised equipment may also be used to care for your child.

The purpose built Children’s Burns Ward opened in the summer of 2010. It can take children up to the age of 16years primarily from the South East of England, but occasionally from anywhere in the country if there is a shortage of burns beds. We can accept all types of burn injury including scalds, flame, chemical and electrical burns, as well as skin loss conditions such as scalded skin syndrome.

The philosophy of the Unit is to provide the highest standard of burn injury care to the child, the parents and others who are directly or indirectly involved both during and after hospitalisation. Treatment is under constant review and updated subject to relevant research.

The ward has four side rooms and a four bedded bay for inpatients, a treatment room and a treatment bathroom. The ward has inpatient children and children who are returning for dressing changes and various therapies.

Because of the complex nature of burns and their physical and psychological impact on patients and their families, the service utilises the expertise of many different specialists. All admissions are assessed by a burns nurse, burns surgeon, occupational therapist and physiotherapist. We also have play specialists, nursery nurses, hospital school team, dietician, psychotherapy team, chaplaincy team, social worker and pharmacists as part of our team.

The doctors, nurses and therapists plan care for the individual child and family from the time of admission, through to discharge and then ongoing for as long as required. The Children’s Burns Ward offers the latest in burn dressings, specialised wound care, and plastic and reconstructive surgical techniques, but treatment is guided by minimising pain and trauma for the child.

At the Children’s Burns Ward, we know that being in the hospital with an injury can be very stressful for both the child and the family. We also know that no one knows the child as well as the parents. That’s why we take a family-centred care approach, and work in partnership with children/ young people and their families in determining treatment plans. 

Children’s Burns Unit Specialist Services 

Physiotherapy
Occupational Therapy
Psychology
Play Specialist and School Team
Burned Children’s Club 

Visiting 

At the Children’s Burn Ward, your child’s health and recovery are our primary concerns. We realise this is a stressful time for you, so we want to provide as much support as possible. Depending on the severity of the burn injury, your child will be staying in the Children’s Burn Ward (E225) of the St. Andrews Centre, or in the Burns Intensive Care Unit (E220)

Only two visitors per child are allowed at any one time. Parents may visit at any time over 24hours. One parent may stay overnight. Other visitors may visit with parents’ permission from 10am to 8pm. Parents may call at any time to check on their child’s condition:

Burns Intensive Care Unit on 01245 516037/8

Children’s Burn Ward on 01245 516973/4 

Infection Prevention 

In an effort to minimise the spread of infection, you will be asked to use the alcohol gel on entry and exit, and wear an apron whilst in the room to cover your clothes while visiting. Please wash your hands with soap and water before leaving the patient’s room and place aprons in the bins provided. Notify the nurse if you have a cold or other communicable disease before entering a patient’s room. Please do not visit if you have diarrhoea or vomiting. 

Burns Outpatients 

The Burns Outpatients Department is part of the St Andrew’s Burns Centre at Broomfield Hospital. It provides a dressing clinic for adult patients with a burn injury. You may be referred via your GP or local hospital Emergency Department with a new burn injury, or attend for wound care after being discharged from the Burns wards. Consultant clinics are also held in the Burns Outpatients department, and there are Physiotherapist and Occupational therapist available. 

The Burns Unit is part of the London and South East Burns Network (LSEBN) and covers a large part of the East of England including London, north of the river Thames. This means that you may need to travel a long way for your burn care. A clinic is held once a week at the Princess of Wales hospital in Ely to help reduce travelling distances for some patients. 

If you are finding it difficult to get to your appointments due to finance or reduced mobility after your injuries, please discuss this with the nurses in clinic or call the Burns Outpatients department. You may be eligible for transport or help with some of your travel costs.  

When you come to Burns Outpatients for dressings you will always see an experienced Burns Nurse. You may also see a Doctor, Advanced Practitioner, Psychotherapist or Scar Therapist if needed. 

Our Burns Outreach Team are based within the Burns Outpatients Department and visit patients that are not clinically well enough to travel to Burns Outpatients. They also support other hospitals, care settings and district/community nurses to ensure that all patients get the best possible burn care. 

Contact Burns Outpatients on 01245 516008 

Our Team 

We have four Burns Consultants who lead our team of specialist doctors.

We also have a team of anaesthetists who will lead on the care of the children in Burns ITU and will look after your child’s pain control throughout their stay.

