Consultant Head & Neck/Maxillofacial Surgeon
Honorary Senior Lecturer Department of Cancer Studies & Molecular Genetics
Regional Head & Neck Oncology Lead for National Institute of Health Research, UK.
Head of Leicester Maxillofacial Research Group. University Hospitals of Leicester NHS Trust
Correspondence Address: Maxillofacial Unit, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester LE15WW email
Chris Avery has been a Consultant Maxillofacial Surgeon at the University Hospitals of Leicester NHS Trust since 2000 and is Honorary Senior Lecturer in the Department of Cancer Studies & Molecular Genetics. I studied dentistry at Bristol (1984) and read Medicine at Cambridge (1992), gaining many prizes. I was awarded the gold medal for the FDSRCS (England) examination. My research qualifications include Master of Surgery (MChir) and Doctorate of Medicine (MD).
The main areas of clinical research include head and neck malignancy, reconstructive free flap surgery, management of morbidity at the flap donor site, novel surgical techniques, PEG feeding, salivary gland surgery and other related topics. Laboratory based research includes the biomechanical aspects of plate reconstruction at the radial free flap donor site and the mandible using a finite element analysis model. Basic oncology projects include the role of EMT proteins in oral cancer. I act as a supervisor for higher research MEng, MD and PhD degrees.
I have published over 70 original papers and leading review articles covering many aspects of oral and maxillofacial surgery, not exclusively cancer, and have contributed several book chapters.
There is a strong personal commitment to supporting trainee surgeons who want to present work at the BAOMS Annual Scientific Meeting and other International surgical meetings. Leicester has the consistently featured within the top 5 units for the number of presentations at BAOMS over the last decade and has a very high rate of successful conversion to publication 1-3. There are two maxillofacial clinical research fellows and these positions have been used by trainees to further their research interests often before taking a substantive higher surgical training post.
Chris Avery has a young family and many outside interests including playing football at the lowest competitive level!
1 Collier JM, Vig N, Hammond D. Publish or perish? Br J Oral Maxillofac Surg. 2010 Oct;48(7):540-3.
2 Avery C, Clifford N, Thakrar M, Neal CP, Brennan P. Leading Article: Trends in presentations at BAOMS Annual Scientific Meetings. Face Mouth & Jaw Surg 2011;1:38-47.
3 Avery C, Clifford N, Neal CP. Oral & Maxillofacial surgery “presentation hotspots” in the UK over the last decade from the BAOMS annual meetings. Br J Oral Maxillofac Surg 2013;51:453-456.
Six key words that describe my research interests.
Flap, reconstruction, morbidity, oncology, biomechanical, gastrostomy.
How I first began pursuing research:
I have always been interested in clinical and basic science. Ideas that have a practical impact on surgical practice are particularly appealing. Having published within every surgical placement has broadened my range of surgical interests. Working on the transplant team with Professor Sir Roy Calne FRS, in Cambridge, was inspiring and consolidated my desire to become a properly trained surgeon with a broad and deep range of surgical skills whilst retaining an active interest in research.
Higher research degree:
MChir [Master of Surgery] and MD [Doctor of Medicine].
Higher research degree University:
Cambridge and Leicester
I supervised myself
Higher degree thesis abstract:
The radial free flap is the flap of choice for reconstruction of the majority of soft tissue defects of the oral cavity. My MChir Thesis reviewed the significant incidence of donor site morbidity associated with the conventional fasciocutaneous and osteocutaneous versions of the flap. The work includes one of the first detailed descriptions of the suprafascial dissection technique and anatomy of the septocutaneous flap. The first description of prophylactic internal fixation of the radial osteocutaneous donor site is included and this technique is now widely used to substantially reduce the incidence of fracture. A biomechanical laboratory model was developed to investigate the strengthening effects of different types of bone plates. Wound management and surgical techniques were developed to further minimise morbidity by improving the success rate of skin grafting at the radial donor site. My MD thesis developed these themes and also included our finite element analysis model of the radius and mandible which has been used to study the complex biomechanics of plate fixation.
Main sources of research funding:
My clinical and laboratory studies did not require substantive grants but minor support from the Maxillofacial department, Synthes (UK) and BAOMS.
Clinical commitment during research period:
I undertook my research thesis whilst a full-time Consultant Surgeon within a unit without an established track record of research, which is not ideal. We have now established a maxillofacial research group with International collaboration.
Current and ongoing research:
There are several ongoing clinical research and audit projects related to various aspects of free and pedicle flap surgery, novel surgical techniques, use of percutaneous endoscopic gastrostomy and improving outcomes for the oncology patient.
Biomechanical studies are in co-operation with the Professor Jingzhe Pan, Head of Mechanical Engineering in Materials at the University of Leicester. Professor Pan has expertise in the modelling of biomaterials for orthopaedic fixation and tissue engineering, bioresorbable materials and finite element analysis modelling. This often involves working with post-graduate engineering students.
