Surgery and Plastic Surgery

The First World War produced severe wounds that challenged existing surgical practice. Facial injuries, burns, shattered bones and extensive tissue damage led surgeons to develop new techniques, while reconstructive surgery became an increasingly important part of the treatment of wounded soldiers.

Development of reconstructive plastic surgery during the First World War: Captain Francis Derwent Wood making a facial mask for a wounded soldier at 3rd London General Hospital, Wandsworth. — Captain Francis Derwent Wood applies plaster to the face of a wounded First World War soldier to create a mask to conceal his injuries, 3rd London General Hospital, Wandsworth.

Surgery and Plastic Surgery in the First World War

The scale and nature of industrial warfare created injuries that could be difficult or impossible to treat using established surgical methods. Artillery and shell fragments could cause extensive damage to the face, head and limbs, while burns and other wounds could leave soldiers with permanent disabilities.

Surgeons responded by developing new techniques and by bringing together different areas of medical expertise. Anaesthesia, antisepsis, blood transfusion and X-ray diagnosis all contributed to the changing practice of wartime surgery.

Wounds of Industrial Warfare

Artillery and machine guns produced severe wounds on a scale that placed enormous demands upon military surgeons. Shell fragments could penetrate the body, destroy bone and damage soft tissue, while facial injuries could leave soldiers with severe disfigurement.

The survival of men with injuries that might previously have been fatal created another problem: how to repair damaged bodies and enable wounded soldiers to return to civilian life.

The treatment of these injuries was closely connected with the wider development of medical services and evacuation, which brought seriously wounded men to specialist surgeons and hospitals.

Surgical Treatment

Wartime surgery involved the treatment of wounds, fractures, burns and infections. Surgeons had to remove damaged tissue, control bleeding and reduce the risk of infection while attempting to preserve as much healthy tissue as possible.

Improvements in anaesthesia and antiseptic techniques made longer and more complex operations possible. The development of blood transfusion also became increasingly important when patients had suffered severe blood loss.

Blood Transfusion in the First World War and X-Rays and Medical Imaging in the First World War provide further context for these developments.

Facial Injuries

Facial injuries presented particularly difficult surgical problems. Damage to the nose, jaw, eyes and other parts of the face could affect breathing, eating, speech and sight as well as appearance.

The development of specialised treatment for facial injuries became one of the most significant aspects of wartime reconstructive surgery. Surgeons worked with dentists and other specialists to repair damaged structures and restore function where possible.

Harold Gillies and Queen Mary’s Hospital, Sidcup

Harold Gillies became one of the leading figures in the development of reconstructive plastic surgery during the First World War. After seeing facial injuries treated in France, he helped establish a specialist unit for facial reconstruction in Britain.

Queen Mary’s Hospital at Sidcup opened in 1917 and became an important centre for the treatment of men with severe facial injuries. Gillies brought together surgeons, dentists, nurses, artists and other specialists, creating a multidisciplinary approach to reconstruction.

The scale of the work was substantial. Gillies later described thousands of facial-injury cases being treated at Sidcup, while teams of British and Commonwealth surgeons contributed to the work.

Sir Harold Gillies, The National Archives, provides contemporary and later evidence concerning the development of plastic surgery during the war.

Skin Grafting and Reconstructive Surgery

Skin grafting became an important technique in reconstructive surgery. Surgeons developed methods for transferring skin from one part of the body to another to repair damaged areas.

Gillies developed the tube pedicle technique, in which a section of skin remained attached to its original blood supply while being gradually moved towards the area requiring reconstruction. Techniques such as these allowed surgeons to attempt increasingly complex repairs.

The development of reconstructive surgery was not simply about appearance. Restoring the function of the mouth, nose, eyes and other parts of the face could make a major difference to a patient’s ability to eat, speak, breathe and live independently.

Henry Tonks and Medical Illustration

Artists also became involved in recording facial injuries and the results of reconstructive surgery. Henry Tonks, a trained surgeon and artist, produced detailed pastel studies of patients treated at Sidcup.

These drawings served a medical purpose as well as documenting the human consequences of war. They provided surgeons with a record of injuries and operations while also revealing the extent of facial damage suffered by wounded soldiers.

The Science Museum’s material on Henry Tonks and facial injuries provides further evidence of this relationship between medicine and art.

Walter Yeo

Walter Yeo became one of the best-known examples of reconstructive surgery during the First World War. He suffered severe facial injuries and underwent treatment that included skin grafting.

His case illustrates both the possibilities of the new techniques and the limitations faced by surgeons. Reconstructive surgery could improve function and appearance, but treatment was often lengthy and the results could not restore the face completely to its pre-war condition.

Burns and Other Severe Injuries

Surgeons also treated extensive burns and other injuries requiring reconstruction. The treatment of burns could involve repeated operations and prolonged hospital care.

Surviving medical records show that some soldiers underwent procedures associated with the development of plastic surgery, including operations involving the eyelids and other damaged areas of the face.

Plastic Surgery, The National Archives, includes surviving records of a soldier who suffered severe facial burns and subsequently underwent reconstructive procedures.

Amputation and Artificial Limbs

Not all severe injuries could be repaired. Damage to limbs caused by shellfire, bullets, frostbite and infection sometimes resulted in amputation.

Amputation created another long-term medical challenge. Soldiers who survived the operation could require rehabilitation and an artificial limb before returning to civilian life.

Artificial Limbs, The National Archives, provides contemporary evidence concerning the development and provision of prosthetic limbs during and after the war.

Surgery, Anaesthesia and Medical Technology

Complex surgery depended upon developments in other areas of medicine. Anaesthesia allowed surgeons to perform lengthy operations, while X-rays could help locate foreign objects and assess damage before surgery.

Blood transfusion became increasingly important when soldiers suffered major blood loss. These developments demonstrate how different areas of wartime medicine became interconnected rather than developing independently.

Gas Warfare and Medical Treatment provides another example of how new forms of injury created demands for specialist medical treatment.

Psychological Effects of Severe Injury

Physical reconstruction could not remove all the consequences of severe injury. Soldiers who survived major wounds could face permanent disability, disfigurement and psychological difficulties after returning from the front.

The psychological consequences of combat and injury are explored further in Shell Shock and Psychological Trauma in the First World War.

The Legacy of Wartime Surgery

The First World War helped establish reconstructive plastic surgery as a distinct medical speciality. Many of the techniques developed or refined during the war continued to influence surgical practice afterwards.

The significance of wartime surgery was not simply that new operations were invented. The enormous number of severely wounded patients created an environment in which surgeons could develop techniques, test new approaches and work collaboratively with dentists, nurses, artists and other specialists.

The experience also demonstrated the importance of treating the whole patient. Successful recovery could involve surgery, rehabilitation, prosthetics, psychological support and long-term medical care.

Medicine in the First World War

Surgery and reconstructive treatment formed part of a much wider transformation of medicine during the First World War. The medical services that evacuated casualties, the development of blood transfusion and X-ray diagnosis, and new approaches to gas injuries, psychological trauma and disease were closely connected.

This article forms part of the wider Medicine in the First World War section.