1.
An injury caused by trench
warfare
A million
British soldiers died in World War One, and double that amount came home
injured. For many of those lucky enough to return, the wounds they had suffered
in Europe would leave them permanently disfigured.
The trenches protected the bodies of soldiers, but in doing so it left
their heads vulnerable to enemy fire. Soldiers would frequently stick their
heads up above the trenches, exposing them to all manner of weapons.
At the start of the war, little consideration was given to the trauma of facial
injuries. It came as something of a surprise that so many victims survived to
the point of treatment. Escaping the war with your life was seen as reward
enough. The advent of plastic surgery would radically change that perception.
2.
The man who fixed faces
The biggest killer on the battlefield and the cause of many facial injuries
was shrapnel. Unlike the straight-line wounds inflicted by bullets, the twisted
metal shards produced from a shrapnel blast could rip a face off.
Not only that, but the shrapnel's shape would often drag clothing and dirt
into the wound. Improved medical care meant that more injured soldiers could be
kept alive, but urgently dealing with such devastating injuries was a new
challenge.
Harold Gillies was the man the British Army tasked with fixing these grisly
wounds. Born in New Zealand, he studied medicine at Cambridge before joining
the British Army Medical Corps at the outset of World War One.
Gillies was shocked by the injuries he saw in the field, and requested that
the army set up their own plastic surgery unit.
Soon after, a specifically-designed hospital was opened in Sidcup. It
treated 2,000 patients after the Battle of the Somme alone. Here Gillies would
do some of his finest work.
Previously viewed with suspicion, facial reconstruction became an integral
part of the post-war healing process. However, in a world before antibiotics,
going under the knife for an experimental form of surgery posed as many risks
as the trenches themselves.
3.
Early success
Facial reconstruction was still a primitive form of surgery.
Experimentation was part of the process and Gillies tried a number of different
methods he had learned from books.
Lieutenant William Spreckley, above, was one of Harold Gillies’ biggest
successes. To fashion him a new nose, Gillies hit the books and came across an
old Indian idea known as the ‘forehead flap’. He took a section of rib
cartilage and implanted it in Spreckley’s forehead. It stayed there for six
months before it could be swung down and used to construct the nose. From start
to finish, the process took over three years. Spreckley was admitted to
hospital in January 1917 at the age of 33 and discharged in October 1920.
4.
What Gillies discovered
Gillies knew that when taking skin from one part of the body to another, it
had to remain attached to survive. He also knew that doing so without
antibiotics would be incredibly dangerous. How he did it would prove to be his
greatest innovation.
His solution involved leaving the flesh attached at one end, rolling it
into a tube and attaching the other end near to where the graft was needed.
Called the tube pedicle, this method allowed Gillies to move tissue from A to B
without worrying about infection. Living tissue was encased by the outer layer
of skin which was waterproof and infection resistant. Gillies was able to leave
these tubes in place for weeks at a time, with little risk. This greatly
reduced the chances of something going wrong. Once a blood supply had grown
into it from the new end, the original connection could be cut. From there the
flesh could be swung into place.
5.
Life after surgery
Many of Gillies’ patients
would never overcome the psychological impact of their injuries.
Despite surgical advances,
disfigurements remained profound, and patients often couldn’t face going out in
public. Some continued to cover their faces despite surgical success.
Inside the hospital, mirrors
were removed to stop them seeing their reflection and fainting. Given the time
it took to carry out complex facial reconstruction, some patients would go
years without properly seeing themselves in the mirror.
Four views of
facial reconstruction after a war wound, July 1916
Nearby park benches were
painted blue to designate them for men with facial injuries. However it was
also done to warn local residents that the appearance of men using them may be
distressing.
Some men could re-enter the
workforce, but they were often too embarrassed to be in public and so would be
hidden away in back-rooms.
Others became completely
withdrawn, unable to face their wives, families and friends.
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