Wednesday , March 22 2023

How VVI played a key role in the design of plastic surgery and modern anesthesia


Metrics from the First World War are terrible. The estimates vary, but in general, there were about 40 million military and civilian victims – 20 million dead and 21 million wounded. Never before has there been a conflict that led to such devastation in terms of death and injuries. In response, during the four years of the war, military surgeons developed new techniques in the battlefield and support to hospitals, which in the last two years have led to more survivors injuries that would be considered deadly in the first two.

On the western front, 1.6 million British soldiers were successfully treated and returned to the trenches. By the end of the war, 735,487 British soldiers were fired after serious injuries. Most of the injuries were caused by explosions and shrapnel.

Many of the injured (16%) had injuries that affected the face, more than a third of whom were categorized as "severe". Historically, this is an area in which little has been tried, and survivors with large injuries have remained with severe deformities that have made it difficult to see, breathe easily, or eat and drink.

A young surgeon from New Zealand's ENT (Ear, Nose and Throat), Harold Gillies, who works on the Western Front, has attempted to repair serious facial injuries and realized there is a need for specialized work. The weather was right, because the military medical management recognizes the benefit of establishing specialized centers for dealing with specific injuries and wounds, such as neurosurgical and orthopedic injuries or gas victims.

Gillies was given in advance, and by January 1916, she set up the first British first Plastic Surgery Unit at a military hospital in Cambridge, Aldershot. Gillies visited the basic hospitals in France to ask the appropriate patients to be sent to their unit. He returned about 200 patients – but the opening of the unit coincided with the opening of the Somme offensive in 1916, and more than 2,000 injuries patients were sent to Aldershot. Treatment was also needed for sailors and aircraft suffering from face burns.

Strange new art

Gillies described the development of plastic surgery as "a strange new art". Many techniques have been developed by trial and error, although some have reflected the work done in India for centuries. One of the main techniques developed by Gillies was a skin pedicure shoe.

The skin cap is separated but not separated from the healthy part of the soldier's body, tucked into the tube, and then sprayed into the injured area. A period is needed to allow new blood supply at the implant site. Then it was separated, an open tube and a flat skin that was sewn on the surface that it was supposed to cover.

One of the first patients to be treated was Valter Ieo, a war crimes officer at HMS Varspite. Ieo had facial injuries during the Battle of Jutland in 1916, including the loss of his upper and lower eyelids. The tubular pedicure produced a "mask" of skin curved over the face and eyes, creating new eyelids. The results, though far from perfect, meant that he had a face again. Gillies repeated the same procedure to thousands of others.

There was a need for larger facilities for surgical and postoperative treatment, as well as rehabilitation of patients, together with various specialties dealing with their care. Gillies played a major role in designing a specialist unit at the Kueen Mari Hospital in Sydney, southeast London. It was open with 320 beds – and by the end of the war, there were more than 600 beds and 11,752 operations were performed. But reconstructive surgery continued long after the cessation of hostilities, with about 8,000 military personnel treated between 1920 and 1925. The unit was finally closed in 1929.

Details of injuries, corrective operations and final outcomes were all recorded in early clinical photography, as well as detailed drawings and pictures created by Henri Tonks who, although dressed as a doctor, gave up medication for painting. Tonks became a war artist in the Western Front, but then joined Gillies, who helped not only in recording new plastic procedures, but also in planning.

The only real progress

A complex facial and head surgery required new ways of giving anesthetics. Anesthesia has generally progressed as a specialty during the war years – both in the way it was administered and in the way that doctors were trained (earlier, anesthetics were often given by a younger member of the operational team).

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Survival from operations requiring anesthesia has improved, although techniques are still based on chloroform and ether. Anesthetic team of Queen Mary developed a method of transferring the rubber tube from the nose to the trachea (plate), as well as work on the endotracheal tube (mouth to trachea), which is made of a commercial rubber tube. Many of their techniques remain in use today. As the Austrian doctor wrote in 1935: "Nobody won the last war, but medical services. Increasing knowledge was the only certain benefit for mankind in a devastating disaster. "

Robert Kirby is Professor of Clinical Education and Surgery at Keele University. This article first appeared on The Conversation (

The author wants to acknowledge the help of Norman G Kirby, General Major (retired), Director of Military Surgery 1978-82

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