|Facsimile of a wax teaching model made by Sergeant Thomas H. Kelsey for the New Zealand Medical Corps facial and jaw injury unit, c. 1917. British National Army Museum Copyright, released under CC BY-NC-ND 4.0 license.|
“A chirurgien should have…the harte of a lyin…the eyes of a hawke…[and] the hands of a woman.”
– John Halle, English surgeon (c. 1529–c. 1568)
Dr. Harold Gillies (1882–1960) was born in New Zealand to a family of Scottish origin. He studied medicine at Cambridge and took further training in otorhinolaryngology. When the First World War started, he volunteered for service but was not called up until 1915. This was a war where “military technology had wildly surpassed…medical capabilities.”
Machine guns and artillery killed and maimed. Flame-throwers produced horrific burns. Tanks crews suffered from burns and shrapnel injuries when a tank was hit by shellfire. Pilots were burned and disfigured in plane crashes.
In 1915, Dr. Gillies was sent to France. He quickly understood that his narrow surgical skills were not enough to treat men with “noses…blown off…jaws…shattered, tongues…torn out, and eyeballs…dislodged. In some cases, entire faces were obliterated.” The loss of a limb might make a soldier a “hero” to the people back home. But the destruction of a jaw or any part of the face made a soldier an outcast, a monster, arousing “feelings of revulsion and disgust” in others, and very often in himself. In France, mutilated soldiers were called les gueules cassés (“broken faces”). Reconstructive surgery was needed to restore function (eating, swallowing, speech) as well as appearance. Dr. Gillies threw himself into this mission and persevered, treating over 2,000 patients during the war. There was no sense, he realized, in restoring an outward appearance by surgically altering soft tissues (skin, muscle) without providing a structural framework of bone or cartilage taken from other places on the patient’s body.
Skin can be used to repair wounds in two ways. A graft is a piece of skin completely detached from its site of origin and placed on a wound. The graft may survive if new blood vessels form quickly and enter the graft to keep it alive. Often, grafts fail. The second approach is to treat a wound with a “skin flap,” a peninsula of tissue that remains attached on one side to the original, uninjured site and retains its blood supply. The flap is maintained until the tissue of the flap is supplied with blood vessels from the wound site. It is then cut free from the one side of original attachment.
Gillies learned these techniques, and improved his skills, by doing them. His great contribution—earning him the title of “father of modern plastic surgery”—was what he called the “tubed pedicle.” Here, the skin flap was made into a cylindrical shape, skin side out, and the free end stitched to the site of injury (figure). This kept the raw underside of the flap enclosed and less exposed to infection.
He was not only a skilled, creative surgeon, but a doctor who respected and encouraged his patients. They needed hope and encouragement to undergo the dozens of procedures, staged at intervals, to produce a more-or-less satisfactory result. He personally said to every new patient, “Don’t worry, sonny…You’ll be all right and have as good a face as most of us before we are finished with you.”
Gillies assembled a team of surgeons, anesthetists, dentists, radiologists, artists, sculptors, and photographers. All surgery was documented by drawings or photos for the instruction of other plastic surgeons. After bureaucratic objections and more of Dr. Gillies’ persistence, the Queen’s Hospital in Sidcup, Southeast London, was established as the place where facial reconstruction of British servicemen and -women took place. He wrote Plastic Surgery of the Face in 1920 and in 1957, Principles and Art of Plastic Surgery with Ralph Millard, a former Gillies trainee. He worked to get plastic surgery recognized as a legitimate branch of surgery.
During World War Two, he again worked as a plastic surgeon and performed some genital reconstructions. In 1945 he began a series of surgeries to construct a penis in a woman undergoing gender change. The phalloplasty technique Gillies used is the basis for the surgical technique used today. In the 1950s he taught plastic surgery techniques in Europe and in India.
This book is not a hagiography. The reader learns of Gillies’ errors in judgement and his personal quirks. There are also interesting asides about the assassination and tangle of alliances that drew Europe into the First World War, a short history of blood transfusion, and the “Spanish flu.”
HOWARD FISCHER, M.D., was a professor of pediatrics at Wayne State University School of Medicine, Detroit, Michigan.