Wartime Plastic Surgery
While the physicians of ancient times made crude efforts at plastic or reconstructive surgery, the real birth of modern plastic surgery came as a response to the battlefield injuries of World War One. That war was, to a great degree, fought in the trenches. The result was a disproportionate number of head and facial injuries, injuries whose scars would be forever on view for those that survived.
That led pioneering British doctor Sir Harold Gillies to establish a wartime medical center designated solely for the purpose of surgical reconstruction meant to minimize the visual effects of wartime wounds. This was Cambridge Hospital, where Doctor Gillies and other physicians established such procedures as utilizing healthy tissue to repair open wounds – in other words, the skin graft.
World War I French, German and ultimately American military units also developed special medical teams for the treatment of disfiguring wounds. In these clinics the staff undertook the initial efforts at lower facial reconstruction (the maxillofacial area) and the use of skin flaps taken from one portion of the body to repair another – such as cartilage grafts for the nose and scalp and brow flaps used for lip reconstruction.
World War Two also accelerated the use of reconstructive plastic surgery. While the U.S. Army had neurosurgery, ophthalmology, orthopedic surgery, oral surgery and other specialties in their table of organization, there were no plastic surgeons per se. In some army hospitals the various units worked together in developing surgical and treatment centers. Out of these collaborations several new procedures emerged.
By the end of the war, there were nine plastic surgery centers in the new Veterans Administration Hospitals across the United States. Their focus was solely reconstructive, and in 1946, there were between 1,000 and 1,700 patients at each center with others overflowing into the orthopedic wards and other floors of every hospital.
The injured soldiers, sailors and pilots of WW II caused the development of disciplines for burn treatment, from initial contact with medical personnel through extended treatment in the medical centers behind the lines and back home. Following on the heels of developments from WW I, advancements were also made in facial, nasal and jaw reconstructions as well as in the use of transplanted cartilage. Grafting and facial reconstruction became a more complex art as the surgeons developed skills to not only repair the wound but to restore the body to something resembling its original condition.
Vietnam and now Iraq have presented medical challenges due to the wounds generated by more powerful weapons. Burns continue to become a more common war injury because of bombing techniques and the types of explosives used in insurgent warfare tactics. The bullets used in today’s infantry weapons can do enormous damage.
One of the keys to burn treatment is immediacy. The sooner a patient is delivered to a hospital, the better the prognosis for long term treatment. From that perspective, wartime plastic surgery and preparation for it has been enormously improved during the post WW II conflicts.
Patient transport is much quicker; as well, all members if the medical corps have had training for initial treatment for burns, facial and orthopedic wounds. Technology for anesthesia, for reconstruction of damaged facial characteristics and for orthopedic repair has moved into the era of CT and MRI scans, arthroscopic gear and specially designed reconstructive surgical materials.
Between the wars, plastic surgery techniques also continued to develop at home. Between WW I and WW II, the military basically ignored reconstructive medicine. By the end of WW II, the U.S. Army had two plastic surgery centers in the European Theater of Operations and shortly thereafter, the range of facilities in the United States. After WW II, plastic surgery became a mainstream medical specialty and cosmetic surgical treatment became a burgeoning consumer choice.
Rhinoplasty (the “nose job” first developed in ancient times) became the first popular cosmetic surgical procedure. Breast augmentation has now become a common option, and cosmetic plastic surgery is now the area where advancements are being made. Various lifts and tucks, augmentations, implants and reductions can now in some cases utilize the tools of microsurgery.
Both reconstructive and cosmetic surgery practitioners now have a range of tools at their disposal that allow for a wide range of increasingly non-intrusive procedures. Modern plastic surgery can not only work miracles in repairing or enhancing the human body, it also is continually shortening recovery periods through the use of newly developed equipment.
