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McIndoe’s Pioneering Techniques

Before the Second World War burns patients died quickly from a chain of medical events which were difficult to stop: massive fluid loss and severe shock followed by multiple organ failure.

In the late 1930s the treatment for shock improved and patients began to survive for longer.

This gave surgeons like McIndoe the opportunity to assess existing treatments and develop new improved procedures.

Banning Tannic Acid

At the outbreak of war the universal treatment for burns was tannic acid applied in a gel form known as ‘Tannafax’.

This prevented further fluid loss and infection by creating a hard protective shell over the wound. However, when applied to delicate skin such as eyelids and fingers, it caused the skin to contract making successful reconstructive surgery difficult. The hard shell also had to be removed before surgery could take place and McIndoe saw for himself how incredibly painful this was for his patients.

He campaigned against the use of tannic acid for burns and by the end of 1940 he had persuaded the RAF and the Ministry of Defence to ban it.

Introducing saline treatments

Instead of using tannic acid, McIndoe treated burn injuries using the basic first aid techniques of keeping the wounds open, washing them with saline and changing the dressings regularly. This was a much more labour intensive process and the Queen Victoria Hospital had one of the highest ratios of nursing staff to patients in the country.

Patients were covered with loose moist dressings soaked in a Vaseline type jelly. These dressings could be easily removed for wound cleaning or preparation for surgery.

Male orderlies were vital to the daily saline bath process. They were required to be strong enough to lift the men from their beds into the baths, be trained to monitor the bathing process and then return the patient to their beds. All of this needed to be carried out with the greatest care so as to cause the minimum discomfort for the patient.

The baths were specially designed to make them easy to use. They were made of ebonite which was saline proof. Some had wheels on them so they could be moved around. Each bath had electronic controls to make sure the temperatures and saline levels were correct. As saline is a highly conductive liquid the baths had to be earthed to make sure none of patients suffered from electric shocks during their treatment.

Saline Baths
Tube pedicles

Tube pedicles

McIndoe had learnt the tube pedicle technique from fellow plastic surgeon, Harold Gillies. He went on to refine the procedure into a more effective skin grafting method for facial and hand reconstruction.

When grafting skin during the First World War Gillies discovered that by cutting a flap of skin usually from the chest or leg it could be stitched it into a tube. This would allow the surgeon, over a period of weeks, to detach one end of the tube and ‘walk’ it up the body from its original location to the site of a burn injury.

As the tube pedicle was moved up the body it took three weeks for the blood supply to establish itself in between grafts. This meant the airmen had to get used to holding themselves in awkward positions with restricted movement so as not to damage the pedicle. These men shown here are all waiting for their pedicles to be cut off their bodies and shaped into new facial features.

By creating a tube the surgeon maintained the blood supply to the tissue keeping it alive and healthy before it was grafted. The tube construction used the patient’s own skin to protect the live tissue inside from infection. Tube pedicles were often used to recreate the airman’s noses, foreheads, lips and chins.