Are Gillies’ Ten Commandments Just as Commanding Today?
It is staggering that Gillies' achievements to a large extent preceded antibiotics, suction, blood transfusion, anesthesia in its current form, and even saline as intravenous fluid. Plastic surgery as a specialty has advanced considerably in the hundred years since Gillies opened the Queen's Hospital in Sidcup and performed some 11,000 operations on more than 5000 wounded soldiers of the First World War. He was actually a trained otolaryngologist before helping to create the specialty which reveres him, and most of his operations on wounded solders were innovative treatments for facial injuries.
But how relevant are his 10 commandments to current practice? Let us look at them.
Sir Harold Delf Gillies' (1882–1960) 10 Commandments of Plastic Surgery1
It remains an important principle of plastic surgery to “measure twice, cut once.” Having said that, more frequently, we find ourselves in theater with a problem that requires an improvised solution. Various reasons account for this need for immediate planning. Increased numbers of surgeons sharing on-call duties and operating on each other's patients have (to some extent) replaced the dynamic which would have existed during Gillies time in practice. Thus, the plan may need to be fairly swiftly formulated and executed without the continuity of a single surgeon's management.
This rule suggests that the surgeon should have a fairly predictable approach to patients and their plastic surgery problems. One is tempted to consider that some colleagues interpret this rule as referring to their cufflinks or hair. The reality is that most of us have our own sometimes unique approach to problems, and we mold this over the years into hopefully something productive of consistently high standards. However, we are encouraged to welcome and indeed ask for the opinion and assistance of colleagues with different styles, and we are expected through audit and appraisal processes to modify our own styles when required.
There is a caveat to this law in modern times. Unfortunately, aging is normal but is becoming less and less acceptable so that cosmetic procedures can result in an overly “false” appearance if applied unscrupulously. Some results might be considered “supranormal.”
Plastic surgery progress has been so impressive that very few defects are now considered beyond reconstructive strategies. “Tumour style debridement” is applied to lower limb trauma as readily as to the malignant sarcoma. Surgeons are comfortable removing healthy living tissue when they have confidence in their reconstructive plan, particularly when evidence or experience inform them that the results and prognosis should be superior with the sacrifice of viable tissue that can interfere with the overall reconstruction plan.
Bearing false witness against anyone or anything, particularly thy defect, will never be desirable. Exaggerating the complexity of a problem to pursue an elaborate procedure is an example of this sort of deception.
It is actually unusual now not to address both the primary and secondary defects simultaneously because of the range and sophistication of reconstructive options.