The nursing team is comprised of highly skilled nurses, many of them children’s trained, who are used to looking after children with varying degrees of burn injury and skin loss conditions. 

Safeguarding Children 

'Every child and young person has a right to life free from abuse'

All members of staff working in the Children’s Burn Service have a professional responsibility to safeguard and protect children. Safeguarding Children (previously Child Protection) is a highly emotive subject, evoking strong feelings in all of us. In order to provide the most effective support and help for vulnerable children and their families, we have a team of specialist doctors and nurses on site.

Ward Information

Department Name: Burns Adults Ward
Destination Number: E221
Telephone Number: 01245 513914

Department Name: Burns ITU
Destination Number: E220
Telephone Number: 01245 513914

Department Name: Stock Ward
Destination Number: E320
Telephone Number: 01245 513922 

Department Name: Billericay Ward
Destination Number: E321
Telephone Number: 01245 513923 

Department Name: Mayflower Ward
Destination Number: E322
Telephone Number: 01245 513924

Hand Trauma and Assessment Unit (B340)

How to find us

We are located in Zone B on the third floor. The location code for Hand Trauma and Assessment Unit is B340. 

Hand Trauma patients - Phone number: 01245 516561

If you have been referred from A&E you have been asked to attend the clinic for review of your injury

The Clinic is run similar to Accident and Emergency and each patient is seen in clinical priority order

Please bring any prescriptions for medication you are currently taking

Following assessment with a Plastic Surgeon a plan for your treatment will be discussed with you

This may include management with dressings, hand therapy or an operation

You may be asked to return on another day for your surgery

Your position on that list will depend on the severity of your injury, the type of anaesthetic needed and your medical history  

However, we can experience high numbers of referrals and due to the emergency nature of the service your operation may be rescheduled for a different day.

Pre-Assessment patients - Phone Number: 01245 516013

Please bring any prescriptions for medication you are currently taking

You will see the nurse who will take a full medical history

You may need to have tests while at the hospital. E.g; Blood tests or ECG

Some patients may need to see an anesthetist

We do advise that in some cases you may be at the hospital for up to 3 hours.

Laser Service

St Andrew's Centre is able to offer laser treatments for the following conditions: 

Pulsed dye laser

Port Wine Stain
Rosacea
Haemangioma/ Angioma
Vascular Malformation
Psoriasis
Vascular scars
Facial/ Nasal Telangiectasia
Solar/Age spots (face and hands)

Long pulse / Q switched ruby laser

Facial hirsutism
Pigmented lesions
Tattoo removal

CO2 laser

Rhinophyma
Skin resurfacng
Other skin ablative surgery 

Most treatments are NHS funded but some private packages are available. 

For more Information : 
Email : Laser.Service@meht.nhs.uk
Telephone : 01245 515027

Therapy Services
 
St Andrew’s Burns and Plastics Department has its own designated Therapy Department, which prides itself on giving a highly specialist and best practice service to the following specialities: Burns, Plastic Surgery, Head and Neck Cancer, Breast Reconstruction. Hand Trauma, Elective Hand Surgery and ENT.

The team consists of both Physiotherapists and Occupational Therapists and is led by a Lead Therapist with over 30 years of experience in the area specialising in the treatment of hand surgical and non- surgical conditions.  A Physiotherapy Consultant, who has attained a PhD in the field of Burns Intensive Care, published many research papers and has over 20 years of experience working with patients with Burns and those following Plastic Surgery and Head and Neck Cancer Surgery.

Burns, Plastic Surgery, ENT Surgery

We work with adults and children who have suffered burns to all areas of the body. The role of the physiotherapist is varied, and involves advising on ways to assist a patient’s breathing, improving a patient’s comfort, and restoring mobility. Additionally, the physiotherapist may be asked to give advice on the extent of a patients potential after rehabilitation.

Key roles of the Physiotherapist

Optimising a patient’s breathing is especially important and particularly whilst a patient requires mechanical ventilation in the intensive care unit. Normally patients in the ICU will be assessed and receive physiotherapy treatment twice per day, however, burn patients often require chest physiotherapy many times throughout the day and night and for as long as required, until a more normal breathing function is restored.

