November 11th, 2018
Today marks 100 years after the conclusion of World War One (WW1) and as such, I thought it would be interesting to reflect on an area of science behind the battlefields. In particular, the practice of facial reconstruction, which was advanced significantly during the war and has ever since been a staple in plastic surgery and regenerative medicine. This blog post will explore the work of Dr. Harold Gillies, who revolutionized the practice of skin grafts through a process called tubed pedicle grafting which was among the first breakthroughs in regenerative medicine at the time. I will also inform you of how this practice benefitted soldiers during the world, and how it is used presently to treat burn victims.
World War One: The Necessity for Reconstructive Surgery
As many of us reflect on the lives of the brave soldiers who sacrificed their lives for freedom, we come to understand how brutal the war actually was. The First World War has been documented as the bloodiest conflict in Canadian history, taking the lives of more than 60,000 Canadians, and over 16,000,000 others worldwide.
Warfare devastated the soldiers physically, and mentally, from the anxiety they felt in trenches, to the pain of not being with their families during this tough time. Their wounds, namely of shredded limbs, ripped torsos and burn-ravaged faces presented the urgent need for new and efficient surgical techniques, many of which we still use in some form today. For many soldiers, the pain they experienced during warfare was equivalent to the disfigurement they endured as a result, which destroyed their mental health and self-perception. Shrapnel explosions would take off parts of a soldier’s face, disfiguring them beyond recognition. In fact, around 16% of the injured soldiers had injuries affecting the face, which, over a third were categorized as “severe”. These facial deformities made it difficult to hear, eat, see or breathe in most cases. For surgeons at the time, skin grafting, or the action of transferring strips of cartilage/skin from one area of the body to another area requiring it, was a novel concept, and was not commonly practiced until the first operation by Dr. Harold Gillies.
Dr. Harold Gillies and the Tube Pedicle Skin Graft
Dr. Gillies, an ENT (ear, nose, and throat) surgeon from New Zealand performed the first tube pedicle graft operation on October 3rd, 1917 and developed a more comprehensive method of skin grafting years later. The tube pedicle skin graft was a type of surgery that separated, but did not detach, a flap of skin from a healthy part of the soldier’s body and stitched it into a tube. Then, this tube of skin was sutured, or stitched, onto a section above the injured area and stretched over the wound. For example, Dr. Gillies’ most famous success was his surgery on William M Spreckley (pictured below) who lost his entire nose in the Battle of Ypres. Dr. Gillies conducted the surgery by cutting out a strip of cartilage from Mr. Spreckley’s chest and sutchering (implanting) it into his forehead. Once the strip of skin was firmly planted into the forehead, Dr. Gillies stretched the flap of cartilage over the nasal cavity, or the hole left from the shrapnel explosion causing the injury on Mr. Spreckley’s face. Overtime, the large strip of cartilage filled the cavity creating a nose-like structure.
Benefit to the Soldiers
This form of surgery was miraculous because it provided blood flow to the reconstructed area from another part of the body using the patient’s own skin and blood, limiting the chance of immune rejection. The grafted, or newly transplanted skin flap would form a connection to the wounded area, which over time would develop into a blood flow pathway. This would ensure that the wounded area could survive with the grafted appendage and not simply reject the new structure. For soldiers, Dr. Gillies’ method of skin grafting disguised the disfiguring injuries so that they would have “a semblance of a normal life” without feeling like they were aliens in society after the war.
Skin Grafting In Today’s Time
With popular examples like the Kardashian family, we tend to overlook the medical benefits of reconstructive surgery amongst the cloud of artificial beauty and “perfection”.
As stated previously, skin grafting is a procedure that involves removing skin or cartilage from one area of the body to an area that has lost its protective covering through transplantation. Burn victims often have to undergo this surgery to restore function in parts of their body where the skin has been damaged to such a point where it cannot function to protect your body, leading to infection and all other kinds of health problems.
This was the case for 9 year old Nikita Cummings, who had burnt 80% of her body through a horrific nightdress incident after it caught on fire. In these cases, the skin dies, turns white and has no sensation due to the damaged nerve endings connected to the skin cells. In fact, people with the same severity of burns can often go into shock, stop breathing, and die. For Ms. Cummings, flames devoured much of her hands, where her melted skin had revealed bone in some areas. Luckily, doctors managed to save her life after this traumatic incident compromised the health of her organs. Surgeons managed to graft layers of skin from her right leg to cover the burnt areas of her neck, belly and face. This example highlights one of the roughly 450,000 cases of treated burn injuries within the United States each year.
I hope this blog post increased your knowledge of how skin grafting has played a pivotal role throughout Canadian history, especially during this time of reflection and appreciation. My inspiration behind this post was to expand my own knowledge of Canadian history by looking at how WW1 revolutionized the practice of medicine throughout the world, and how our modern techniques have been adapted from these practices.
Ibreez Asaria Future Science Leaders (FSL) Discover 2018/2019