The First World War left millions dead, but for many survivors, the battle did not end when they left the front lines. They carried lifelong reminders of the war in the form of injuries and disabilities that they had survived. Life was never the same again; this became their new normal. Among them were thousands of men with devastating facial injuries caused by bullets, shell fragments, and explosions. Missing jaws, shattered cheekbones, destroyed noses, and extensive soft-tissue damage became an increasingly common sight in military hospitals.
These injuries created challenges that traditional surgery was not equipped to address. Surgeons could often save a patient's life, but restoring the ability to speak, eat, breathe, and interact socially was another matter entirely. The need to care for these wounded soldiers led to a period of rapid surgical innovation, giving rise to many of the principles that underpin modern plastic and reconstructive surgery.1,2
At the center of this development was Harold Delf Gillies, a New Zealand-born surgeon working in Britain during the war. Through a combination of technical innovation, meticulous planning, and an understanding of the psychological impact of facial disfigurement, Gillies helped establish facial reconstruction as a specialized field. His work at Queen's Hospital in Sidcup would influence reconstructive surgery for decades after the guns of World War I fell silent.
Previous wars had certainly produced facial injuries, but the trench warfare of 1914–1918 created unique circumstances. Soldiers often remained protected behind trenches with only their heads exposed above the parapet. As a result, the face became particularly vulnerable to enemy fire and shell fragments.3
At the same time, improvements in battlefield evacuation, anesthesia, antiseptic techniques, and infection control increased survival rates. Men who would previously have died from severe trauma were reaching hospitals alive, often with extensive facial destruction. Medical staff suddenly faced injuries that had few established treatment protocols.4
The consequences of these injuries extended far beyond physical disability. The scars and deformities that soldiers carried served as constant reminders of the war, affecting their mental and emotional well-being long after the fighting had ended. Many injured soldiers became reluctant to appear in public, fearing social rejection and unwanted attention. For these men, reconstruction represented more than a surgical procedure, it offered the possibility of returning to everyday life.
Harold Gillies began his medical career with training in general medicine before pursuing a specialization in ear, nose, and throat surgery. While serving in France during World War I, he closely observed the reconstructive work of French surgeon Hippolyte Morestin on soldiers with severe facial injuries. These experiences highlighted the need for specialized care and motivated Gillies to advocate for a dedicated center for facial reconstruction in Britain.4
In 1916, a specialist facial injury unit was established at Cambridge Military Hospital in Aldershot. As the number of patients increased, a larger facility became necessary. This led to the opening of Queen's Hospital in Sidcup in 1917, which became the world's first hospital dedicated specifically to facial injuries.5
The hospital became both a treatment center and a place where new surgical techniques could be developed, tested, and refined.
The scale of facial trauma seen during the war forced surgeons to move beyond conventional methods. One of Gillies' most significant contributions was the refinement of pedicle flap surgery, in which tissue remained attached to its original blood supply while being transferred to a damaged area. Maintaining vascular connections dramatically improved tissue survival compared with earlier grafting techniques.2
Gillies later developed the tubed pedicle flap, a method in which skin was rolled into a tube before transfer. The design reduced infection, protected the blood supply, and allowed tissue to be moved over considerable distances. For many years, this technique remained one of the most reliable reconstructive procedures available.5
Unlike many surgeons of his era, Gillies preferred a staged approach. Instead of attempting complete reconstruction in a single operation, he carefully planned a series of procedures over months or even years. This method often produced better functional and cosmetic outcomes, particularly in complex facial injuries.
Gillies understood something that many surgeons of his time overlooked: surviving an injury was only part of the journey. He realized that severe facial disfigurement could affect how a person viewed themselves and how they interacted with society, often leaving emotional scars long after the physical wounds had healed.
Artists and photographers documented patients throughout their treatment, creating detailed visual records that assisted surgical planning and education. Some patients who could not undergo complete reconstruction received facial prostheses designed to restore a more natural appearance.
Gillies viewed reconstruction as more than repairing damaged tissue. His goal was to restore confidence, dignity, and a sense of identity. This holistic understanding of patient care remains central to reconstructive surgery today.
By the end of the war, Gillies and his team had treated thousands of servicemen and performed more than 11,000 operations. The experience gained at Sidcup established many of the principles that continue to guide reconstructive surgery, including tissue preservation, staged reconstruction, multidisciplinary care, and attention to aesthetic outcomes.2
The influence of Gillies extended beyond military medicine. Techniques developed during World War I later proved invaluable in treating burns, congenital abnormalities, cancer-related defects, and civilian trauma. His work also inspired future surgeons, including Sir Archibald McIndoe, who expanded reconstructive surgery during the Second World War.
World War I created an unprecedented demand for facial reconstruction. The injuries produced by industrialized warfare forced surgeons to develop new techniques and rethink the goals of treatment. Through his work with wounded servicemen, Harold Gillies demonstrated that successful reconstruction involved more than physical repair. It required restoring function, appearance, and the ability to participate fully in society.
More than a century later, many of the principles established at Sidcup remain visible in modern reconstructive practice. The specialty that emerged from the challenges of World War I continues to shape the lives of patients around the world.
1. Alberti, Fay Bound. 2022. "Harold Gillies and the Battleground of Surgical Innovation." The Lancet 399 (10344): 2094–2095.
2. Manahan, Michele A., and Stephen M. Milner. "The Gillies's Approach to Posttraumatic Reconstruction of Ballistic Injuries in Evidence a Century Later." Eplasty 18 (2018): pb1.
3. National Army Museum. n.d. "The Birth of Plastic Surgery." Accessed August 2026.
4. National Archives. n.d. "Sir Harold Gillies." Medicine on the Western Front Educational Resource. Accessed August 2026.
5. Royal College of Surgeons of England. n.d. "Sir Harold Gillies' Patient Case Files." Accessed August 2026.
