Plastic surgery and war have an interconnected history. It’s not so strange when you think about it—throughout the ages and across the continents, warfare has produced some of the most horrifically disfigured people the world has ever seen. Throughout history, plastic surgery skills have been needed to help the victims, and, while stepping up, plastic surgeons have advanced the field during wartime.
Today, the trend continues with endless strife in the Middle East. Weapons in Iraq, Afghanistan and other areas include the conventional and the improvised—both capable of destroying lives and maiming bodies. Repressive regimes contribute to the need for plastic surgeons to offer their skills.
Most historians point to India as the birthplace of plastic surgery. As long ago as about 800 A.D., surgeons were using flaps from cheeks and foreheads to reconstruct noses and ears.
The field advanced at a very slow pace at first. Gaspare Tagliacozzi, an Italian surgeon often credited as the father of plastic surgery, performed rhinoplasty surgery on people injured in wars and in civil violence using grafts from patients’ arms. His famous book, published in 1597, is revered for its comprehensive account of the procedure he perfected.
The American Society of Plastic Surgeons (ASPS) notes that the wars of the last two centuries have been the driving force behind modern plastic surgery. The Society’s Web site, www.plasticsurgery.org, identifies World War I as the stage for giant leaps forward in reconstructive medicine.
“Never before had physicians been required to treat so many and such extensive facial and head injuries. Shattered jaws, blown-off noses and lips and gaping skull wounds caused by modern weapons required innovative restorative procedures.” The ASPS says that some of the most talented surgeons in the Western world applied themselves to serving humanity during that time.
Today, ongoing strife in the Middle East produces more victims in need of reconstructive surgery than modern medicine can hope to keep up with. The U.S. has now been involved in conflicts for two decades in the region, starting with the successful effort to restore Kuwaiti independence in 1990-1991 following the Iraqi invasion—the “Gulf War”—and continuing through the ongoing conflicts in Afghanistan and Iraq.
What will be learned from the cases of thousands of disfigured men, women and children during these decades? A few trends are already apparent, and the most obvious lessons have nothing to do with advances in medical care. Instead, portraits of the maimed are used to stir controversy and illustrate shortcomings in our systems.
Witness the stormy reaction to Time magazine’s cover image two weeks ago—that of a young Afghan woman mutilated by her husband on orders from the Taliban. The beautiful eighteen year-old, now missing her ears and a nose, posed next to the incendiary caption, “What happens if we leave Afghanistan.” Almost immediately, the “blogosphere” lit up with rants agreeing that we must stay to help protect the human rights of Afghanis like Aisha, alongside posts arguing that the Taliban actually gains strength the longer we stay in the country.
Another sad fact that’s readily apparent is that military and medical systems in the U.S. are not prepared to handle the influx of veterans who need reconstructive surgery. More and more soldiers survive their battle wounds only to learn firsthand the limits of the Veterans Administration system. Many who need plastic surgery face long wait times. Even worse, points out an article in the July 2009 issue of the Annals of Plastic Surgery, many procedures straddle the line between cosmetic and reconstructive surgery and guidelines within the VA system can be unclear. This situation can serve to decrease veterans’ access to surgery altogether.
To date, it seems as if the opportunities to advance medical knowledge coming out of the current Middle East wars are overshadowed by media grandstanding, politics and shortsightedness. But maybe there’s still hope that some good things will result from the endless fighting.
For one thing, a variety of non-profits are stepping up to help veterans get the plastic surgery they need. Iraq Star is one (www.iraqstar.org), filling the gap the VA system sometimes leaves behind in the wake of closing wounds, grafting skin and providing prosthetic limbs. UCLA’s Operation Mend is another (www.operationmend.ucla.edu).
History may just show us that one of the more positive results of war in Iraq and Afghanistan is in advancing the growing field of transplantation. Indeed one component of the Operation Mend program at UCLA Medical Center is a hand transplant program in which Dr. Kodi Azari, the surgeon who has performed five of the nine hand transplant surgeries in the United States, operates.
The Medical Director of the new UCLA Hand Transplantation Program, Dr. Sue McDiarmid, explained to a university newsletter, "UCLA Today," two weeks ago that the program is a natural component of Operation Mend. She said, “With two wars on, the need for our servicemen and women is there.” Surgeons like Azari and their teams are already perfecting techniques for the incredibly detailed surgical procedure, and the program is facing the need to learn to handle other important aspects of successful transplantation, such as the appropriate match between a cadaver hand and the patient for physical and psychological reasons.
Another key to improving limb transplants—and any other kind of transplant, for that matter—is that of finding ways to lessen and maybe someday eliminate the immunosuppressant drugs required to keep the body from rejecting the transplant. Remarked Azari, “That’s the holy grail. Once that happens we will have entered a brand new frontier in medicine.” (See the entire article at: http://operationmend.ucla.edu/workfiles//Hand_transplant_program_to_offer_life_altering_surgery.pdf)
Could the wars in Iraq and Afghanistan be the catalyst for such progress? In this case, a result like that would be some consolation in the face of the enormous cost of war.