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 11th of January 1916, Gillies was ordered by War 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 19th 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 20TH 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)
1. Observation is the basis of surgicalal diagnosis : There is no
better training for a surgeon than to be taught observation by
a physician.
2. Diagnose before you treat.
3. 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.
4. 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.
5. The lifeboat : It is well to have a reserve plan.

23. Cont...
6. 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.
7. 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