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Memorial Day is the annual remembrance and recognition in the United States of all members of the Armed Services that have sacrificed for the freedoms that we continue to enjoy today. From Lexington and Concord to Bagdad and Kabul, millions of men and women have given in incalculable ways some of even the ultimate sacrifice. While wars are unfortunate and tragic, they have played major roles in shaping our country.

Just as war as shaped America, it is also heavily responsible for the development of plastic surgery as we know it today. While certain plastic surgery operations can be traced back thousands of years to Egypt and India, they were largely operations of the nose, ear or lip to correct congenital or traumatic injuries. It was not called plastic surgery then and such a term only first appeared in a rhinoplasty textbook in 1818. But it was war that created the need for extensive face and body reconstruction.

The first World War and the doctors involved in it became the cornerstone of modern plastic surgery. The unique and devastating weapons of World War I were considerably advanced compared to earlier conflicts. This was particularly true with machine guns and artillery. Fighting within trenches, soldiers did not realize how quickly a machine gun could catch them in the face or skull as they popped their heads above the line. Shrapnel and exploding artillery shells created major wounds that were both extensive and comminuted. Bones were not just broken, they were shattered. An unimagineable number of shattered jaws, blown-off noses ears and lips, and open skull wounds presented themselves to battlefield doctors with little prior experience.

Surgeons had to create new innovative reconstructive procedures to rebuild faces and limbs of the soldiers both during and after World War I. Techniques such as skin grafting, flap reconstruction, bone grafting and facial prosthetics became well developed with the considerable patient population who needed it. Specialized centers for plastic surgery were created in France and England and some of the classic treatises on plastic surgery were written based on these experiences.

U.S. doctors returned from the war and brought these experiences with them, teaching a new generation of surgeons the exciting field of plastic surgery. This new surgical specialty interest resulted in the formation of the American Society of Plastic Surgeons in 1937 to provide a forum for exchange of ideas and establishing a formal training program for what constitutes a plastic surgeon. Plastic surgery was off and running and, although there have been five other major wars since, none has had the impact that World War I had.

On the surface, it may be hard to see how much of the cosmetic surgery done today has anything to with the reconstructive history of plastic surgery. But the connection is that every cosmetic procedure that I can think of had its beginning in a reconstructive operation. Cosmetic surgery is largely reconstructive procedures modified and refined to elective face and body changes.

War is tragic and most certainly hell for both soldier and civilians involved. But its one benefit is that it creates the need for reconstructive plastic surgery procedures from which the benefits affect both the present and many future generations as well.

Dr. Barry Eppley

Indianapolis, Indiana

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