FACIAL RECONSTRUCTION IN WWI

Our latest guest piece on our WWI exhibition comes from the Royal College of Surgeons.

Having worked in otolaryngology, it was not until the First World War that Sir Harold Gillies (Fellow RCS 1901) began to develop maxillo-facial surgery and has since been considered by some to be the father of plastic surgery.

Gillies developed and devised independently the potential and varied applications of a new medical technique, the tubed pedicle and the twin tubed pedicle. This used grafted flaps of skin and also tissue from other parts of the body. He was distinguished for his thorough pre-operative planning clinics, which contributed to his precisely planned procedures.
Following the outbreak of the War, Gillies joined the Royal Army Medical Corps (RAMC). He witnessed first-hand the horrific effects of war and the disfigurement of men caused by battle. He also worked alongside renowned dentist Charles Auguste Valadier. Gillies became inspired about Valadier’s efforts to repair jaw wounds using new skin graft techniques. He also went on to observe renowned surgeon Hippolyte Morestin, a pioneer in maxillo-facial surgery, to learn more about skin grafting. Their advances underpinned much of the work that he later did and led him to recognise the need and importance to start special treatment in this field. He managed to persuade the War Office to allow him to set up a dedicated unit at Aldershot, Hampshire. Following the Battle of the Somme, Aldershot proved to be inadequately equipped to cope with the demand of the massive influx of casualties. Gillies pressed for a larger, purpose-built facility, devoted exclusively to plastic surgery, to replace the unit. With the help of Sir William Arbuthnot Lane, chief army surgeon of the RAMC, a hospital was built at Sidcup, Kent. The Queen’s Hospital opened in June 1917. It became the largest centre of its kind in the world and was developed as the War’s major centre for pioneering maxillo-facial and plastic surgery. Between 1917-1921, the hospital and its associated convalescent units admitted over 5000 servicemen and completed more than 11,000 operations.

Gillies often called on the talents of artists to help him. The sculptor F. Derwent Wood collaborated with Gillies in cases when the manipulation of living tissues needed to be supplemented with modelling in an artificial substance, such as wax. In 1915 the ex-surgeon turned artist Henry Tonks, volunteered to paint portraits of men with facial injuries and helped to design their repair.

The Team

The War led surgeons to attempt ground-breaking procedures, through trial, practice and experiment. In Gillies’ case, he had the foresight to use a multidisciplinary approach, working closely with a range of medical staff such as dental surgeons and other surgeons, who formed his team of experts (also consisting of physicians, anaesthetists, nurses, and artists) and this enabled him to carry out the pioneering work. The meticulous detail of the injuries recorded in the drawings and paintings helped record his procedures. These also act as a record of the extent of the horrific injuries sustained by the soldiers during the war. Gillies’ notes highlight the importance of record-keeping, and the way in which it served to influence future generations.

Gillies and his team made a significant contribution to the First World War through his innovative treatment and the advancement of reconstructive surgery.

After the War

Gillies saw that his new specialty was still necessary in peacetime. He set up in private practice, was elected to the staff at St Bartholomew’s and was appointed consultant in plastic surgery to the royal Navy, The Royal Air Force, the Queen Alexandra Military Hospital and, St Andrew’s Hospital, Dollis Hill, St James’s Hospital (Balham), the North Staffordshire Royal Infirmary, the London County Council Hospital, and the Ministries of Health and of Pensions.

Following the outbreak of the Second World War in 1939, he organised plastic surgical units in different parts of the country and personally supervised the largest unit at Park Prewett Hospital, Basingstoke. Shortly after the war, Gillies formed the British Association of Plastic Surgeons of which he was the first president. He was also honorary president of the International Society of Plastic Surgeons. He continued to train and teach people from all over the world, as well as, operating and advising. In 1920 his book ‘Plastic Surgery of the Face’ was published, setting down the principles of modern plastic surgery and becoming the leading textbook in its field.

After his death, the British Association of Plastic Surgeons created a fund in his memory to promote education and research in plastic surgery.

Engineers at War exhibition

Archives, Institution of Mechanical Engineering

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