Patients who have had head and neck cancer or ENT surgery will require physiotherapy to maintain a clear chest afterwards, to manage and remove the tracheostomy tube at the right time, and to restore general mobility. 

Patients who are very unwell following burns, surgery and other illness may be confined to bed over a protracted period. This results in a rapid loss of muscle tissue and strength whilst prolonged limited movement leads to restricted and sometimes painful movement of important joints. It is vital therefore that physiotherapy is available to provide a range of rehabilitation exercises designed to support the patient’s limbs and optimise movement and comfort. Additionally, the physiotherapist is available to help to restore the patient’s baseline mobility.

As a burn patient’s wounds heal, physiotherapy and occupational therapy will be required to ensure scars are kept as soft and supple as possible using massage techniques and pressure therapy.

Key roles of the Occupational Therapist

The occupational therapists focus is to preserve the patient’s functional movement throughout the rehabilitation process, providing assistance and practise of the activities of daily living e.g. feeding, washing and returning to normal routines.

Occupational therapists tend to concentrate on rehabilitation of the upper limbs, as daily functions depend a great deal on a range of good hand and arm movements. Occupational Therapists make special splints, specifically designed for each patient to maintain functional positions of joints and discourage the formation of deformities after burns and long periods of immobility.

Hand Therapy Service

We provide specialist care for both adults and children with both non-surgical or surgical conditions of the hand and forearm,

Care is carried out by a Specialist hand therapist who are state registered Occupational Therapists and Physiotherapists.

Patients receive individual assessments and treatment sessions.  We work closely with plastic and orthopaedic surgeons.  Your Therapist will have detailed knowledge and understanding of your surgery or condition and will plan with you a treatment programme.  This may include various evidence based assessments.  Treatments may include splinting, paraffin wax, electrotherapy, exercises, joint mobilisation and rehabilitation to support your return to work and leisure activities. 

Location

The Department is located within Zone E121, which is within the St Andrew’s Outpatients, to give patients the opportunity to have multi-disciplinary team discussions during their Outpatient appointment when required.

Contacts

Main Therapy Reception – 01245 516009

Facial Palsy Services

Overview of service

The service is run by a consultant Plastic Surgeon, and a dedicated, highly specialised team including Facial Physiotherapists, Oculoplastic Surgeons, Nurses, with support from Neurophysiology Consultants. 

We offer treatments for the following conditions:

Newly diagnosed facial palsy in newborns, children and adults.
Recurrent facial palsy.
Longstanding facial palsy with synkinesis, asymmetry and other problematic symptoms.
Facial dystonia.

We treat patients from throughout our local catchment area, as well as from other regions of the UK through GP referrals, and referrals from other specialist centres. We are currently in process of organizing regular patient information days.

For information regarding outpatient department referrals please contact: 01245 516010

For information regarding Mid Essex referral centre referrals please contact: 01245 514450.

Secretary
St Andrews Centre 
Broomfield Hospital
Chelmsford
Essex
CM1 7ET 

Useful external links for further information

Facial Palsy UK:

www.facialpalsy.org.uk/

NHS Choices Bell’s Palsy:

http://www.nhs.uk/Conditions/Bells-palsy/Pages/Introduction.aspx

Children's Burns Club - DREAM. BELIEVE. ACHIEVE.

The club offers support to young burn survivors and their families to help them come to terms with burn trauma and altered body image.

We organise fun activities including residential camps, days out, workshops, parties and encourage the benefits of peer support amongst members.

This support helps rebuild self-esteem, confidence and expectations after a burn injury and along the way lasting friendships are made by the children and their families whilst giving mutual support to one another.

The club is open to any child or young person under the age of 18 years old that has a been treated by a burns consultant; any young person aged 18-24 is able to join the Young Adult CBC group

The Children’s Burn Club is a registered charity under the umbrella of the Mid Essex Hospital Trust; the hospital  fund all staffing costs.

This means any income raised or donated to the club goes directly to supporting the children, young people and families that need it to increase the support offered to them.

Contact us!

Tel: 01245 515988 | Mob: 07473374592
Facebook: Children's Burns Club
Email: Childrensburnsclub@meht.nhs.uk

This video shows children - who will be attending the ward - what the unit is like and what to expect. It is also be beneficial for school friends to see where their friend has been treated and care for.

