A coffee-break discussion by two Oxford surgeons about a difficult operation on a baby with a cleft palate sparked research into a new material for medical devices. The resulting invention by consultant plastic surgeon Tim Goodacre and registrar Marc Swan has yet to be used on a patient, but they are hoping clinical trials could start later this year.

However, ironically, the device may first come on the market for use in dental implants or skin reconstruction, rather than to treat the children whose plight the surgeons were focusing on.

The ‘expanding tissue’ implant is an example of how new technology is being enthusiastically embraced by surgeons — the subject of a study by Dr Eamonn Molloy and Maja Korica, of the Saïd Business School.

Dr Molloy said: “Surgeons are enthusiastic inventors. We tend to think that new technology 'hits' surgeons and that — sometimes reluctantly — they adopt it.

“The reality is very different. Surgeons are not only seeking out technological solutions to patient care and treatment, they are inventing responses and equipment themselves where they see the need.

“They are developing concepts and are designing, producing, testing and using these technologically driven treatments.”

The Oxford plastic surgeons' discussion was taken forward by materials scientist Prof David Bucknall, who has since moved to the Georgia Institute of Technology.

Three other researchers, Jan Czernuszka, Jinhyun Hannah Lee and Zamri Radzi, have been working on the idea at Oxford University's department of materials science.

Mr Goodacre explained: “When a child has a cleft palate, the repair that does the least damage is one that was invented in the 1880s. It's very crude, in a way, and we haven't advanced much in more than 100 years.

“Our motivation was to help these children with an operation that doesn't involve leaving raw areas in the mouth that take a long time to heal.”

The idea was to inject a hydrogel material that would expand gradually. The material could be removed later, leaving spare tissue to use in the repair.

The John Radcliffe surgeons believe the material developed at Oxford is better than a rival German device, because it expands in only one direction and more slowly.

Prof Bucknall returned to Oxfordshire to use the Isis neutron source at Harwell to look at the ‘hydrogel’ material molecule by molecule, to check that it would expand in the right way.

Prof Bucknall said: “Isis provided us with the high level of structural detail we needed to assess the new material. It gives unique and accurate results that we can’t obtain with any other technique.”

Mr Swan said: “It is an incredible facility and we are very fortunate to have it on our doorstep. It allowed us to show that the molecules are aligned in the right way.”

Clefts are the most common birth defect in Britain, with one in every 700 babies affected.

“Babies born with cleft palates usually have problems feeding, and may have speech difficulties in later life, as well as issues with their hearing, dentition and facial growth,” said Mr Swan.

“The most severe cases often have the least favourable outcomes and, unfortunately, these are the most challenging children to treat surgically.”

However, in commercial terms, this is a small market. The surgeons have been advised their best chance is to aim for larger, faster growing markets which are more attractive to investors.

Cleft palates are particularly tricky and it might be easier to introduce the technique for other birth defects, such as fused fingers.

The Oxford effort certainly backs up Dr Molloy's belief that surgery is an “open and innovative profession”, with surgeons keen to take up new technology.

He said: “They will look very pragmatically at any possible solution to improving care. They want new tools and are constantly pushing forward.”

The study revealed that new, technologically complex techniques are seen by some as a ‘young man’s sport’ and older surgeons who decline to move with the technology are seen as ‘past it’ and can suffer the commensurate loss of professional status and caseload.

“Most of the surgeons with whom we spoke were very aware of the importance of keeping abreast of new developments and of mastering new clinical technologies for the benefits of their career and professional standing,” said Dr Molloy.

Meanwhile, the Oxford plastic surgeons are learning a lesson in patience, and it could be at least two years before any device could come to market, with trials expected next year.

Mr Goodacre said: “We haven't tried it on a patient yet. I'm desperately wanting that to happen, but the task of getting through the licencing authorities is enormous — quite rightly.”

Angela Oldacres, of the university's technology transfer company Isis Innovation, said: “Diversifying into both dental and reconstruction makes the overall commercial proposition much more attractive to investors, which will help in getting this technology to market.”

n Isis is looking for commercial partners to help develop the technology. For more details, contact angela.oldacres@isis.ox.ac.uk