Gillies Created Reconstructive Surgery “Through Trial and Error”

(p. C6) During World War I, a handful of soldiers who had suffered catastrophic facial wounds traveled to Paris on a journey of last resort.

. . .

Trench warfare produced a huge number of facial injuries, and bespoke masks could never keep up with the demand.

. . .

But masks were of limited value, because they could conceal, but never heal, grievous wounds. Disfigured men needed a medical breakthrough to help them. Ms. Fitzharris, the author of “The Butchering Art” (2017), a history of Victorian medicine, chronicles the life of the British plastic surgeon Harold Delf Gillies, whose innovations and operating-room magic saved thousands of warriors from their fates and allowed them to walk in the world again. Both heartbreaking and inspiring, “The Facemaker” tells a profound story of survival, resurrection and redemption.

Born in New Zealand and educated in England, Gillies entered the Royal Army Medical Corps early in the war, at age 32. A champion amateur golfer, he began his soldiering as a novice military doctor. The second Battle of Ypres, in May 1915, was his baptism by fire. It was there, Ms. Fitzharris says, that he “first stepped into a field hospital’s makeshift operating theater,” where he labored around the clock, standing on a floor awash with blood. A month later, he was assigned to the Allied Forces base hospital in Étaples, France. The dental surgeon Auguste Charles Valadier showed him how to use bone grafts to reconstruct faces without distorting the features and to restore a patient’s ability to speak and eat.

That summer, Gillies sought out Hippolyte Morestin, an eccentric French surgeon devoted to achieving high-quality aesthetic results. Gillies watched Morestin remove a large cancerous growth from a patient’s face and close the wound with a flap of skin from the patient’s neck. It was a turning point for Gillies, who would describe the moment as “the most thrilling thing I had ever seen. I fell in love with the work on the spot.”

. . .

[Gillies’s] . . . key insight was that a multidisciplinary approach was needed: the combined work of plastic surgeons, dental surgeons, nurses, radiologists, artists, sculptors and photographers.

Gillies conceded it was “a strange new art,” without textbooks, precedent, or experience to guide its practice. Through trial and error, he re-created missing mouths and noses, filled in gaping voids of bone and flesh, restored obliterated jaws, treated horrific burns, and performed skin grafts. Until then, most surgeons had stitched together the edges of a gaping wound, a process that could cause necrosis and cellular destruction as well as further disfigurement. Among other things, Gillies learned that, to achieve the best results, he needed to perform surgery incrementally and space operations out over time, to allow patients to recover from one surgery to the next. Some men required 15 or 20 operations, occasionally as many as 40. “Never do today what can be put off till tomorrow” became his motto.

And Gillies mastered the use of the flaps, which are made to cover a wound and which have, as Ms. Fitzharris tells us, their “own blood supply in the form of a single large artery or multiple smaller blood vessels.” Gillies’s greatest invention was the tubed pedicle—a flap of skin attached to a “protective, infection-resistant cylinder,” which was itself attached to the injury site. It “dramatically reduced the chance for infection,” Ms. Fitzharris writes.

For the full review, see:

James L. Swanson. “Repairing the Wounds of War.” The Wall Street Journal (Saturday, May 28, 2022): C6.

(Note: ellipses, and bracketed name, added.)

(Note: the online version of the review has the date May 27, 2022, and has the title “‘The Facemaker’ Review: Repairing the Wounds of War.”)

The book under review is:

Fitzharris, Lindsey. The Facemaker: A Visionary Surgeon’s Battle to Mend the Disfigured Soldiers of World War. New York: Farrar, Straus and Giroux, 2022.

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