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How WWI played a key role to shape plastic surgery and modern stunning

Metrics from the First World War are horrendous. Estimates vary, but in total there were about 40 million military and…

Metrics from the First World War are horrendous. Estimates vary, but in total there were about 40 million military and civilian victims – 20 million deaths and 21 million injured. Never before had a conflict brought about such destruction in terms of death and injury. In response, during the four years of war, the military surgeons responded to new technologies in the battlefield and supportive hospitals, which during the last two years of the war resulted in more survivors of injuries that would have been fatal in the first two years. 1

9659002] On the west front, 1.6 million British soldiers were treated successfully and returned to the excavations. By the end of the war, 735,487 British troops had been exposed to major injuries. The majority of the damage was caused by blisters and scratches.

Many of the injured (16 percent) were injured on the face, more than a third of which were categorized as “difficult”. Historically, this was an area where very little had been tried, and survivors with major facial injuries were left with major malformations that made it difficult to see, breathe easily, or eat and drink.

A young ENT (ear, nose and throat) surgeon from New Zealand, Harold Gillies, who worked on the west front, saw an attempt to repair the damage in facial injuries and realized that there was a need for specialized work. The time was right because the military medical leadership recognized the benefit of establishing specialist centers to deal with specific injuries and wounds, such as neurosurgical and orthopedic injuries or victims of gasification.

Gillies was advanced and January 1916 established Britain’s first plastic surgery unit at Cambridge Military Hospital in Aldershot. Gillies toured basal hospitals in France to seek suitable patients to be sent to his unit. He returned expecting about 200 patients – but the opening of the unit coincided with the opening of the Somme Offensive 1916, and over 2000 patients with facial injuries were sent to Aldershot. Treatment is also required for seamen and pilots suffering from facial burns.

A strange new art

Gillies described the development of plastic surgery as a “strange new art”. Many techniques were developed by attempt and error, although some reflected work that had been done centuries earlier in India. One of the most important techniques that Gillies developed was tube poison skin transplantation.

A flap of the skin was separated but not separated from a healthy part of the soldier’s body, sew in a tube and then suture to the injured area. A period of time required for a new blood supply at the implant site was required. It was then loosened, the tube opened and the flat skin sewn over the area that needed the lid.

One of the first patients to be treated was Walter Yeo, Gunnery warrant officer at HMS Warspite. You have sustained facial injuries during the Battle of Jutland in 1916, including the loss of his upper and lower eyelids. The pipe pedal produced a “mask” of the skin grafted over the face and eyes and produced new eyelids. The results, but far from perfect, meant that he had a face again. Gillies continued to repeat the same kind of procedure on thousands of others.

There was a need for major surgical and postoperative treatment facilities and also the rehabilitation of patients, together with the various specialties involved in care. Gillies played a major role in designing a specialized device at Queen Mary’s Hospital in Sidcup, Southeast London. It opened with 320 beds – and at the end of the war there were over 600 beds and 11 752 operations had been carried out. However, reconstructive surgery continued long after the hostilities ceased, with approximately 8000 military subjects treated between 1920 and 1925. The device finally ended in 1929.

The details of the damage, the actions to correct them and the final results were all recorded in detail, both through early clinical photography and also through detailed drawings and paintings created by Henry Tonks who, despite being trained as doctors, had given up drugs for painting. Tonks became a war artist on the west front, but then went to Gillies to help not only with the recording of the new plastic procedures but also with his planning.

The Only Real Development

The complicated facial and head surgery required new ways of delivering anesthetics. Anesthesia had generally developed as a specialty during the war years – both in the way it was administered and also how doctors were trained (formerly anesthetics had often been given by a younger member of the surgical team).

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Survival from operations requiring anesthesia improved, although technicians were still based on chloroform and ether. Queen Mary’s stunning team developed a method of sending a rubber tube from the nose to the trachea (trachea), as well as working on the endotracheal tube (the mouth of the trachea), made of commercial rubber hose. Many of their technologies are still in use today. As an Austrian doctor wrote in 1935, “ Nobody won the last war without medical care. The increase in knowledge was the only determinable gain for humanity in a devastating disaster.”

Robert Kirby is a professor of clinical education and surgery at Keele University . This article first appeared on The Conversation (theconversation.com)

The author would like to confirm the assistance of Norman G Kirby, General Director (Retired), Chief of Army Surgery 1978-82

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