History of Plastic Surgery

Harold Gillies went to Cambridge University to study medicine and qualified as a surgeon in the United Kingdom. When Gillies went to France in the year 1915 to fight in the First World War, he witnessed the facial wounds that were inflicted by the new style of warfare. The weapons used during WWI included heavy artillery that created injuries that were unseen before. Also, the heavy artillery caused a  rise in the number of facial injuries that were sustained by soldiers. During the war, shells were filled with shrapnel and were the reason as to why there were many facial and head wounds. The hot metal could tear through flesh to produce ragged wounds or even rip entire faces off. Facial injuries were untreated on the front line which meant there was a high rate of infection from the wounds since the shrapnel contained bacteria and dirt. Surgeons would sometimes stitch a wound together that would be missing a significant amount of flesh which resulted in faces being pulled in a grimace after healing.

When Harold Gillies returned back home to England, he set up a special ward for facial wounds at the Cambridge Military Hospital in Aldershot, England. Gillies was able to persuade his medical chiefs that a hospital that was dedicated for facial injuries was required to accommodate the demands of injured soldiers in 1916. After Harold Gillies had been able to persuade his medical chiefs, The Queen's Hospital was established at Frognal House in Sidcup, England, in 1917.

Gillies understood that healthy tissue needed to be moved back to its normal position and that gaps needed to be filled with tissue from other places on the body in facial surgeries. Before Gillies became interested in facial injuries and how to fix them, surgeons already had experience with skin grafts. After surgeons completed the work that was needed on the bone structure of a man's face, they started to work on the soft tissues in the face. Most successful skin grafting was to release and lift a large flap of skin, medically called a pedicle, from near the wound. With the pedicle still connected with the donor site, the free end of the pedicle would be swung over the site of the wound without severing the connection to the body. Maintaining a physical connection ensured that the blood was supplied to the skin which increased the chances of the graft being accepted by the body. 

Harold Gillies was puzzled on how to ensure that large skin grafts could be accepted over the site of an injury until he operated on William Vicarage. Gillies was able to develop a new method of facial reconstructive surgery in 1917. Gillies proposed that he could raise a ?Masonic Collar Flap' of skin from William Vicarage's chest to repair the lower part of his face. Gillies noticed that the edges of the pedicle flaps curled into themselves under tension, he then decided to sew the skin into a tube and discovered that the of was and the blood supply was better. Once the tubed pedicle became attached near the site of the injury, it could be cut away from the donor site then opened and spread out to graft a much wider area if required.

This operation marked a significant advance in reconstructing faces of severely injured men and established the foundations of modern plastic surgery. Harold Gillies was one of the people that recognized the disfigured men that came home from war would be at a disadvantage when looking for jobs. Patients of Harold Gillies responded differently to their operations. Many of his patients went home grateful for their surgeries while other stayed at the Queen's Hospital not wanting to show themselves to the judgemental people in the world.

Many of the techniques that Harold Gillies developed during the First World War are still used today in modern reconstructive surgeries. The idea of cosmetic plastic surgery additionally emerged as a result of Gillies work. Harold Gillies desire to restore normal appearance was considered revolutionary to the medical world. Patients could directly choose the nose or jaw that their doctors could build for them.

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