One of our oncology higher surgical trainee’s, Mr Alistair Fry, is undertaking an MD based on a oncology molecular biology study of the role of EMT related proteins in oral squamous cell carcinoma. The laboratory work is in collaboration with Dr Eugene Tulchinsky, Head of EMT research at Leicester University and with Professor Ian Mackenzie at the Blizard Institute, London who has an interest in Stem Cells and EMT.
Current active grants and project titles:
BAOMS – Investigation of the role of ZEB1 and ZEB2 (SIP 1) in Epithelial Mesenchymal Transition in Oral Squamous Cell Carcinoma Progression.
2013 BAOMS Maxillofacial Research Grant and the 2014 Royal College Surgeons Research Fellowship [https://www.rcseng.ac.uk/fds/news/2014-fds-research-fellowship-awarded].
Advice for OMFS researchers:
Decide if you want to be an academic or a surgeon with an academic interest. I have always considered myself to be the latter and find the clinical element of my work to be an extremely important source of professional satisfaction.
All seemingly good ideas should be subjected to early critical analysis by both yourself and colleagues so that unsuitable projects may be eliminated at an early stage.
Projects should be well defined, topical, achievable, presentable and ultimately publishable. I hope that a paper may change the clinical practice of my colleagues as there is no more critical audience than your surgical peers.
Try to avoid multi-centre trials or projects that involve your peers collecting data. They are often happy to have their name on your paper but less enthusiastic about doing the work so the project may fail!
All trainees have a CV with a list of work in progress but few have successfully published in a respected peer reviewed journal. Will this be you when sitting down for a consultant interview?
If you can work within an environment that nurtures research and has a proven track record of success then you will find there is much support and wise counsel readily available.
Difficulties encountered when returning back to Specialist training:
My difficulty was that the opportunities for undertaking research whilst obtaining a full surgical training were limited at that time but opportunities have since increased substantially. I undertook the bulk of my Thesis research work whilst a Consultant. This had the advantage that I had not compromised my surgical training and I had a reliable financial income but was challenging. Although I successfully supervised myself this is not to be recommended. Ideally you should combine clinical work with research in a department with an established research programme and financial support.
Best ten papers published 2010-2014:
Avery C. A Review of the Radial Free Flap: Still Evolving or Facing Extinction? Part One. Soft Tissue Radial Flap. Br J Oral Maxillofac Surg 2010;48:245-252. http://dx.doi.org/10.1016/j.bjoms.2009.09.004
Avery C. A Review of the Radial Free Flap: Still Evolving or Facing Extinction? Part Two. Osteocutaneous Radial Flap. Br J Oral Maxillofac Surg 2010;48:253-260.http://dx.doi.org/10.1016/j.bjoms.2009.09.017
Avery C, Crank S, Neal CP, Hayter JP, Elton C.The use of the pectoralis major flap for advanced and recurrent head and neck malignancy in the medically compromised patient. Oral Oncol 2010:46:829-833.http://dx.doi.org/10.1016/j.oraloncology.2010.08.004
Avery C, Martin T, Parmar S. The use of the anatomically contoured low profile unilocking titanium radial plate for prophylactic internal fixation of the radial osteocutaneous donor site. Br J Oral Maxillofac Surg 2011;49:152-153. http://dx.doi.org/10.1016/j.bjoms.2010.01.013
Avery C. The sternocleidomastoid perforator flap. Br J Oral Maxillofac Surg 2011;49:573-575. http://dx.doi.org/10.1016/j.bjoms.2010.09.008
Avery C, Sundaram K, Jasani V, Peden A, Neal CP. A comparison of sensory recovery at the subfascial and suprafascial donor sites of the free radial flap. Br J Oral Maxillofac Surg 2012:50:495-499. http://dx.doi.org/10.1016/j.bjoms.2011.10.011
Bujtar P, Simonovics J, Sandor G, Jingzhe P, Avery C. Refinements in osteotomy design to improve structural integrity: a finite element analysis. Br J Oral Maxillofac Surg 2013:51:479-485. http://dx.doi.org/10.1016/j.bjoms.2012.09.015
Avery C, Bujtar P, Simonovics J, Sándor G, Pan J, Váradi K. A finite element analysis of bone plates available for prophylactic internal fixation of the radial osteocutaneous donor site using the sheep tibia model. J Med Eng Phy 2013:35:1421-1430. http://dx.doi.org/10.1016/j.medengphy.2013.03.014
Avery C, Ghandi N, Peel D, Neal CP. Indications and outcomes for 100 patients managed with a pectoralis major flap within a UK maxillofacial unit. Int J Oral Maxillofac Surg 2014: 43: 546–554. http://dx.doi.org/10.1016/j.ijom.2013.10.009
Bujtar P, Simonovics J, Váradi K, Sándor G, Avery C. The biomechanical aspects of reconstruction for segmental defects of the mandible: a finite element study to assess the optimisation of plate and screw factors. J Craniomaxfac Surg 2014:6:855-862. http://dx.doi.org/10.1016/j.jcms.2013.12.005