Harold gillies

plastic surgery

1. HAROLD GILLIES

2. Introduction Harold Delf Gillies :- Born 17 June 1882 Dunedin, New Zealand. Died :- 10 September 1960 (aged 78) The London Clinic, Marylebone, London. Gilles suffered a slight cerebral thrombosis while undertaking a major operation at the age of 78 on the damaged leg of an 18-year-old girl on 3 August 1960. Occupation :- Otolaryngologist and pioneer plastic surgeon. Years active :- 1910-1960 Known for :- Plastic surgery, sex reassignment surgery. Spouse :- Kathleen Margaret Jackson. Children :- Michael Thomas Gillies  (son)

3. Frognal House, later become Queen Mary's Hospital, in 2002

4. Aesthetic Reconstruction Rhinoplasty , skin grafts and facial reconstructions have been practised for centuries. However, it was New Zealander Harold Delf Gillies who standardised these techniques and established the discipline of ‘plastic surgery’. In 1920, his textbook “ Plastic Surgery of the Face ” was published, setting down the principles of modern plastic surgery ; principles which were adopted by surgeons from every part of the world. Gillies wrote his first textbook “ Plastic Surgery of the Face ” in 1920 and,, with Ralph Millard completed “The Principles and Art of Plastic Surgery” in 1958. As well as being a fine surgeon , he was also a champion golfer and inveterate practical joker.

5. Cont... The First World War was a challenge to most surgeons. The introduction of more destructive weapons resulted in devastating injuries. In addition, in trench warfare the head was more exposed than the rest of the body, and soldiers faces was often shattered or burnt beyond recognition. Despite the best effort of surgeons, many soldiers were left hideously disfigured. Realising this need, a young surgeon operating out of Aldershot hospital, England, began performing operations which involved rebuilding the face by taking tissue from other parts of the body.

6. Cont... Gillies was a “versatile and brilliant man” who was entirely devoted to his studies. When others would meet after lectures for coffee and conversation, Gillies would go to his room and continue studying. That same year Gillies was made a Fellow of the Royal College of Surgeons and awarded St. Bartholomews ’ Luther Holden Research Scholarship.

7. THE FOUNDER OF BRITISH PLASTIC SURGERY During world war 1, he meet Frenchman Auguste Valadier who was experimenting with taking tissue from other parts of the body – a process that greatly excited Gillies . On the 11 th of January 1916, Gillies was ordered by W ar Office to Cambridge Military Hospital, Aldershot, “for special duty in connection with Plastic Surgery”. His request for a british unit has been granted: he was to be Britian’s first plastic surgeon with full responsibility for getting the Aldershot unit up and running. “ A Strange New Art”

8. Cont... Rebuilding the face by taking tissue from other parts of the body was not a new idea. For centuries, Indian surgeons has been practising a form of rhinoplasty , where crescent shaped flaps of skin were drawn from the patients’ foreheads and fashioned into substitute noses. During the 19 th century, the French and Germans had developed a technique whereby skin could be transferred from one part of the body to another. Indeed, by the time Gillies arrived on the scene, they had made considerable progress in plastic work “ but appearance was of secondary importance”

9. Cont... “No one, it seemed, had given serious consideration to the aesthetic side, not even the French, who might be thought sensitive to it.” For Gillies , plastic surgery not only involved restoring function but also making the person look normal and sometimes more beautiful than before. He was driven by the idea that the surgeon should be creative, imaginative – in fact an artist. In addition to describing his work in written form, he was the first person to make pictorial records of pre- and post- facial reconstruction cases.

10. THE INNOVATOR Seeking to make the patient look better necessitated some major innovations. His most notable innovation, the pedicle tube, came about purely by chance. While raising the skin from patient’s shoulders, Gillies noticed its tendency to curl inwards. Then came a flash of inspiration: “ 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? The horrific injuries suffered by Vicarage also led to another major innovation, “ the idea suddenly came to me, a new way of restoring function and appearance to reverted eyelids”. The method that Gillies subsequently used on Vicarage became known as the ‘epithelial outlay technique’.

11. Cont... Gillies used what he called an ‘intranasal skin graft’ to correct a nose defect caused by leprosy. This established a new principle in the treatment of facial disfigurement from leprosy. He also pioneered a new method for re- attaching severed limbs. This involved de- gloving the amputated section of skin and suturing the limb on bone to bone, tendon to tendon, and nerve to nerve. The technique proved successful and a similar method is being used today.

12. FROM PLASTIC TO COSMETIC Perhaps Gillies ’ greatest innovation, if it can be called that, was the pioneering of what is known today as ‘cosmetic surgery’. After the war, Gillies continued to operate on ex- servicemen, his roll of patients slowly diminished. To compensate, he established his own private clinic at 56 Queen Anne Street, London. Face lifts were not only the cosmetic changes gillies helped pioneer. He and his cousin, Archibald Mclndoe , a fellow plastic surgeon and New Zealander, published a paper in 1938 on their mammaplasty technique devised for correcting breast abnormalities.

