McIndoe orchestrated trips to East Grinstead. There the soldiers were dispatched, often under protest, to mix with the local population. The people of East Grinstead grew to embrace McIndoe and his army of strangely reconstructed men. They would make every effort to accommodate them, removing mirrors from their pubs, cafés, and restaurants and taking care to give the lives of McIndoeâs Guinea Pigs a veneer of normality. In time East Grinstead became âthe town that never stared,â and it served as the perfect preparation for the Guinea Pigsâ reentry into a world that inevitably would.
Gallows humor became de rigueur for the Guinea Pigs. They recruited a treasurer with badly burned legs, so that he wouldnât run off with the petty cash, and a secretary whose fingers had been injured, so he couldnât keep minutes. At the start of World War II, the Guinea Pig Club was tiny. But with the onset of the bombing campaign, those numbers rapidly swelled, and by the end, its membership numbered more than six hundred. They were testing times that saw McIndoe and his team forced to refine their techniques as they went, learning from successes as well as mistakes. But these lessons would transform the field of plastic surgery.
â
T HE PRACTICE OF MILITARY MEDICINE during the war focused principally upon the salvage of life and limb. McIndoe didnât save the lives of the Guinea Pigs, at least not immediately. That task was achieved by the hospitals that received them. But McIndoeâs work and the experience of those he treated taught clinicians that there was something at least as precious as life that modern medicine might preserve.
Today plastic surgery has its own image problem. All too often we associate it with tummy tucks and celebrity nose jobs rather than the plight of burn victims.
But plastic surgery retains many of the values that drove McIndoe and his heroic club of Guinea Pigs. It is, in the main, still about the restoration of function and appearance to people whose lives have been cruelly and irreversibly altered by illness and injury. The fact that we, in modern times, have been able to move beyond the pursuit of simple survival is something to celebrate.
Plasticity, in the context of surgery, refers to the ability to mold and alter the appearance of the body. McIndoe was able to find areas of healthy skin and move them to cover those areas that had been destroyed by fire. More than this, he was able to achieve a result that was aesthetically acceptable. But there were limits. These waltzed skin flaps were supplied by an indefinite weave of capillaries and venules running through the layers of tissue. This blood supply was tenuous, and flaps of this type had to be limited in length and breadth if they were to survive. More extensive injuries were not so easily addressed using this technique.
Larger and thicker areas of skin need much greater volumes of blood flowing through them to keep them alive. In terms of blood supply, the situation is akin to the difference between the needs of a village that subsists on the trickle of dozens of mountain streams and those of a city built on the banks of a coursing river.
This problem could, in theory, be overcome if a block of tissue could be harvested along with the artery and vein that supplied and drained it. These vessels could then be connected to the bodyâs core circulation at the new site to which the graft was being moved. By moving and then connecting a flap directly to the circulation in this way it could be perfused with a rich flow of blood and made viable more or less immediately.
If this could be achieved, then McIndoeâs waltzing flaps would no longer be necessary. Instead free flaps of skin and tissue could be taken and moved in a single operation. No longer would the patient be forced to undergo countless operations and wait contorted for weeks while the tissue established a useful blood supply.
But the vessels
Gallows humor became de rigueur for the Guinea Pigs. They recruited a treasurer with badly burned legs, so that he wouldnât run off with the petty cash, and a secretary whose fingers had been injured, so he couldnât keep minutes. At the start of World War II, the Guinea Pig Club was tiny. But with the onset of the bombing campaign, those numbers rapidly swelled, and by the end, its membership numbered more than six hundred. They were testing times that saw McIndoe and his team forced to refine their techniques as they went, learning from successes as well as mistakes. But these lessons would transform the field of plastic surgery.
â
T HE PRACTICE OF MILITARY MEDICINE during the war focused principally upon the salvage of life and limb. McIndoe didnât save the lives of the Guinea Pigs, at least not immediately. That task was achieved by the hospitals that received them. But McIndoeâs work and the experience of those he treated taught clinicians that there was something at least as precious as life that modern medicine might preserve.
Today plastic surgery has its own image problem. All too often we associate it with tummy tucks and celebrity nose jobs rather than the plight of burn victims.
But plastic surgery retains many of the values that drove McIndoe and his heroic club of Guinea Pigs. It is, in the main, still about the restoration of function and appearance to people whose lives have been cruelly and irreversibly altered by illness and injury. The fact that we, in modern times, have been able to move beyond the pursuit of simple survival is something to celebrate.
Plasticity, in the context of surgery, refers to the ability to mold and alter the appearance of the body. McIndoe was able to find areas of healthy skin and move them to cover those areas that had been destroyed by fire. More than this, he was able to achieve a result that was aesthetically acceptable. But there were limits. These waltzed skin flaps were supplied by an indefinite weave of capillaries and venules running through the layers of tissue. This blood supply was tenuous, and flaps of this type had to be limited in length and breadth if they were to survive. More extensive injuries were not so easily addressed using this technique.
Larger and thicker areas of skin need much greater volumes of blood flowing through them to keep them alive. In terms of blood supply, the situation is akin to the difference between the needs of a village that subsists on the trickle of dozens of mountain streams and those of a city built on the banks of a coursing river.
This problem could, in theory, be overcome if a block of tissue could be harvested along with the artery and vein that supplied and drained it. These vessels could then be connected to the bodyâs core circulation at the new site to which the graft was being moved. By moving and then connecting a flap directly to the circulation in this way it could be perfused with a rich flow of blood and made viable more or less immediately.
If this could be achieved, then McIndoeâs waltzing flaps would no longer be necessary. Instead free flaps of skin and tissue could be taken and moved in a single operation. No longer would the patient be forced to undergo countless operations and wait contorted for weeks while the tissue established a useful blood supply.
But the vessels
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