Abdominal Tubed Pedicle Procedure at Hill End Hospital

13^th April 2023

The BAPRAS Collection is working with UCL in supporting new Heritage professionals.
Myrto Staratzi is working with us for her placement module as part of her MA Museum Studies.
She has explored the Collection, then researched and written this piece.

One of four plastic surgery units developed during WW2, Hill End Hospital, St Albans, was one of the main sites that received casualties from Dunkirk. Hill End Hospital used to be a large psychiatric hospital but, with WW2 looming, it was evacuated. Much of the patient load from St Bartholomew’s Hospital was transferred there in order to accommodate more effectively the immense number of casualties anticipated during that time.

Rainsford Mowlem was the lead plastic surgeon at Hill End. It is worth noting that before his time there, Mowlem had experience with treating only four serious burn injuries. During his service at Hill End, reconstructive techniques needed to be developed quickly and effectively. To help with the dissemination of that technical knowledge, Diana “Dickie” Orpen became Mowlem’s artist, between 1942 and 1946.

These sketches show a detailed representation of a complex abdominal tubed pedicle procedure. Dickie was often allowed as little as 15 seconds to view each stage of an operation. Considering this, and the level of detail and artistry these sketches contain, her skills seem even more impressive.

In Figure 1 we see how the dorsum of this patient’s foot has been significantly injured. Their toes are drawn back by scar contracture, probably the result of a healed burn.

Through the sketches we can see how tissue was transferred from the abdominal area to the patient’s hand. Then from his hand to his foot, where the scar was excised and the foot reconstructed. The first sketch is dated 10^th of March 1944. Looking at Figure 2, where the tubed pedicle is finally inset, we can see that the date is almost a month later, the 3^rd of April. The patient had to wait for almost a month with his hand and foot connected by the flap, in order for the blood supply to adequately nourish it sufficiently to permit completion of the procedure. Today, thanks to microsurgery, this type of procedure has become essentially obsolete.

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