13. Cont... 1920, Microtia reconstruction buried carved costal under mastoid skin, then separated it from head with a cervical flap. Use of temporalis muscle transplantation for upper/lower eyelid function in facial paralysis.

14. Walter Yeo , the first person to receive plastic surgery, before (left) and after(right) skin flap surgery performed by Sir Harold Delf Gillies in 1917 . The pictures of Walter's face before the surgery are blurry and hard to come by. In the tragic accident he was recorded as having lost both his upper and lower eyelids. The surgery was some of the first to use a skin flap from an unaffected area of the body and paved the way for a sudden rash of improvements in this field

15. Gillies Fan Flap for lip reconstruction.

16. Gillies needle holder with scissors.

17. Gillies approach

18. Figure 73-8 Some techniques for the closure of scalp defects. A and B, Rotation flaps. C, Gillies ' tripod technique (1944). D, Bipedicled flaps. E, Double opposing rotation flaps. If complete closure cannot be obtained, split-thickness skin grafts are applied over the pericranium to cover the remaining exposed areas. F, Kazanjian and Converse's crisscross incisions through the frontalis muscle or the galea aponeurotica to distend the flaps and achieve closure of the defect. G, A large flap transposed over a lateral scalp defect. The residual defect is covered with a split-thickness skin graft over the pericranium . (From Marchac D: Deformities of the forehead, scalp, and cranial vault. In McCarthy JG, ed : Plastic Surgery. Philadelphia, WB Saunders, 1990:1538.)

19. Sex reasignment In 1946, he and a colleague carried out one of the first sex reassignment surgeries from female to male on  Michael Dillon . In 1951 he and colleagues carried out one of the first modern sex reassignment surgery from male to female using a flap technique on Roberta Cowell , which became the standard for 40 years.

20. THE FATHER OF 20 TH CENTURY PLASTIC SURGERY Between the Wars, the name Harold Delf Gillies became synonymous with plastic surgery. Gillies was undoubtedly the founding father of this newly established discipline. At the age of 78, he was given the Special Honorary Citation of the American Society of Plastic and Reconstructive Surgery, in recognition of his “development of the speciality of plastic surgery”, and his “ outstanding scientific contributions to the advancement of its practice”.

21. Cont... Today Gillies is remembered each year when the American Academy of Facial Plastic and Reconstructive Surgery gives out its Harold Delf Gillies award for best science research paper. In addition to Americans, Gillies had trained literally hundreds of surgeons from the ‘dominions’. There was no plastic surgery before he came. Everything since then, no matter whose name be attached to it, was started by Gillies , perfected by him and handed on by him to lesser men, who have often claimed it as their own.

22. PRINCIPLES (AS OUTLINED IN PRINCIPLES AND ART OF PLASTIC SURGERY) Observation is the basis of surgicalal diagnosis : There is no better training for a surgeon than to be taught observation by a physician. Diagnose before you treat. Make a plan and a pattern for this plan : Use paper, bandage or jaconet shaped to the defect and carry out a pretence operation in reverse. Do not rush in with a piece of skin hoping it will fit. Make a record : Start with a diagram in the notes. While you operate have special methods recorded by Artists or Leica . Follow up the case with the camera, for that is where most of us slip up. The lifeboat : It is well to have a reserve plan.

23. Cont... A good style will get you through : Surgical style is the expression of personality and training exhibited by the movements of the fingers; its hallmark – dexterity and gentleness. Replace what is normal in a normal position and retain it there : If some of the bones of the face have got out of place, it is incumbent on you to put them back in place and hold them there. If the soft tissue is too large for primary closure without distortion, it is better to retain what is left in normal position and so define the defect to be filled. 8. Treat the primary defect first : Borrow from Peter to pay Paul when peter can afford it. When Mahomet is along way from the mountain, try to move the mountain to Mahomet. 9 . Losses must be replaced in kind : thus the eyebrow is grafted from the hairy scalp, thin skin for an eyelid and thick for a palm.

24. Cont... 10. Do something positive : When a lacerated lip is a jig-saw puzzle, look for landmarks and you can find two bits that definitely fit, put them together – at least you will have made a vital first move. 11. Never throw anything away : In plastic surgery, never throw anything away until you are sure you do not want it. 12. Never let routine methods become your master : Routine methods must be mastered, but never let them master you. The answer to this question, how do you make this or do that? Should be, as in all surgery, ‘Show me the case!’ 13 . Consult other specialists : The reaction of one man’s mind to another’s is increased by the stimulus of sharing mutual problems. 14. Speed in surgery consist of not doing the same thing twice : It’s the old story of the hare racing back and forth at terrific speed while the tortoise, without retracing one step, slowly crosses the finish line. 15 . The after care is as important as the planning or the surgery itself : Or, for that matter, the surgery itself!. How futile it is to lose flap or graft for the lack of the little postoperative care. 16. Never do today what can be honourably be put off till tomorrow : When in doubt, don’t. It is well to remember that Time, although the plastic surgeons most trenchant critic, is also his greatest ally.

25. Thank you