Pedicle Tubing

I have been tracking in awe through the galleries at Project Facade; a exhaustingly comprehensive collection of the facial reconstruction procedures developed for victims of World War I. The project came out of the Gillies Archives at the Queen Mary Hospital in Sidcup, just southeast of London. Project Facade is an exhausting collection of arresting images, terrible injuries, and incredible repairs. While browsing the case studies and galleries you will come into constant contact with images of and references to "pedicle tubing." It is an obvious term, but the true use and nature of the procedure is not as immediately apparent. Here is a full definition of the procedure from Project Facade:

The tube pedicle was developed simultaneously yet independently by Sir Harold Gillies at the Queen’s Hospital Sidcup and ophthalmic surgeon Vladimir Petrovich Filatov in Odessa, Russia between 1916 and 1917. A tube pedicle is a flap of skin sewn down its long edges, with one end left attached to the site of origin, the other is attached to the site to be grafted.

The procedure begins with the lifting of a long, large flap of skin by making a roughly ‘U’ shaped incision. The rounded end of the flap is cut to shape to fit the area to be repaired. The long edges of the skin flap are stitched together to form a tube to prevent drying out and infection of the raw side of the skin flap. The shaped end of the tube is then attached to the site to be repaired whilst the other end of the tube remains attached to its site of origin. After a number of weeks, the tube is cut near the area to be repaired leaving enough skin on the graft site to shape and model. The remainder of the tube can once again be opened and returned to its original position. On occasion, multiple tubes might be taken to rebuild substantial parts of the face or body.

Tissue must be taken from distant parts of the body in stages. For example a tube might be taken from the stomach area and attached to the wrist. After a number of weeks the tube would be disconnected from the stomach, the arm raised and the loose end of the tube attached to the site on the face to be repaired. Once again after a number of weeks the tube is disconnected from the wrist and this loose end of the tube is attached to another part of the face. Only then can the tube be opened and modelled to the face.

Sir Harold Gillies is a fascinating study in his own right. He not only pioneered facial reconstruction and plastic surgery, but preformed the both first sex reassignment surgery from female to male in 1946 and from male to female in 1951. To the strong stomached, I highly recommend browsing around Project Facade. The more you explore the more the accomplishments of these pioneers of plastic surgery begin to shock more than the unimaginable damage suffered by the poor soldiers.

From: Project Facade