Israeli plastic surgeons scramble to restore faces, functioning limbs to victims of terror, war

Until the First World War, most wounded soldiers were injured by swords, knives, and bullets from pistols. Even if they were scarred, they had to live with it because they regarded themselves as fortunate to have evaded death – and the medical specialty of plastic surgery, in any case, was almost nonexistent. 

But when the “Great War” erupted between the Allies (France, Russia, the British Empire, and later Italy and the US) against the Central Powers (Germany and the Bulgarian, Austro-Hungarian, and Ottoman empires), the combatants – sometimes by simply peering out at the enemy from their trenches – suffered horrific wounds from machine guns, shells filled with exploding shrapnel aimed at causing severe damage, burns, poison mustard gas, and other chemical weapons. 

Some nine million soldiers died, 23 million were wounded, and as many as eight million civilians were killed. Faces, jaws, arms, legs, and other body parts were torn to shreds in the wounded who managed to survive. 

A soldier would look in the mirror and – with ghastly, giant holes in his forehead or cheeks – be unable to recognize himself. He turned to look behind, but no one was there. He touched the reflection, but it didn’t move. To his horror, he finally realized that the face he saw was his.

Amazingly, the first reconstructive plastic surgery dates back to the 8th century BCE, performed by Sushruta, the most celebrated physician and surgeon in India. Many of Sushruta’s contributions to medicine and surgery preceded similar discoveries in the Western world. He reportedly was the first to describe the use of “pedicled” cheek flaps for reconstruction of the nose. But victims had to wait millennia for World War I’s development of modern plastic surgery. 

Fortunately, physicians at the beginning of the 20th century quickly recognized the need to repair the wounded – but few knew how. Because of the tightness caused by missing skin, some wounded were unable even to close their eyes or mouths. 

Treating wounds from war and terror

THE “FATHER of plastic surgery” was surgeon Harold Gillies of New Zealand, who had trained in England and was dispatched to France to treat the wounded among the Allies. On his return to England, he improvised repair techniques and established a ward for facial injuries, followed by the Queen’s Hospital in London – the world’s first hospital to be devoted to the treatment of facial injuries.

Gillies decided to remove all mirrors in the hospital to protect the wounded from being shocked by how they looked. 

Among the techniques he and his colleagues developed were skin grafts from other parts of the body and taking “flaps” of healthy skin still attached to the body to cover spots where it was missing. 

Thousands of soldiers suffered long-term disabilities as a result of the war, and improvements in facial reconstruction brought some relief. 

Gillies understood that the disfigured men he treated found it difficult to find jobs, so he introduced training programs to give the men interests and new skills. Many of his patients returned to their families, thankful for their improved functions and appearance, but some men never left the Queen’s Hospital because they didn’t want to show their faces to the world. 

During World War II, plastic surgeons were more advanced, and even tattooed skin grafts, injecting them with color pigments to match the regular skin.

Today, these and more advanced techniques are used by the 80 Israeli plastic surgeons who perform reconstruction in public hospitals around the country; there are more than 200 more who do aesthetic plastic surgery in private hospitals and clinics, which are much more profitable, explained Prof. Josef Haik, a leading specialist in aesthetic & reconstruction plastic surgery and burns and director of Sheba Medical Center’s division of plastic and reconstructive surgery and its national intensive care burn unit in an interview with The Jerusalem Post.

Born in Israel, he is very well traveled; speaks Hebrew, English, Arabic, and Portuguese; has led humanitarian delegations to Kenya, Haiti, the Dominican Republic, Peru, Guatemala, Romania, and St. Lucia; has established a lab for growing and storing skin; and conducted research in Israel, Canada, Australia, Brazil, and more. 

AFTER THE murderous incursions by Hamas terrorists on October 7 to settlements near Gaza and the Nova music festival, the more than 12,000 wounded IDF soldiers plus civilians have kept Israeli plastic surgeons busy round the clock – and the flow continues. 

Over 500 wounded soldiers have undergone amputations of legs, arms, hands, and other organs since October 7. They suffer penetrating injuries, contusions, and soft-tissue injuries. Plastic surgery has to be performed to suit the stump to the prosthesis, Haik said. 

Aesthetic plastic surgeons from the private hospitals volunteered and came to treat the wounded early in the war. The Israel Association of Plastic and Aesthetic Surgery assembled a list of about 300 plastic surgeons from the US, France, and other places who wanted to come and help with the wounded, and about 50 – mostly non-Jews – came, some even for months, Haik recalled. “We also received donations of bones, ligaments, tendons, and skin from other countries.

“Physical rehabilitation is very slow, and of course, most need psychological treatment for post-trauma for long periods,” added Haik, who says he has treated hundreds of victims since the war began. 

Because of wars and terror attacks, Israeli plastic surgeons and other specialists are world experts in treating victims, and teams from other countries come here to learn, he added. “We are at the cutting edge, send delegations all over the world, and have invited useful drugs that improve results.” 

To save more lives and improve the quality of life of the wounded who were affected by severe scars, deep burns, deep cuts, and life-threatening situations, members of the association managed to spend two days at the Tel Aviv Hilton recently to learn more at the group’s annual conference about the latest innovations in reconstructive surgery. Over 140 research studies were presented. 

“We are proud to be at the forefront of this complex treatment and help victims get back on track with their lives,” said association chairman Haik at the event, which was also attended by the IDF’s chief medical officer, Brig.-Gen. Dr. Zivan Aviad-Bar. 

Aviad-Bar said “the Medical Corps has a significant role to play in this war. We place senior caregivers – doctors and male and female paramedics – at the front of the fighting, give high-quality doses of fresh, refrigerated whole blood and plasma, and our processes of learning during the war allow us to do things differently and better. The arrival time of senior medics to the wounded is very fast, and each battalion has between four to six medics. 

“The evacuation times from injury to the hospital are faster than ever. Studies show that the return of blood products, plasma, or whole blood reduces mortality. In the past year, over 1,000 rescue missions took off, leading to the evacuation and rescue of over 1,800 injured.” 

But there are not enough plastic surgeons – or specialized nurses – to treat wounds and burns here. 

“Some of them are serving in the reserves, reducing our numbers,” Haik noted. “Surgeons who work only in public hospitals can’t make a decent living due to low salaries, and there aren’t enough manpower slots, so the majority work privately in aesthetic surgery,” said Haik, who performs aesthetic surgery privately in Ramat Gan in the late afternoons and evenings. 

“Young doctors don’t remain in public hospitals because there are no financial incentives. No one will strike, so the [Finance Ministry] takes advantage of the situation,” he concluded.