Miss Georgina Williams: Transforming Lives Through Plastic and Reconstructive Surgery
Miss Georgina Williams is a consultant plastic and reconstructive surgeon at Imperial College Healthcare NHS Trust. She also covers the major trauma centre at St Mary’s Hospital when on call and is featured in the latest series of Channel 4’s Emergency documentary, operating on a patient who was attacked by several dogs. Discover the transformative impact of reconstructive surgery and the inspiration behind her career.
Do you have a typical working day?
My theatre days start at 07.30 in the pre-admission area where I review and consent patients having surgery and put surgical marks on them in preparation for their procedures. The surgical team, theatre staff and anaesthetists then come together for a meeting where we discuss the patient list for the day. We aim to start operating by 08.30 and stagger local and general anaesthetic cases throughout the day to maximise the efficiency of our theatre time. I’ll usually finish anywhere between 17.00 or 20.00 depending on how many patients are on my list. As a team, we also review patients after theatre to ensure they are well enough to go home.
What are your areas of expertise?
Head and neck as well as breast reconstruction are my areas of specialist interest and what I did my fellowship on at the Trust. Charing Cross has a strong history of free tissue transfer – a discipline within plastic surgery which involves taking tissue such as skin and/or fat or muscle from one area of the body, as well as its supplying artery and draining vein, and reconnecting it to another part of the body. For example, in breast reconstruction, I take skin and fat from the tummy – akin to a tummy tuck, but with it’s supplying and draining blood vessels, remove a small portion of rib under the breast area where there are vessels we can attach onto, and then connect the flap artery and vein to those running underneath the ribs. I then shape the skin or fat into a breast and close all the wounds.
Miss Georgina Williams
"As surgeons, we are trained to think in a logical way, especially when caring for trauma patients."
Channel 4’s Emergency shows how you operated on Heidi – a patient who came to St Mary’s after being attacked by several dogs. You described the wounds as “the most extensive dog bites [you’ve] ever seen”. What were your first thoughts upon realising the complexity of Heidi’s injuries?
As surgeons, we are trained to think in a logical way, especially when caring for trauma patients. Broadly speaking, the way we approach trauma patients is using principles from a course we do called Advanced Trauma Life Support (ATLS) which aims to recognise and manage life threatening issues in sequence from most to least life threatening. When I first saw Heidi, the main thoughts that ran through my head were: is she haemorrhaging? Do we need to stem the bleeding? How is her breathing, circulation, blood pressure and heart rate? Given the fact that A&E resus had successfully resuscitated her with blood and fluids and she was stable, I was able to take her to theatre early to thoroughly wash her injuries, trim away any dead tissue and administer antibiotics. I had to act quickly as saliva contains lots of bacteria which can cause devastating infection if not managed appropriately.
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 caring for someone like Heidi?
The major trauma pathway is a very well-oiled system and many teams interact smoothly in order to provide patients with the best care. It starts with prehospital emergency medical care delivered by the London Ambulance Service, and occasionally the helicopter emergency medical service. In resus, the on-call A&E consultant, trauma team lead, registrars, senior house officers and nurses assessed Heidi; the A&E team played a vital role in stabilising Heidi enough to go to surgery; and anaesthetists provided pain relief before surgery as well as the expertly-delivered emergency anaesthetic. Radiographers, scrub staff, healthcare support workers and operating department practitioners all provided support throughout Heidi’s surgery too, not to mention my own registrar and senior house officer who helped me perform the case. After I performed the initial surgery, the plastic surgery team at St Mary’s, who specialise in trauma, took Heidi back to theatre after 48 hours and performed a skin graft. A team of doctors, consultants and ward nurses with experience in caring for trauma patients, then took over Heidi’s day-to-day care.
Miss Georgina Williams
"The major trauma pathway is a very well-oiled system and many teams interact smoothly in order to provide patients with the best care."
Plastic and reconstructive surgery can be transformative. What is the impact of your work?
Reconstructive surgery can have a huge impact on a person’s quality of life. For breast cancer patients, the removal of one or both breasts can really affect their sense of identity, femininity and self-esteem. Reconstructive surgery can allow these patients to begin to accept their body again and come to terms with a new sense of self. Aside from an aesthetic and mental impact, reconstructive surgery can have a functional impact. Take for example, something like a facial nerve palsy; there can be devastating effects on a patient’s eyes with loss of tone, leading to laxity (looseness of a limb or muscle) and exposure of the eyeball itself which can compromise the patient’s vision. A simple procedure under local anaesthetic can protect the globe from exposure related damage, minimise side effects such as continual eye watering, and improve the aesthetic appearance.
In Heidi’s case, the surgery I performed minimised the risk of infection and made a skin graft possible which had a much quicker healing time compared to if we left the injuries to heal naturally. This allowed Heidi to move on to the rehabilitation part of her journey which is so important for trauma patients.
You are also involved in research. Tell us about this.
I have been involved in different types of research relating to plastic surgery throughout my training and as a consultant. I have co-authored chapters in textbooks for plastic surgery and I was the unit lead for a randomised control trial called NINJA which was organised through the Reconstructive Surgery Trials Network (RSTN) at Chelsea and Westminster as a trainee. This was to establish whether there was a difference in the different ways of managing a common type of paediatric hand injury. More recently I have focused my research efforts into breast surgery and head and neck surgery.
Miss Georgina Williams
"To make such profound changes to a person’s life within the space of a few hours or a day in surgery will never cease to inspire me."
What do you love the most about your job?
That is a difficult question! There is so much I love about my job. I love fixing things and solving problems whilst also having a strong interest in having an aesthetic outcome, which is essential in plastic surgery. Being able to do this using my hands, and to make such profound changes to a person’s life within the space of a few hours or a day in surgery will never cease to inspire me. I find it immensely humbling that my patients place their full trust and confidence in me.
Who is your biggest inspiration?
My father who was a neurosurgeon was my initial inspiration to read medicine – he instilled in me a fascination in science and a love of nature. My mother was widowed at a young age and went from being a radiographer to raising two young children (my brother and I) single-handedly and becoming a full-time carer for her mother who was very unwell. Seeing her endless compassion and hard work had a profound effect on me, more so as I grew up and reflected on the challenges she had to navigate. She always told me to believe I could achieve what I wanted if I put my mind to it, and for that I am so grateful.
As a trainee and fellow, the consultants in the Department of Plastic Surgery across Charing Cross and St Mary’s hospitals were hands down the most inspirational surgeons for me – they work so diligently for the benefit of their patients, never shy away from a challenge and support each other and their trainees. I am proud to have been a consultant colleague of theirs now.
