Harold Gillies had always been an imaginative and able doctor but until 1914 he was as famous for his golf and practical joking as for his surgical talents. When war broke out the 32 year old New Zealander joined the Royal Army Medical Corps and was sent to the 83rd Dublin General Hospital at Wimereux. There he supervised the work of an untrained but creative dentist, Charles Valadier, who was experimenting successfully with skin and bone grafts to repair the severe facial wounds which often occurred in the Trenches.
Intrigued by what he saw Gillies moved away from the front to Paris where Hippolyte Morestin was conducting similar work, albeit in a more conventional surgical environment. Inspired by the Parisian he returned to England to advocate for the establishment of specialist plastic surgery units. Despite scepticism from the medical world by January 1916 Gillies was in charge of a small team based at Aldershot.
Rejecting the advice of contemporaries to use synthetic materials for reconstruction Gillies built upon the grafting work of Morestin and Valadier by focusing above all on functionality. Gillies first major influx of casualties came from the battle of Jutland, and along with them came his most enduring surgical innovation.
William Vicarage had lost most of his jaw in the battle and to restore it demanded extensive grafting. Vicarage’s new jaw was made from skin grafted from his shoulders, Gillies left the grafted skin attached at the shoulder and fashioned it into a tube maintaining blood flow and thus encouraging it to take to the new site. He named his invention the tube pedicle and it went on to become a fundamental technique of reconstructive surgery that was used in widely both world wars.
Despite handling the Jutland casualties well the Aldershot unit was unprepared for the volume casualties received from the Somme. In anticipation of the offensive Gillies was granted 200 additional beds, but within days 2,000 casualties had arrived. The army consequently moved the plastic surgery team to the larger Queen Victoria Hospital at Sidcup in 1917 where they dealt with injuries from Passchendaele.
Gillies became known as ‘the father of plastic surgery’ for his work and in 1930 received a knighthood in recognition of his important breakthroughs. He continued to work with casualties from the war beyond the armistice, finally completing his work in 1921.
Despite impressive progress in surgical techniques the psychological impact of severe facial disfigurement continued to be problematic. Mirrors were banned in Gillies’ wards because of their distressing and demoralising impact. Plastic surgery patients were disproportionately depressed, disturbed and suicidal even compared the already high levels of psychological trauma caused by World War One. Furthermore the volume of casualties meant that not everyone who needed treatment got it, and those who did couldn’t rely on getting the best out of their surgeons. For some tin masks stood in for surgical reconstruction but the expressionless plates were a poor substitute given that Gillies aimed for fully functional flesh and blood reconstruction.