burn victims -- 5/28/14

Today's selection -- from Extreme Medicine by Kevin Fong M.D. Reconstructive cosmetic surgery was rare before World War II, but the unprecedented carnage of that war brought change. Soldiers and sailors were surviving devastating burns, and so there was an urgent need for advances in this area. Airman Tom Gleave was one of these burn victims. And the innovation used to treat him was known as "waltzing":

"In retrospect, the cosmetic results of these surgeries look primitive at best. But at the time, the idea that badly damaged faces might be reconstructed in this way was revolutionary. It would fall to [Dr. Archie] McIndoe to refine and advance [reconstructive surgery for burn victims], and the air war of the Battle of Britain would provide his defining challenge.

"First, [Tom] Gleave got new eyelids pinched from the unburned skin of his thighs. These tiny islands of skin were removed and sculpted into place. They were so small they could rapidly establish themselves at their new location ... seizing upon the bed of vessels and perfused tissues that lay there waiting to be covered, like a minuscule sod of earth being transferred from one lawn to another. Oxygen and nutrients readily diffused into these small tokens of flesh. And the wounds left by taking these grafts were discrete enough that they could be left to heal spontaneously.

"But larger patches can't be moved in this way; their needs are more demanding. In plastic surgery, the battle, ... is between blood supply and beauty. A full-thickness flap of skin about the size of an adult's palm, cut out and moved as a single slab, will die before it has a chance to pick up a new supply of blood.

"To get around this problem, McIndoe would raise a flap of skin, leaving it attached at one edge like a trapdoor. This kept the flap alive, supplied by the vessels running through its attached edge, but left it fixed in position. McIndoe would then fold the sheet of skin into a tube, stitching its long edges to each other to protect its raw undersurface from infection.

"To move this tube of skin, he would make an incision in the patient's arm and form a pocket into which its free edge could be tucked. He would then stitch the flap into place, fastening arm to thigh in the process, and wait for it to heal into position. This healing could take weeks, during which the patient was handicapped by the strange new anatomical arrangement.

WWII burn victims at the Queen Victoria Hospital in East Grinstead. The strips of flesh used for
surgical reconstruction of their faces were kept alive by "waltzing"

"Once the flap had established itself in the pocket, its link with the thigh could be severed. This arduous process left a flap of skin, previously from the thigh, now drawing its blood supply from the patient's arm and free to be moved to any location which the arm could reach. This process of walking a tube of skin end over end from one part of the body to another was known as waltzing. ..."

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Kevin Fong M.D.


Extreme Medicine: How Exploration Transformed Medicine in the Twentieth Century


The Penguin Press HC


Copyright 2012 by Kevin Fong


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