Pioneers of plastic surgery: the story of Kiwi innovation over the war years (Part 1)

“War is the only proper school for surgeons” - Hippocrates (Ancient Greek physician)

‍Aotearoa’s legacy in plastic reconstructive surgery

For a country as small and relatively remote as Aotearoa New Zealand, its impact on the global evolution of plastic and reconstructive surgery has been truly extraordinary. In the early twentieth century—shaped by the devastating realities of World Wars I and II—New Zealand surgeons emerged as pivotal figures in shaping this transformative field. These trailblazing Kiwis helped revolutionise reconstructive surgery, influencing techniques and philosophies that still define the specialty today.

During this critical period, six surgeons in particular with strong ties to New Zealand—Sir Harold Gillies, Sir Archibald McIndoe, Rainsford Mowlem, John Barron, Henry Pickerill, and Sir William Manchester—played internationally significant roles. Their work embraced the new surgical specialty of plastic and reconstructive surgery, leading to the creation and refinement of innovative surgical procedures that not only saved lives but also restored dignity and function to countless individuals—physically, emotionally, socially, and mentally. Many of their innovations remain in practice to this day, continuing to inspire modern surgeons across the world.

Journeying offshore

In the first half of the 20th century, medical school students in Aotearoa did not offer postgraduate medical training. The country’s historical ties to Britain—and a prevailing belief at that time that professional success required further education in “the old country”—meant many aspiring Kiwi surgeons travelled halfway around the world to pursue specialist training and experience in countries with larger populations. This migration of talent laid the groundwork for New Zealand’s lasting international imprint on the development of reconstructive surgery.

WWI: the crucible of trench warfare

The origins of New Zealand’s pioneers of plastic surgery can be traced back to the gruesome carnage of World War I. Trench warfare introduced facial trauma on a horrifying and entirely new magnitude due to the exposure of soldiers’ heads and shoulders to relentless machine gun fire. Injuries never encountered before became tragically common. In response, the field of plastic and maxillofacial surgery developed at a rapid rate, born out of necessity and shaped amid the chaos of war.

Many of the fundamental techniques still taught to today’s surgical trainees were first developed during this time, and later refined in WWII. New Zealand’s pioneering surgeons were thrust into a field with few precedents, as the field of plastic and maxillofacial surgery was in its infancy and the surgical principles of the time were inadequate. Their breakthroughs came through hands-on experience and a relentless drive to improve the care of those grievously wounded in battle.

After WWI, the term “reconstructive” was coined to describe this specialist surgery, emphasising the restoration of body parts damaged or destroyed in war. This distinction gave rise to the title Plastic and Reconstructive Surgery, setting it apart from cosmetic procedures.

Note regarding the below: Archival materials can contain sensitive content that may be upsetting. Some items may include images, information, or language now considered outdated and offensive. Please be aware of this when accessing them.

Credit for first six images below: Ref PA1-o-467, Alexander Turnbull Library, Wellington, New Zealand. Copy of an album containing photographs of some specimens of plastio facio-maxillary cases of the New Zealand section, Queen's Hospital, Sidcup, Kent, England. Image reproduced with permission.

WWII: burns and a maturing specialty

At the outset of WWII, the United Kingdom had just four formally recognised plastic surgeons—known collectively as “the Big Four.” Remarkably, three of them—Gillies, McIndoe, and Mowlem—were New Zealanders, underscoring the country’s central role in advancing the specialty. WWII introduced new challenges for these surgeons, including devastating burns from aerial combat and fires caused by fuel ignitions lit on cold nights in desert camps. High numbers suffered horrific burns, with injuries unlike anything seen in WWI.

After WWII, several of these surgeons, including Pickerill, Brownlee, Hutter, Roy, and Manchester, returned home, bringing with them invaluable experience and leadership that would help shape the future of reconstructive surgery in Aotearoa.

Read Part 2 about pioneers of plastic surgery here.

Read Part 3 here.

‍Dr Earle Brown FRACS FRCS is a well-known plastic surgeon who, before retiring from practice in Aotearoa New Zealand, played a role in the development of plastic surgery in our country. He is the former Head of Unit and Consultant Plastic Surgeon, Middlemore Hospital, New Zealand.

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Find out more about the history of plastic surgery.

Read about New Zealand’s contribution to plastic surgery and the origins of the word ‘Plastic’.

Read about Sir William Manchester’s role in the establishment of plastic surgery in New Zealand.

Discover the work of Sister Joyce Walters in the establishment of the New Zealand plastic surgical nursing service.

Skin deep: unveil the secret superpowers of your body’s largest organ.

Planning is of the essence: read Part 1, Part 2, and Part 3 of a summary of reconstructive surgery techniques.

Ink is the first incision: read about planning a plastic surgical operation.

Find out about war photography of plastic surgery: read Sandy Callister’s article, ‘Broken Gargoyles’: The Photographic Representation of Severely Wounded New Zealand Soldiers in Social History of Medicine Vol. 20, No. 1 pp. 111–130.