The North Thames Cleft Centre is based at Great Ormond Street and the St Andrew’s Centre, Broomfield Hospital, for the care of children and adults with cleft lip and palate and related conditions.

Contact the team

Clinic appointments at 01245 516201
Cleft Team Secretary at 01245 516120
Clinical Nurse Specialists at 01245 516029
Speech and Language Therapists at 01245 516020
Dental Nurse at 01245 516012
Inpatient Admission Officer at 01245 513635 (option 2)
Email mse.midessexcleftservice@nhs.net

If you are a clinical professional and are looking to refer a patient, visit https://www.mse.nhs.uk/gp-resources.

Address

North Thames Cleft Centre
St Andrew’s Centre
Broomfield Hospital
Court Road
Broomfield
Chelmsford
Essex
CM1 7ET

 

Services we offer

• Inpatient surgery for infants through to adults
• Multidisciplinary clinics
• Cleft orthodontics
• Cleft-related speech and language therapy
• Feeding clinic for cleft patients
• Participation in national research trials.

Conditions we treat

Cleft lip repair and palate repair is carried out at St Andrew’s Centre, Broomfield Hospital.  Sometimes patients are transferred to Great Ormond Street Hospital. 

• Cleft lip repairs Cleft lip repair is carried out at St Andrew’s Centre, Broomfield Hospital.  Sometimes patients are transferred to Great Ormond Street Hospital. The operation is usually carried out at 3 to 6 months of age. Find out more at https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/cleft-lip
• Cleft palate repairs Cleft palate repair is carried out at St Andrew’s Centre, Broomfield Hospital.  Sometimes patients are transferred to Great Ormond Street Hospital. This operation is usually carried out at 9 to 13 months of age. Find out more at https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/cleft-palate

Other operations we do and useful patient information:

• Alveolar bone graft – find out more at https://www.gosh.nhs.uk/medical-information/procedures-and-treatments/alveolar-bone-grafts
• Buccinator flap operation – find out more at https://www.gosh.nhs.uk/conditions-and-treatments/procedures-and-treatments/buccinator-flap-operation

• Caring for your child’s teeth after cleft repair – https://www.gosh.nhs.uk/medical-information/procedures-and-treatments/caring-your-childs-teeth-after-cleft-repair 

• Palate examination for parents and carers – https://www.rcpch.ac.uk/sites/default/files/2018-04/2015_palate_examination_-_parent_information.pdf
• Nasal speech and velopharyngeal dysfunction – https://www.gosh.nhs.uk/parents-and-visitors/clinical-support-services/speech-and-language-therapy/services-we-provide/nasal-speech-and-velopharyngeal-dysfunction
• Pharyngoplasty operation – https://www.gosh.nhs.uk/conditions-and-treatments/procedures-and-treatments/pharyngoplasty/
• Rhinoplasty – Open tip rhinoplasty for children with craniofacial disorders | Great Ormond Street Hospital (gosh.nhs.uk)
• Speech and language development 12-24 months – https://www.gosh.nhs.uk/conditions-and-treatments/procedures-and-treatments/speech-and-language-development-12-24-months/
• North Thames Cleft Service – https://www.gosh.nhs.uk/wards-and-departments/departments/clinical-specialties/cleft-lip-and-palate-information-parents-and-visitors/about-north-thames-cleft-lip-and-palate-service
• CLAPA – https://www.clapa.com
• CRANE – https://www.crane-database.org.uk
• Cleft Collective – http://www.bristol.ac.uk/dental/cleft-collective
• Clinical outcomes – https://www.gosh.nhs.uk/conditions-and-treatments/clinical-outcomes/cleft-clinical-outcomes/

Overview of Service

We offer treatments for the following conditions:

• Newly diagnosed facial palsy in newborns, children and adults.
• Recurrent facial palsy.
• Longstanding facial palsy with synkinesis, asymmetry and other problematic symptoms.
• Facial dystonia.

We treat patients from throughout our local catchment area, as well as from other regions of the UK through GP referrals, and referrals from other specialist centres.

Signposting

Facial Palsy UK visit  https://www.facialpalsy.org.uk/

Useful Information visit  https://www.facialpalsy.org.uk/support/useful-info

Patient Guides visit  https://www.facialpalsy.org.uk/support/patient-guides/

Self Help Videos visit  https://www.facialpalsy.org.uk/support/self-help-videos/

What are the treatment options for Facial Palsy?

