The eureka moment
Gillies’ development of the pedicle tube procedure was a breakthrough in plastic surgery.
Of Gillies’ many discoveries, two significant ones came about through a single patient, Able Seaman Willie Vicarage. An explosion on HMS Malaya had burnt all the skin off his face, leaving horrific scarring. Vicarage’s nose was all but gone, his eyelids turned inside out. Gillies devised a technique for crafting new eyelids, then went on to make another breakthrough.
Reconstructive surgeons work with what is left – they do not add, but move and remove. In Gillies’ work, cartilage was borrowed from one place and used in another, and skin partially cut from a neighbouring area and turned to cover or correct wounds. The difficulty was in having enough tissue to transfer – “free flaps” of tissue lifted entirely from another part of the body and transferred generally did not take. These were the days before microsurgery allowed the minute stitching together of blood vessels.
So, Gillies had little to work with when Vicarage was sent for surgery in October 1917. When he cut down across Vicarage’s chest, lifting a large flap to fold over the face, he noticed that the edges of the skin curled inwards. It was a “eureka” moment – Gillies realised if he stitched the edges together he could create a tube of living flesh. And if he did that, he could move the end of the tube wherever he needed it by slowly “walking” the tube up or down the body in caterpillar fashion. He could stitch the free end of the “pedicle tube” wherever it reached to, wait a few days for it to heal as blood started flowing, then cut the opposite end and move it where needed. If the tube had to move a long way, a wrist could be used as a temporary stitching point and subsequently raised or lowered closer to where the tube was needed.
Gillies later wrote, “another needle was threaded and, in an astonished silence, I began to stitch the flaps into tubes”.
Although sole credit for the new pedicle tube procedure cannot be given to Gillies – at least two other surgeons independently devised the same technique during WWI – he was recognised for its development and also for the wide number of applications it had. It gave reconstructive surgeons far more material to work with than before.