Plastic Surgery Innovation through War , Disaster , and Pandemic

373e wound dressings, and portable negative-pressure wound therapy. Two publications described surgical staff collaboration modeling and recruitment from terrorist attacks. Our results show war was a significant contributor during the first half of the twentieth century; however, the last few decades show a shift toward other disaster types. Sir Harold Gillies became a dedicated reconstructive surgeon to restore deformed soldiers in World War I. In 1917, he developed his tubed pedicle flap, which provided the ability to close difficult wounds with poor local options.2 Berkman inserted wires laterally through metacarpals, allowing patients to have enough extension and flexion to carry out minor duties the next day.3 Ralph Millard, whose cleft repair is still widely performed, was also shaped by his experiences in the Korean conflict. War is not the only disaster to influence changes in our practice. More recently, terrorist attacks have led to new ways of organizing surgical staff during mass casualties.4 The modern field of plastic surgery originated from the global catastrophic events of World War I and continues to progress from innovations devised during disasters. Our study has highlighted advancements that have arisen from tragedy. We found war has been the greatest motivator of ingenuity. Terrorism and natural disasters have emerged as events leading to innovation during the last few decades. The current COVID-19 pandemic may alter practice as well. An electroceutical fabric dressing designed for chronic wounds was adapted as a face mask effective at eliminating COVID-19.5 The widespread use of telemedicine from COVID-19 will expand the reach of plastic surgical evaluation to smaller communities. Plastic surgery procedures that may have resulted in a short admission may become outpatient on a more universal level as a result of attempts to limit hospitalizations during COVID-19. Our field must do what it has always done: use a major crisis to spark innovation to improve the care of patients.

wound dressings, and portable negative-pressure wound therapy. Two publications described surgical staff collaboration modeling and recruitment from terrorist attacks. Our results show war was a significant contributor during the first half of the twentieth century; however, the last few decades show a shift toward other disaster types.
Sir Harold Gillies became a dedicated reconstructive surgeon to restore deformed soldiers in World War I. In 1917, he developed his tubed pedicle flap, which provided the ability to close difficult wounds with poor local options. 2 Berkman inserted wires laterally through metacarpals, allowing patients to have enough extension and flexion to carry out minor duties the next day. 3 Ralph Millard, whose cleft repair is still widely performed, was also shaped by his experiences in the Korean conflict. War is not the only disaster to influence changes in our practice. More recently, terrorist attacks have led to new ways of organizing surgical staff during mass casualties. 4 The modern field of plastic surgery originated from the global catastrophic events of World War I and continues to progress from innovations devised during disasters. Our study has highlighted advancements that have arisen from tragedy. We found war has been the greatest motivator of ingenuity. Terrorism and natural disasters have emerged as events leading to innovation during the last few decades. The current COVID-19 pandemic may alter practice as well. An electroceutical fabric dressing designed for chronic wounds was adapted as a face mask effective at eliminating COVID-19. 5 The widespread use of telemedicine from COVID-19 will expand the reach of plastic surgical evaluation to smaller communities. Plastic surgery procedures that may have resulted in a short admission may become outpatient on a more universal level as a result of attempts to limit hospitalizations during COVID-19. Our field must do what it has always done: use a major crisis to spark innovation to improve the care of patients.

Plastic Surgery Innovation through War, Disaster, and Pandemic
T he coronavirus disease of 2019 (COVID-19) pandemic has impacted the practice of medicine. Historically, the field of plastic surgery has been influenced by catastrophic events. Modern warfare in World War I resulted in mass casualties and survivors with deformities. Plastic surgery arose as a distinct specialty to restore form and function in these wounded soldiers. 1 Subsequent crises have provided challenges to drive development of new plastic surgical solutions. The purpose of this study was to (1) assess innovations in plastic surgery that emerged from disasters and (2) identify possible ideas that may arise from the COVID-19 situation.
PubMed and Ovid databases were searched for articles documenting origination of plastic surgery ideas during a disaster using search terms "disaster," "war," "plastic," "burn," "terror," and/or "novel." Types of "disasters" were categorized as war, terrorism, accident, and natural disaster. Articles were included if they discussed novel therapies that emerged in association with the disaster.
Eighteen articles met inclusion criteria (Table 1). Eleven papers described innovations during war, including percutaneous fixation of hand fractures with use of Kirschner wires, delayed wound closure, cleft lip repair, vascular repair of traumatic injuries, mafenide acetate Table 1

Date of Disaster
Tubed pedicle skin flap graft (Gillies, 1932