Although you hear people mostly talking about cosmetic plastic surgery, the main work of nearly all plastic surgeons is reconstructive: covering all aspects of wound healing and reconstruction after congenital, acquired and traumatic problems, with aesthetic surgery playing a smaller but important part in their working week. British plastic surgery was born during the First World War. The brutal nature of trench warfare caused terrible head and facial injuries among soldiers on both sides of the conflict, with bullets and explosive shells causing mutilation on an unprecedented scale. Up until this point, there were surgeons who performed reconstructive and grafting procedures alongside more general surgery, but none who specialised in these areas. By the 1930s there were four plastic surgeons practising in England. They were Gillies, Kilner, McIndoe and Mowlem, who became known as ‘The Great Four’.
Historically, plastic surgery units were free-standing hospitals, often in the countryside outside major cities. That approach, developed in war time was unsustainable for modern healthcare. Indeed, as trauma centres are beginning to be established in England, plastic surgery is playing an important part in the planning of the systems of trauma care.