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The term plastic surgery is derived from the Greek word ‘plastikos’, meaning to mould or shape. It was first used in 1818 by a German surgeon, Carl von Graefe, in his text, Rhinoplastik, which outlined rhinoplasty techniques, ancient and modern. In China, too, there were early attempts at reconstructive plastic surgery. For instance, texts from both the Chin and Tang Dynasties – from around 300 AD and 700 AD – describe techniques for repairing a cleft lip. 

By the Middle Ages plastic surgery techniques had developed in Europe. The emperor Justinian II (known as ‘Rhinometus’, or ‘the one with the amputated nose’) is believed to have had his nose reconstructed in the eighth century. After a decline through the Middle Ages the rebirth of science and medicine during the Renaissance saw the further development of plastic surgery techniques for the nose, the jaw, eyelid disorders and for breast reduction – with a decline again towards the end of the sixteenth century. When reconstructive surgery resurfaced again in Europe at the end of the eighteenth century noses were again the focus remained a focus, with successful nasal reconstructions performed both in Britain and in Germany at the end of the eighteenth century - and von Graefe coined the use of the term ‘plastic’ surgery. Small advances continued through the nineteenth century, aided by developments in anaesthesia and sterile techniques. But plastic and reconstructive surgery remained in its infancy as a surgical specialty until the advent of the First and Second World Wars. 

 With unprecedented numbers of soldiers sustaining horrific and maiming injuries, plastic surgery units were set up to treat severe burns, maxillofacial injuries, gaping wounds and missing body parts. In Britain the first units at Aldershot and Sidcup were founded by Dunedin- born Sir Harold Gillies. Trained as an ear, nose and throat surgeon, he turned his considerable talent to skin grafts and reconstruction, especially facial reconstruction. Gillies continued to advance the work after the war, bringing plastic surgery into mainstream medicine. He taught and inspired young surgeons from around the world, including another New Zealander and relative, Sir Archibald McIndoe. McIndoe became Gilles assistant in the newly created specialty of plastic surgery at St. Bartholomews Hospital in London and then joined him in private practice. McIndoe quickly became a leading figure in the field and at the beginning of the Second World War founded the plastic surgery unit at East Grinstead which has specialised in dealing with injuries to the jaw along with other trauma. 

Another New Zealander, H.P. Pickerell, also worked with Gillies at Sidcup. Pickerell returned to Wellington and established Basham, a private hospital specialising in plastic and reconstructive surgery. Most of the cleft lip and cleft palate operations in New Zealand at this time were performed at Basham. Burwood military hospital, now part of Christchurch hospital, was established in 1943 to deal with the injuries of wounded soldiers returning home. Joe Brownlee was in charge, followed by Sir William Manchester on his return from war-torn Europe. Initially most of the operations done at Burwood concerned reconstruction of war injuries but over time more and more civilians came to be treated there. Burwood can be considered New Zealand’s first true plastic and reconstructive surgery unit. 

Middlemore Hospital, built by the Americans in 1944 to tend their Pacific casualties, also specialised in plastic and reconstructive surgery. Middlemore was taken over by the Auckland Hospital Board in 1947 and when Sir William Manchester was appointed to Middlemore Hospital in 1951 he set up the Middlemore Plastic Surgery unit – or, to give it  it’s official title ‘The Regional centre for Plastic, Reconstructive, Maxillofacial and Hand Surgery. 

The work by plastic and reconstructive surgeons in response to the devastating injuries of war fully established the specialty and demonstrated its seemingly miraculous possibilities to the world. Lives were regained with the reconstructive techniques perfected. Important advances included the use of the iliac bone for reconstruction of the face and the widespread use of leg and abdominal flaps to deal with soft tissue defects at the extremities. The increased ease of graft harvesting and use of penicillin and sulfonamides to control wound infections led to less amputation and less disfigurement. 

Gradually the techniques developed in response to dealing with the wounds of war became more widely available although there were very few trained plastic and reconstructive surgeons in the country. Many general surgeons did what they called plastic surgery, but lacked specialised training.  New Zealanders, like Gillies, McIndoe, John Barron and Rainsford Mowlem, who had trained and worked in military units in Britain, stayed on, becoming leaders in the field in Britain. But others, like Sir William Manchester and Frank Hutter, returned to set up and run New Zealand’s fledging plastic and reconstructive surgery units. 

Manchester went to Middlemore Hospital. A plastic surgery unit was set up at Hutt Hospital under Hutter ; Burwood became an integral part of Christchurch Hospital; and finally, a plastic surgery unit was set up at Waikato Hospital by Patrick Beehan and Keith Wilson. The development of micro instruments, including the binocular operating microscope and fine suture materials, spawned the whole new field of microsurgery in the 50s. This revolutionised and vastly extended the possibilities of plastic and reconstructive surgery, including the neurovascular reattachment of severed extremities. It allowed tissue flaps comprised of some combination of skin, bone, muscle and fat to be moved from one area of the body and reattached to another with arteries and veins as small as one to two millimeres in diameter sutured to reconnect a blood supply. 

The first reimplantation in New Zealand was at Waikato Hospital in 1971. This was followed a month later by the successful reattachment of a hand at Middlemore Hospital. While reimplantations make up only a very small number of the operations carried out by plastic surgeons, they are now a routine procedure.