“The Maestro”: A Pioneering Plastic Surgeon—Sir Archibald McIndoe and His Innovating Work on Patients With Burn Injury During World War II

Abstract

This article describes McIndoe's revolutionary methods of burn treatment and rehabilitation of patients with burn injury and outlines his personality traits that made him one of the most important plastic surgeons of the twentieth century. As a consultant plastic surgeon to the Royal Air Force, he set up a plastic surgery unit in the Queen Victoria Hospital in East Grinstead. By using biographical data and photography, McIndoe's work on burns treatment and the challenges he faced are presented. Before World War II, little was known about the treatment of severe burns and their complications, and even less was done about the rehabilitation and social reintegration of patients with burn injury. McIndoe changed all that by developing new techniques for the management and reconstruction of burn injuries. He helped his patients become and get accepted as a normal part of society again. The patients with burn injury treated by him formed the Guinea Pig Club. Sir Archibald Hector McIndoe, a charismatic plastic surgeon with an uncanny instinctive knowledge of psychology, recognized early that the rehabilitation of a burned patient was as important as the reconstruction of his physical body. His therapeutic approach to patients with burn injury was mental and physical.

Albert Ross Tilley: The legacy of a Canadian plastic surgeon

“…The black eschar also made it very difficult for the medical staff to detect infections, which often went unrecognized until the indicative aroma wafted into the nostrils of patient and staff. With the goal of avoiding septicemia, the coagulum was ripped from the wound so antiseptic agents could be administered, but this commonly proved ineffective and agonizingly painful for the patient (10). Results of coagulants applied to burns of the face were equally distressing.…”

“…If by some divine intervention the patient persevered through the shock, the next hurdle to their recovery was infection. With odds stacked so highly against recovery from severe burns, the treatments that developed were largely chemical interventions geared toward minor burns, with surgical involvement a rare occurrence (10). Breakthroughs in treating shock changed everything.…”

“…The position of the fuel tank often resulted in its contents exploding in the face of the pilot, which accounts for the characteristic facial burns sustained. In addition to the hands and face, airmen commonly experienced burns to their wrists, neck, thighs and scalp (10).…”

“…This was especially important for burned hands, which were much more mobile under water and proved quite favourable for circulation and the salvaging of the greatest proportion of digits possible (16). Patients under Tilley's care would soak for 1 h in tubs of saline two to three times per day, during which time, dressings would seamlessly float off the burn site and save the patient from the potential agony of removing them under dry conditions (10).…”

“…A coagulating agent would be applied to the burn that caused a tough hide of scab-like tissue to encase the wound (10). This functioned as a chemical dressing of sorts, and was believed to be advantageous by many physicians in its ability to protect the wound, prevent lifethreatening fluid loss and guard against sepsis (8).…”