“Plastic surgery has one of its roots in reconstruction after war injuries.” – Professor Riccardo Giunta.
With social media often equating plastic surgery with aesthetics, the public is often misled or misinformed about its roots and intentions. In reality, reconstructive plastic surgery was born from the need to reconstruct trauma injuries in World War One. Pioneers in this field include Gillies, McIndoe and Esser, each establishing techniques that have evolved over time, allowing for the continuing and growing expertise used today. Each conflict brings with it the need for the innovation of new techniques.
“The treatment of severely burned patients – a fundamental component of plastic surgery – led to the establishment of centres for severely burned patients for specialised plastic surgery treatment in Great Britain during the First World War,” explains Professor Giunta, Immediate Past President of ESPRAS. “In the following decades, centres for burn surgery were established throughout Europe, based on this model.”
The development of microsurgery, enabling microvascular procedures, spelled a fundamental shift in the treatment of conflict injuries, allowing for complex reconstructions following traumatic injury. Such procedures are spotlighted by Demmer et al. in their 2023 paper Multidrug-resistant bacterial colonisation in Ukrainian war injuries: a need for multimodal therapy1, referencing cases such as that of an 18-year-old soldier, who sustained a complex femoral blast injury in the Russia-Ukraine conflict. Treated at Germany’s LMU Klinikum hospital, the patient underwent a chimeric double-barrel fibula free flap procedure. It is highly specialised microsurgical techniques such as these that the authors of the paper describe as ‘often indispensable’ in such cases.
Crucially, this shows that the treatment of traumatic injuries isn’t just about surgery. The golden thread is solidarity across European countries and collaboration between them, with the requirement for ‘indispensable’ microsurgical techniques running parallel with the need for cross-border collaboration, such as that seen in the Russia-Ukraine war. Since the start of the war, over 3,000 Ukrainian patients have been transferred to European hospitals.2 These hospitals, across 22 European countries, emphasise the cooperation among European countries throughout the EU’s solidarity mechanism.
Demmer et al. outline the processes and challenges involved in this collaborative effort:
‘Since the outbreak of the war in Ukraine in February 2022, approximately 620 injured war victims have been treated in Germany. For the first time since World War II, German hospitals are confronted with the challenges and complications of war injuries on a larger scale. The injured soldiers receive primary care in Ukraine and are then transported to Germany for rehabilitation and definitive treatment.’
“The aim is that patients in conflict zones are able to access the skills of microsurgically experienced plastic surgeons,” continues Professor Giunta. “The advances we have made since World War One are remarkable, and they should be available to all victims of conflict.”
This need for the availability of techniques, and highly skilled surgeons, extends to war zones worldwide, with British consultant plastic surgeon, Miss Victoria Rose, compelled to deliver her microsurgical experience to complex trauma cases in Gaza after noticing the increasing trauma workload faced by colleagues since war broke out in October 2023.3 Miss Rose, whose main area of expertise is in complex microsurgical reconstruction, said in an interview:
“People think all we do is cosmetics […] Every single person bombed here benefits from a plastic surgeon even if just to remove shrapnel.”
Her words bring home the urgent need for access to the expertise of highly trained plastic surgeons in conflict zones, and that this expertise should not be limited by geography or infrastructure. “We are proud of our European colleagues and their tireless work, both in Europe and worldwide. In working together as a collaborative surgical community, we truly are aligning with ESPRAS’s mission statement of ‘Better Together`” concludes Professor Giunta.
References:
1 Demmer, W., Mesas, I., Wiggenhauser, P.S., Braig, D., Gilbert, F., & Giunta, R.E. (2023). Multiresistente Keimbesiedelung bei ukrainischen Kriegsverletzten: Notwendigkeit zur multimodalen Therapie [Multidrug-resistant bacterial colonisation in Ukrainian war injuries: a need for multimodal therapy]. Handchirurgie Mikrochirurgie Plastische Chirurgie, 55(6), 457–461. https://doi.org/10.1055/a-2108-8978