Seeking to make the patient look better necessitated some major innovations; These were largely initiated by Gillies and which later became standard practice in plastic work. His most notable innovation, the pedicle tube, came about purely by chance. On October 3, 1917, an Able Seaman by the name of Vicarage was wheeled into the operating theatre at Queen Mary's Hospital. All the skin had been burnt off his face in a cordite explosion on H.M.S. "Malaya." The burns had left extensive scarring. The eyelids and lower lip were turned inside out, and all that remained was a twisted blob which had once been a nose. Gillies described the injuries as "appalling". Cutting the skin off the patient's chest, he made a scroll large enough to cover his face. Adequate blood supply was ensured by leaving the lower ends of the scroll attached to the chest. Apertures were then cut for the mouth and eyes and when it was stitched into position, it was given added blood supply from two thinner strips of skin raised from the shoulders with the free ends grafted on to the new face. While raising the skin from the patient's shoulders Gillies noticed its tendency to curl inwards. Then came a flash of inspiration:A photo gallery of some of Gillies’ work was published by the BBC. This gallery contains some disturbing images.
"If I stitched the edges of those flaps together, might I not create a tube of living tissue which would increase the blood supply to grafts, close them to infection, and be far less liable to contract or degenerate as the older methods were?" ... "another needle was threaded and, in an astonished silence, I began to stitch the flaps into tubes".
This innovation proved extremely successful and within a few weeks, tubes were seen sprouting from scores of his patients. The pedicle tube simplified grafting and made it more certain that a shattered face would be recognisable again.
During World War II Gillies acted as a consultant to the Ministry of Health, the RAF and the Admiralty, organizing plastic surgery units and training doctors in the techniques. He wrote several books on the subject of facial reconstruction.
In 1946, he and a colleague performed the world's first sex reassignment surgery from female to male. In 1951 he and colleagues performed the first sex reassignment surgery from male to female.
More cases from Gillies’ reconstructive work during World War I can be seen at Project Facade.