Plastic surgery as a medical specialty was born out of the horrors of World War I and the tremendous toll taken on mankind. Besides the thousands of soldiers who were killed, millions more were crippled or hideously deformed, requiring ingenious and specialized surgical treatment.
Never Been Seen
Surgeons at the time faced gaping skull wounds, severe facial burns, shattered jaws, and noses and lips that were shot off--injuries of a type and severity that had never been seen before.
As described by plastic surgeon James, H. Carraway, M.D., they could be attributed to modern weaponry: "When the engines of planes caught on fire, soldiers' faces would get severely burned, when planes crashed. Soldiers' heads would hit the control panels] and they would sustain severe fractures. Sniper trench warfare also caused soldiers to sometimes have their jaws blown off." Ironically, steel helmets that soldiers wore saved lives, but when hit [these helmets could shatter into steel shards that injured soldiers' unprotected races.
Impetus Of Faciomaxillary Injuries
Plastic surgery made its debut by the impetus of faciomaxillary injuries, so severe and new to surgeons, other technological advances moved the discipline of plastic surgery forward, such as improved anesthesia techniques, utilization of antiseptic surgical techniques, and the availability of the electric light bulb to illuminate the surgical field and body cavities.
Failure To Understand
According to Bamji Andrew, M.D., curator of the Gillies Archives, Queens Hospital, Sidcup, "Prior to the 20th century, plastic surgery existed but was hamstrung by a lack of anesthetics and a failure to understand the problems of infection. Techniques developed in an inchoate and uncoordinated way, with little direct communication between surgeons. The First World War changed that by simply producing huge numbers of patients with facial injuries.
Sir Harold Gillies
Founding fathers included Sir Harold Gillies, born in New Zealand and trained as an otolaryngologist; Vilray Blair, an orthopedic surgeon from St. Louis; Robert Ivy, a general surgeon from Philadelphia; Lee Cohen, an American otolaryngologist who studied in Europe; and Varaztad Kazanjian, an American immigrant who studied dentistry at Harvard Dental School and worked on the staff at Massachusetts General Hospital.
Treatment For Soldiers
Plastic surgery was needed by the many soldiers. In Britain, injuries of wounded soldiers were managed comprehensively, beginning with treatment on the battlefield, leading eventually to treatment at a rehabilitation hospital as necessary. Harold Delf Gillies, M.D., a young army doctor at the center at Shepherd's Bush, treated soldiers with severe skeletal injuries, nerve lesions, and orthopedic problems.
As an otolaryngologist, he saw an urgent need to separate soldiers with facial and maxillary injuries from the rest, and offer them specialized treatment. Operating with dental specialist, Auguste Valadier, Dr. Gillies learned how to repair jaw defects by using tissue and bone from other parts of the body. He read about and learned about these injuries by meeting with other surgeons, such as plastic surgeon Hippolyte Morestin.
He thought that soldiers with facial injuries should be segregated and given special attention, so he successfully arranged for Cambridge Hospital to open. On European battlefields, injured soldiers were transferred to Cambridge hospital if pinned with labels (that Dr. Gillies reportedly bought himself), that read "Faciomaxillary injury--Cambridge Hospital, Aldershot."
Plastic surgery was not used widely at then time. In 1916, 2,000 soldiers with Faces or jaws shot away arrived from the Battle of Somme. Suffocation, sepsis, gangrene, and hemorrhage loomed, and they often arrived at the hospital crying, "Kill me, kill me." Operating on these soldiers, Dr. Gillies became proficient at creating skin flaps to reconstruct noses, mouths, eyelids, and ears. In 1915, Varaztad Kazanjian, a dentist at the time, became chief dental officer of the British Army's first Maxillofacial Treatment Center in France.
Miracle Man of the Western Front
While soldiers were to be returned to England within three weeks, some chose to stay for further treatment. "The severely wounded and disfigured men were loath to be seen by member of their families," Dr. Kazanjian said. Surgeons would wire small fragments of jaw together, devise splints to hold the jaws of patients who had no teeth, and construct internal facial splints of vulcanized rubber to prevent the patient's face from contracting until more extensive bone grafting could be tried. For these feats, he was referred to as "Miracle Man of the Western Front."