As Seen in The News Journal 11-6-16
“Unlike the student of today, who is weaned on small scar excisions and graduates to harelips, we were suddenly asked to produce half a face.”
This quote, from Sir Harold Gillies, describes the challenges faced by reconstructive surgeons after World War I. At the outbreak of WWI, there was no recognized specialty of plastic surgery in the United States.
During World War I, over 21 million soldiers were injured. The injuries tended to be far more severe than in previous conflicts, due to the advancement of military weaponry. There were also more facial injuries due to fighting with trench warfare, which exposed the head to gunfire.
There was suddenly a great need for reconstructive surgeons. The specialties of otolaryngology (ear, nose, and throat), oral and maxillofacial surgery, general surgery and dentistry pooled their expertise to treat the unfortunate soldiers. The new specialty, Plastic Surgery, was named after the Greek word “plastikos” meaning “to mold, or form”.
Surgeons like Sir Harold Gillies of Britain helped to develop the practice of plastic surgery as it is practiced today. On one single day in July of 1916, Gilles and his colleagues were sent some 2,000 war casualties. Gilles tried new ideas and techniques, some with great success and some with utter failure.
Gilles frequently used tubed skin flaps to rotate skin from one portion of the body to another, such as forehead skin to recreate a nose.
This is done by lifting a “trapdoor” of tissue, rolling it into a tube shape, and attaching the end of the tube to a new location. After a few weeks, new blood supply will be established there and the tube can be detached at its origin and trimmed to fit the defect.
Gilles was the first to realize that these flaps could be moved longer distances by “waltzing” them up the body, first tethering an arm to, for example a thigh or abdomen, then dividing and moving the tubed flap to wherever the arm could reach.
He also refined the techniques of skin grafting, showing that grafts between identical twins would not be rejected, unlike grafts transferred from an unrelated person.
This was the one clue in the discovery of the body’s immune system, which attacks foreign tissue. To this day, transplantation of any living tissue from one person to another (except identical twins) requires a lifetime of immunosuppresive drugs.
The reconstructions were painstakingly slow, and in the pre-antibiotic era, infections were always a significant risk.
Sadly, World War II brought another influx of reconstruction patients for surgeons to work on. Many of the soldiers were airmen who were badly burned.
Burn care was poorly understood, and patients endured painful dressing changes, eventually frequently succumbing to infection Those that did survive were institutionalized in order to “shield” (or hide?) them from society.
Dr. Archie McIndoe, from New Zealand, joined his esteemed older cousin, Dr. Harold Gilles, in his practice of facial reconstruction. McIndoe was a gifted surgeon and innovator, dedicated to restoring the best cosmetic outcome to the deformed faces of the soldiers.
McIndoe literally ran the Queen Victoria Hospital , and his “Ward 3” became known for its innovative plastic surgery as well as the antics of its men.
Because of the long stays and multiple surgeries, the men became close (it also helped that McIndoe provided free beer on the ward).
The men respected McIndoe’s pioneering spirit, and were grateful to be in his care, calling him “Maestro” and “The Boss”. They also formed a group, which they dubbed “The Guinea Pig Club”.
In Kevin Fong’s book, “Extreme Medicine: How Exploration Transformed Medicine in the 20th Century”, the author describes in detail what it was like to be a patient of Dr. McIndoe’s and the challenges the men faced when trying to integrate back into society.
Fong writes, “Gallows humor became de rigueur for the Guinea Pigs. They recruited a treasurer with badly burned legs, so that he wouldn’t run off with the petty cash, and a secretary whose fingers had been injured, so he couldn’t keep minutes.”
Many of the reconstructive techniques in daily use today can be traced back to the dedicated and innovative surgeons in the post-war eras. Their “guinea pigs”, the brave men who were injured in the wars, contributed greatly to the knowledge of plastic surgery.