“Teamwork is what carries us through when we treat patients with such horrific injuries”: Meet Kshem Yapa, consultant plastic and reconstructive surgeon

To mark the launch of the second series of Channel 4's Emergency, we are publishing a series of Q&As with key staff involved in our major trauma centre.

No two days are the same in our major trauma centre. Here, Kshem Yapa gives us an insight into his role as a consultant plastic and reconstructive surgeon and shares his experience of treating 33-year-old Zoltan who features in Emergency, from refashioning and reconstructing his leg for a prosthesis, supporting his rehabilitation and being inspired by his positivity.

Tell us about your role and work in the major trauma centre.

I’m a plastic and reconstructive surgeon. I deal with some of the most severely injured patients who have lost soft tissue through injury, this includes skin muscle and nerve. I use various techniques to try and reconstruct soft tissue, including microsurgery, which helps us transplant blocks of tissue from one part of the body to another. I get to work with lots of different specialties such as orthopedics, vascular surgeons, and neurosurgeons.

No two days are the same and you get used to this degree of uncertainty. One of the unique things at St Mary’s is that anything can happen at any time and our doors are always open for new patients. So, while I have a basic outline of what my day could look like, I have to adapt as events unfold. I am primarily based at St Mary’s, but I also perform non emergency hand surgery operations that takes place at Charing Cross.

What was your role in Zoltan’s care?

Zoltan came to St Mary’s Hospital with severe crush injuries after being hit by a van whilst walking along a pavement in central London. Soon after I met Zoltan, I assessed whether his leg could be reconstructed and I had to tell him – as he was being wheeled into theatre – that unfortunately due to the nature of his injury, we would have to amputate his leg below the knee. He was incredibly brave and resilient and said, ‘do what you need to do’. I carried out the amputation and I was also involved in reconstructing his limb because he didn’t have a lot of skin – we had to use artificial skin so that he could have a below knee amputation, rather than an above knee amputation. I then had the privilege of following him in clinic and seeing his progress as he worked with our physiotherapists.

I also saw Zoltan a couple of weeks ago just before he was about to cycle from London to Brighton on the one year anniversary of his original injury. I have seen him through his whole journey and it’s been inspiring to witness his amazing recovery.

What is it like to break difficult news to patients, such as telling Zoltan you would have to amputate his leg?

It is very difficult. However, the fact that we have specialist teams on site – many of whom are leading experts in their field – makes this kind of news easier to break because we are confident that we have the best teams available to provide care to our patients. Zoltan is an example of this – he has been able to have the best possible outcome because of the multiple teams involved in his care.

As you have alluded to, it takes a whole team of people to care for trauma patients – can you give us a sense of the scale of the teams and disciplines involved in the major trauma centre, for instance in Zoltan’s care?

It is a real privilege to work in a centre where we have every specialty on site. We know that however serious the injury, we have everybody on site to provide the best possible joined up care. In Zoltan’s case, there were orthopaedic surgeons, vascular surgeons, me from the plastic surgery side, nurses, physiotherapists, and psychologists. Teamwork is what carries us through when we treat patients with such horrific injuries.

How long have you been at the Trust? What changes have you seen in the major trauma centre?

I have been at the Trust for three and a half years. I joined as a consultant at the start of the Covid-19 pandemic. It was a challenging time to treat trauma patients under these circumstances and then during the aftermath, where we experienced an increase in patients with self-harm and mental health issues. Since I joined, the burden on trauma has been going steadily up and the demands on the service have also been going up – things like knife crime and gang related violence have sadly contributed to this. As a team, we are constantly expanding; we currently have eight consultants, and we are looking to recruit more.

Would you recommend other people consider a similar career path?

Definitely. Major trauma is a very exciting and fast-paced specialty to be in. You step into people’s lives when they are at their most vulnerable and you get to put the skills that you’ve learned into use to have a positive impact.

The training is long and you have to be prepared to work hard. But despite this and the unique set of challenges that the NHS is currently facing, it is an immensely rewarding and exciting job.

What have been some of your career highlights and what have been some of the challenges?

In terms of career highlights, I’d mention two. When I was a trainee in Manchester, I was involved in caring for patients in the aftermath of the bombings at the Ariana Grande concert and I feel like I had a real impact there. It was a proud moment because I had learnt all these skills and I was able to put them into practice. My other career highlight is when I was appointed as a consultant at the Trust. This was the culmination of such a long journey and an incredibly proud moment. Then of course there are individual patient stories and positive outcomes which make the job worthwhile.

In terms of the challenges, you really need resilience – it is a long road and during training you often have to work in different centres around the country, which can be disruptive to your personal life. You have to sacrifice a lot. In terms of the job now, when you see and treat patients who are severely injured, you need to be conscious of the impact it has on you. It is important to have regular breaks, downtime and holidays – you can’t provide the best care unless you look after yourself as well.

Another challenge is our hospital estate and space – we have limited theatre capacity. We are a very busy centre with lots of different specialties and sometimes there just isn’t the theatre space to do the cases in as timely a fashion as we’d like. But I don’t think this is something that is unique to Imperial College Healthcare and things have improved – we now have a daily trauma theatre that is dedicated to plastic surgery, which wasn’t the case when I first joined.

From a plastic surgery point of view, what would be ideal would be to expand our space and manage our plastic surgery unit within a contained unit as we are always looking to develop new services. For example, we have a large population of diabetic patients who need reconstruction for their diabetic soft tissue wounds and to incorporate this service when we are already quite overwhelmed with trauma is very difficult.

Tell us about your other work in the Trust, including outside the major trauma centre.

I am an educational supervisor to several of the trainees, which is a really enjoyable part of my role. The field of plastic surgery is lucky to attract very able, enthusiastic and keen trainees so it is really fun to organise teaching days and mentor these individuals. It is important to invest in younger generations to protect both the specialty and the NHS.

What was it like being involved in the documentary and having cameras following you?

It was very strange at first as I’m not used to a microphone being attached to my scrubs! However, I got used to being filmed quite quickly and I think it was a good thing to be involved in as we want the public to know what work we do at our major trauma centre. I’m not sure that everyone really understands how busy we can be and some of the cases that we see. From a patient perspective it was also really important to be involved – I think Zoltan got a lot of motivation from having his journey and progress documented.

Zoltan’s story is incredibly inspiring – how often are you able to see the impact of your work like this?

All the time. As a consultant you see patients from their initial assessment and treatment through to your outpatient clinic so you can really see their progress. Not everyone is as motivated as Zoltan and not everyone has those really good outcomes, but quite often patients do and it is really inspiring. It teaches you to be more positive and grateful for what you have.

What’s your biggest inspiration at work?

I have three. Number one are my colleagues – they are enthusiastic, collaborative, innovative – and they inspire me to do my best work. Number two are our patients who overcome such awful injuries, and number three are our trainees, it is really inspiring to feel like I am doing something worthwhile in supporting them.

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