Plastic Surgery…in the war

This week I have received some exciting news. No, I didn’t win the lottery, if that’s what you’re thinking. Or discovered a cure for cancer. I received a letter from a certain university which more or less confirmed my research placement for the summer of 2k17. However it’s is on the condition that I am accepted through the Nuffield summer placement. Without exaggeration, I opened the acceptance email and I gave myself a high five (sad, I know).
The short email was formal of course but I would like to summarise it to a brief ‘you go girl!’. This was I had waited for, my chance to discover a side of medical research, which is fundamental to medical discoveries. I will be undertaking a 4-6 week journey through the world of research based around infection, immune system and inflammation, so I decided it was appropriate to write this post surrounding this matter. So without further ado, let’s get started.

Perhaps I should explain myself before I dive into the topic, world war plastic surgery. It seems like the least appropriate topic but bear with me here. I was casually scrolling online on the web, as one does on most days and I came across a documentary which blew my mind (no war pun intended here), one of the lasting names Harold Gilles. A New Zealander otolaryngologist, (treats the head and neck regions) who revolutionised the modern industry of plastic surgery. For back in the days of war, being killed was not the worst thing for soldiers, no it was having to live with permanent disfigurement. Like a bad tattoo, it reminded them of the horror they had been though, however it like a tattoo it was not their choice. The reality of war was not merely the 6 figure death tolls or demolished countries, it was those who were left unrecognisable.

 

Harold Gilles

Facial reconstruction surgery was risky, it was in the early stages of development and with very little resources Gilles did the impossible. The surgeries relied on moving unharmed parts of the body, to the wounded parts. Second Lieutenant Henry Ralph Lumley was once of the most extreme cases by Gilles. Lumley had been severely burnt as a First World War pilot, so much so that I have not included the details. Like the thousands of wounded admitted to Sidcup in Greater London, his was sadly, a tragedy.

Henry Lumley before his injuries, hopeful for his future

Fuelled by previous attempts from grafting tissue by William Vicarage, Gilles embarked on his journey to save Lumley’s existent face, more importantly his life which was balancing on the verge of fatal infections. His plan was to carve out a skin mask from Lumley’s chest which can flipped up to reconnect with his exposed face. Now Gilles was in the process of experimentation, as with all new fields but he had mastered the art of minimising infection, which was vital when no safe readily available antibiotics was around. Whilst transferring parts of the patients’ body such as skin, the living tissue had to be in a constant blood supply, which was very difficult to do if you wished to remove it. Without the outer protection of out largest organ, the water and infection proof skin, microbes and pathogens plagues the body’s immune system and thus was born tubed pedicles. So how does one get around the implications of removing skin and the benefit of leaving it intact? Half removed it, no seriously, that is what a tubed pedicle is. A piece of tissue still attached to the body in a small area and rolled up so that the expose surface area is only the outer layer of skin. This piece was largely free from infection and could be moved across the length of the body. However Gilles’ task was too ambiguous and the grafting of the large section of skin from the chest, whilst being ill, resulted in Lumley’s heart failure and death. No doubt, Gilles had gained much expertise from his mistakes, from then on, he took less dramatic measures, decreasing the size of skin drafts.

William Speckley’s spectacular evolution

On a lighter note, perhaps the most successful of Gilles’ patients was Lieutenant William Spreckley. Like Lumley, he suffered from facial injury. Gilles had learnt about the ‘forehead flap’ which he applied to Spreckley. A piece of cartilage from the rib was taken and ‘grown’ under Spreckley’s forehead which was close to his disfigured nose. This acted as the foundations for his new nose as he had lost his previous nose cartilage. A tuned pedicle was then used to reconstruct the surface of the nose. After three years of work, Spreckley was discharged in October 1920, only 36.

In many of Gillies’ works, he proved perfectionist, he wasn’t aiming for solely functionality of the face but as close to ‘normal’ as he can do. Despite the sufferings of the patients, local residents were often scared at the sight of Gilles’ patients. Therefore though he was not a qualified psychiatrist, he did his best for the mental health of his patients. Mirrors were removed from the hospital which would have disheartening to see themselves in the recovery state. The surgeries only really gave a chance for war veterans to regain what they had lost, it was mostly up to themselves to discover their personalities again. They had to face the harsh realities of human nature, amputees were regarded as war heroes than those who had gone through painstaking years of surgery even after the war. For them the war had never been over, it was a civil conflict with themselves and society.

McIndoe, another giant of facial reconstruction

To, me the history of plastic surgery as we know it only add to the appreciation of the works done by Gilles and also Sir Archibald Hector McIndoe, a fellow plastic surgeon from New Zealand. It makes me rethink the perfectionists we have become today. We desire dangerous cosmetic procedures to add the icing on the cake for our unwounded faces.

Author – Jiangmin Hou
Jiangmin is a 5th year high school student currently studying five STEM subjects at Scottish Higher level-Mathematics, Physics, Biology, Computer Science and Chemistry. She is interested in pursuing a degree in Medicine after completion of Secondary Education.