• Physiotherapy
• Botox
• Surgery 

Physiotherapy  

Physiotherapy is an important treatment for Facial Palsy. Your physiotherapist will complete a thorough assessment of your condition and individual presentation and work with you to produce a personalised treatment plan. They will monitor your progress using photographs and certified outcome measures which will include you completing some questionnaires. 

Physiotherapists work with you to improve facial symmetry, reduce muscle tightness and pain, improve function, and discuss management strategies. Treatment normally includes massage, stretching, exercises, education and synkinesis management. 

The team here at St. Andrews comprises of Marie Matanle and Christopher Keast, who see patients every Monday.

Botox

Botox is a drug which weakens and/or paralyses muscles. Used alongside physiotherapy as an adjunct; it can be injected into muscles which have become tight or overactive. Sometimes we inject the unaffected side to improve symmetry – for example if you are unable to raise the eyebrow on one side, we may inject the contralateral side to reduce the effect of this and improve symmetry. Botox takes about up to 2 weeks to see an effect. 

Surgery 

There are a range of reconstructive surgical operations for the correction of Facial Palsy. As all cases of the condition vary, each surgical intervention is tailored very specifically to a patient’s needs. For example, surgery can help with eyelid closure by inserting a small gold weight or correcting the position of the eyelid, or can help with mouth movements by transferring muscle from elsewhere in the body to the face, to improve function. Surgery will be discussed in outpatient clinic initially, and if required can take place at Broomfield Hospital. 

This video shows the preparation for patients going to burns theatre.

This video explains the transition from the children’s burns service to our adult burns services within Mid Essex.

Welcome to St Andrews hand trauma and surgery services

This is a regional unit which specialises in hand trauma, burns and plastic surgery.

We provide care for approximately 5 million people from a very large area which includes Essex, East London, Kent, and the Suffolk border.

You have been asked to attend a clinic so the specialist trauma team, which consists of doctors and specialist nurses, can assess your wound and plan a course of treatment you may require.

All trauma patients are given a time to arrive, please note this is not a fixed appointment time, there may be a delay before you are seen as this is an emergency clinic.

Please bring with you any notes or x-rays that you are given by A&E, any medication you normally take along with any antibiotics or pain killers you are taking currently. We ask that one person escort you to the unit, as you may not be insured to drive with a hand injury, or after having surgery.

Your treatment may consist of the need for hand surgery. This is often arranged without the need to stay in overnight, depending on the injury. It could be a good idea to bring a small overnight bag in case you require admission.

Due to the nature of emergency trauma theatre there may be a wait of a few days before your surgery can be completed. This is usually carried out within 1-7 days. However surgery can still be postponed at very short notice if there is a patient requiring more urgent surgery. We apologise for any concerns this may cause and will try to manage each case individually.

If you are given any medication please continue to take them according to the instructions. Pain killers such as paracetamol and Ibuprofen can be taken as well if they are required.

Before your operation

You may be asked to go home and return at a later date for your operation. You may continue to eat and drink until the day of you operation when you will be advised to remain ‘nil by mouth’ from a specific time it required.

At times there maybe unexpected space in theatre, so you may be asked to come in for your operation at short notice.

Caring for you wound at home

Your bandage should be kept clean and dry.

To reduce swelling and pain, you should keep your hand above heart level, preferably at shoulder level. At night your arm should be raised on a couple of pillows. Please remove all jewellery from the affected hand as swelling may cause constriction, ending in the jewellery being cut off if it cannot be removed

You should contact the hand trauma unit or the emergency department if you have any of the following:

• you have bleeding which does not stop. To try and stop the bleeding please
  • raise your hand above your head
  • press firmly on the area for at least 5 minutes
• your fingers appear pale or cool
• your fingers have pins and needles that start after you get home
• you can no sleep due to pain, even though you have taken pain killers
• your bandage becomes wet, or dirty.
• you have smelly discharge from you wound

Contact us

If you have any concerns please ring the hand trauma unit on 01245 513300 Monday to Sunday (8am to 8pm).

Outside of these hours please contact Mayflower ward on 01245 516303

Directions

Access the Hand Trauma Unit (B340) via the east entrance. Take the lifts to the 3rd floor and follow the corridor round to the left. We are situated passed theatres on the right.