By Jean Balchin 11/05/2017

A pastel portrait of Gunner John Dyson by Henry Tonks in 1917, depicting the pioneering skill of Harold Gillies’s surgery.

As an art history student, I am often asked to describe or praise artworks I’m not particularly fond of. This strangely captivating pastel portrait is not one of them. It reminds me of a softer Egon Schiele portrait, or deftly sketched Impressionist painting. Yet its significance extends beyond the mere skill of the artist, or the pleasing colour combinations on the page. It represents a new lease of life for the artist’s model.

      The words ‘plastic surgery’ call to mind images of botoxed L.A socialites addicted to tummy tucks and facelifts. But Kiwi surgeon Sir Harold Gillies (1882–1960) had a far nobler pursuit, stitching together the faces of at least 4,000 British and New Zealand soldiers mutilated by bullets, shipboard fires and shell shrapnel in the trenches. “Before the Great War,” said one Kiwi nurse at Queen’s Hospital in Sidcup, England, “men with shattered faces died of wounds or broken hearts. Now they go to a special hospital where marvels of surgery are performed, and step out into the world again whole and confident.” The trench warfare created new types of injuries that hadn’t been encountered previously; noses, jaws and ears sliced off by hot chunks of metal, infected with bacteria and left to fester in the mud and the rain.

History of Plastic Surgery

      Gillies was by no means the first reconstructive surgeon. For many centuries, Indian surgeons had practiced a kind of rhinoplasty wherein crescent-shaped slices of skin were cut from patients’ foreheads and moulded into substitute noses. French and German surgeons during the 19th century also developed a technique whereby skin could be transferred from one part of the body to another. Gillies admitted that by the time he arrived on the plastic surgery scene, considerable progress had been already made, “but appearance was of secondary importance. No one, it seemed, had given serious consideration to the aesthetic side, not even the French, who might be thought sensitive to it.”

      Gillies was the first to standardise the techniques of rhinoplasty, skin grafts and facial reconstructions, establishing the discipline of ‘plastic surgery’. His textbook, Plastic Surgery of the Face was published in 1920 and set down the principles of modern plastic surgery. It was described by the British Medical Journal as “one of the most notable contributions made to surgical literature in our day”. Gillies was also a talented painter and exhibited his work in 1948 at Foyale’s Art Gallery, London. Looking at his paintings and pastel drawings, one can see where his surgical skill and attention to aesthetic detail comes from. A medical friend of Gillies once wrote that “in many hundreds of hours spent assisting or in watching Gillies in the operating room I never once saw him perform a hurried or rough movement. All the actions of his hands were consistently gentle, accurate and deft.”

A ‘Strange New Art’

      Gillies described his surgery as “a strange new art” and was preoccupied with making the patient look normal and sometimes even more beautiful than before. At the first International Congress of Plastic Surgery in Stockholm in 1955, he declared; “within us all there is an overwhelming urge to change something ugly and useless into some other thing more beautiful and more functional.” Gillies was the first surgeon to make pictorial records of pre- and post-facial reconstruction cases and also spent at least an hour before each operation visualising the final outcome. He would pace relentlessly around the hospital ward, scrawling designs in notebooks, cutting them out meticulously and fitting them back together like a jigsaw puzzle. Gillies’ artistic skill also extended to sculpture, and he sometimes used a lump of wax in order to mould onto it the features and contours he hoped to restore to the patient’s face. His usual method was to mould a plaster model of how he imagined the patient’s face would eventually look.

The Pedicle Tube

      Gillies implemented a number of major innovations which later became standard practice in plastic work. His notable innovation was the pedicle tube, and was discovered almost by accident. One day in 1917, a sailor called Vicarage was wheeled into Gillies’ operating chamber. All the skin on Vicarage’s face had been burned off by a cordite explosion on his ship, and his face was covered in thick scarring. His eyelids and lower lip had been turned inside out and his nose was merely a fleshy blob. Gillies cut some skin off Vicarage’s chest and made a scroll of flesh large enough to cover his face. The lower ends of this scroll were left attached to the chest in order to ensure adequate blood supply. After cutting apertures for the mouth and eyes, Gillies lifted the skin from the patient’s shoulders and noticed that it began to curl inwards. Then came the eureka moment:

“If I stitched the edges of those flaps together, might I not create a tube of living tissue which would increase the blood supply to grafts, close them to infection, and be far less liable to contract or degenerate as the older methods were?” … “another needle was threaded and, in an astonished silence, I began to stitch the flaps into tubes”.

This idea proved to be enormously successful, and soon tubes could be seen sprouting out from many patients. Living tissue was encased by the outer layer of skin which was waterproof and infection resistant. This pedicle tube technique simplified grafting, and helped the surgeon to restore a shattered face.

      Other innovations pioneered by Gillies included the epithelial outlay technique, and the intranasal skin graft, used to correct nose defects caused by leprosy. Gillies developed the eyelid technique after worrying about Vicarage, who had to spend all night during an air-raid trying to sleep with his eyes open because his lids had been burnt off. He also developed a new technique for re-attaching severed limbs, which involved de-gloving the amputated section of skin and suturing the limb on bone to bone, tendon to tendon, and nerve to nerve. Moreover, Gillies helped pioneer sex change operations at a time when such operations were the subject of ethical protest and media sensationalism. After the war, Gillies established a private clinic where he continued to treat clients with facial deformities. However, during the 1930s, his clinic was frequented by society women, film stars, and stage folk who desired facelifts and other cosmetic changes such as breast implants.

  Thus, from facial reconstructive surgery to sex change operations and leprosy treatments, Harold Gillies was a pioneer in his field. The art and science of modern plastic surgery owe a great deal to this humble Kiwi artist and surgeon.