The Art of Reconstrcution workshop

TH

E A

RT

OF

RE

CO

NS

TR

UC

TIO

N

The Art of Reconstruction

The Art of Reconstruction workshop was held in February 2011 andwas attended by 12 consultant surgeons from a plastic surgery or generalbreast surgery background. The 3 day workshop was split into taughtmodules investigating shape, form, spatial relationships, contour andnegative spaces. Initially it was a little intimidating having our limitedartistic talents exposed in front of a group of respected peers, but theworkshop was conducted in a very relaxed, friendly atmosphere andvery quickly it became apparent that we were improving and beginningto understand a little more with each exercise. The theories developedon the first 2 days were then put into practice on the final day whenwe had an opportunity to sculpt both a head, and a torso. The torsomodels had been cast from mastectomy patients and we used the skillsand knowledge gained earlier in the course to create a symmetricalbreast. It was fascinating that a variety of ‘breasts’ were created whichon first inspection would be considered to be very acceptable resultssurgically and many of us were quietly pleased with our efforts. However,on closer assessment with the course Artist, asymmetries were obvious,and we discussed the best ways to identify these. We learned to inspectthe torso from various angles and studied the effects of lighting thetorsos from different directions.

Plastic Surgeons Who Attended theDrawing Workshop in February 2011

V RamakrishnanLondon Broomfield Hospital

Jonathan StaianoBirmingham City Hospital

Michael IrwinCambridge Addenbrooke's Hospital

Sunil ThomasBirmingham Selly Oak Hospital

Stephen McCulleyNottingham University Hospital

Graham OfferLeicester Royal Infirmary

Joe O'DonaghueNewcastle Royal Victoria Infirmary

Tuabin RasheedkNottingham City Hospital

Anzors GvaramadzeLincoln County Hospital

J S K KhooCharing Cross Hospital

Kenneth GrahamMerseyside Whiston Hospital

AHRCArts and Humanities Research Council (AHRC) International Network Grant 2011/12

Post-workshop Experience in Theatre

After completing the workshopand returning to the operatingtheatre, I have made severaladjustments to my operatingprocedure. Perhaps the mostuseful practical taught elementthat I learned was theimportance of examining breastsfrom the woman’s perspectiveie looking straight down betweenthe cleavages. This really highlightsdifferences in projection of thetwo breasts and mostimportantly, lack of lateralfullness. I have always sat thepatient up on the operating tableintra-operatively in order toassess breast shape, but I nowuse a step and stand over thetop of the patients head so thatI can look down between the

cleavage in order to see what the patient will see postoperatively. Thesecond most useful taught element is that I now turn the operatingtheatre ‘spot lights’ off whilst assessing shape – these bright lights tendto ‘flatten’ the shape and certainly mask subtle differences. Controllinglighting and ones viewpoint was an important element of the taughtworkshop.

Overall, it was an excellent workshop experience and a very enjoyable3 days, but most importantly it made a definite difference to my clinicalpractice. As with most courses, I feel that I probably understood andretained only a small amount of what was on offer and I would be verykeen to repeat and develop in this type course at some stage in thefuture.

Guy SterneBirmingham City HospitalDudley RoadBirminghamWest MidlandsB18 7QH

http://www.swbh.nhs.uk/

TH

E A

RT

OF

RE

CO

NS

TR

UC

TIO

N

The Art of Reconstruction

A successful drawing and modelling workshop for several UK plasticsurgeons, took place in Lincoln School of Art and Design in February2011. The Art of Reconstruction (AHRC) is a new research project withProfessor of Drawing Mike Esson, (Professor of Drawing at Universityof Lincoln) who works within the College of Fine Arts (COFA) at theUniversity of New South Wales (UNSW), Australia. Mike Esson is alsoDirector of the International Drawing Research Institute, College ofFine Art, University of New South Wales, Sydney. The UK Arts andHumanities Research Council (AHRC) network grant essentially bringsexternal international networking dialogue into developing The Art ofReconstruction here in Lincoln and the UK. Professor Esson has rundrawing and modelling courses for plastic surgeons in Australia forseveral years. The Network award also brings into the project ProfessorBelinda Colston from Forensics in the Faculty of Health, Life and SocialScience, University of Lincoln and Guy Sterne, a member of the UKAssociation of Plastic, Reconstructive and Aesthetic Surgeons (BAPRA)and a distinguished plastic surgeon, who is an advisor.

The Lincoln drawing research group is a cross discipline initiative startedseveral years ago. There have been two International drawing conferencesand numerous exhibitions of cross disciplinary work in Art, Architectureand Design. This has enabled membership of the International DrawingResearch Institute College of Fine Art, UNSW, Australia. Partners include:Glasgow School of Art, Central Academy of Fine Art, Beijing, China LuXun Academy of Fine Art, Shenyang, China. The Fashion Institute DongHua University, Shanghai, China, University of Lincoln UK and the IndusValley School of Art, Karachi ( to be confirmed).

Professor Michael Healey,Professor of Art & Design,University of LincolnPrincipal InvestigatorAHRC Network Grant

AHRCArts and Humanities Research Council (AHRC) International Network Grant 2011/12

Professor Mike Esson of College of FineArts, University of New South Wales,Sydney, Australia. Visiting Professor ofDrawing, University of Lincoln.

Professor Mike HealeyDrawing Research GroupUniversity of Lincoln

TH

E A

RT

OF

RE

CO

NS

TR

UC

TIO

N

Summary

Rationale: Since Aristotle and Hippocrates in ancient Greece throughClaudius Galen in the middle ages and Leonardo de Vinci in the renaissanceart has been inextricably entwined with medicine. Although more oftenviewed in the context of illustrations, such as from Max Brodel in theearly 20th century, today’s advances in modern plastic surgery now callfor a far more dynamic involvement directly supporting the proficiency,and thereby outcomes, of the surgeons technical skill. 21st Centuryplastic surgery is as much concerned with improving the perceivedquality of life as it is, over and above, essential reconstruction. Thisrequires an aesthetic sensitivity and understanding of art and form thatis not part of a surgeon’s normal training. Building from the success andfeedback of an initial provisional workshop for surgeons in November2009 this project is structured as a pilot study to develop a new researchnetwork that will extend the application of the visual arts in medicineenabling the development and treatise of the intersection of art andscience in respect of the new practice based ideas and concepts currentlyformulating in plastic surgery. Research considerations: In integratingthe visual and representational skills of art to the reconstructive technicalskills of a plastic surgeon there are a number of key issue to address. -Is there an added value applying ‘art based’ skills to the understandingand implementation of aesthetic considerations within the operatingtheatre? - Can we examine the intention of the value of ‘art based’ skillsto the understanding of aesthetic considerations within the operatingtheatre? - Can we improve on NHS pre and post operative patient andsurgeons perceptions of “success”? - Can we discuss and assist incultivating an ability to identify facial and body characteristics differingfrom the norm? Applications and Beneficiaries: - Primary and initialbeneficiaries will be participating NHS surgeons who acquire new skillsenabling a more informed and confident aesthetic decision-makingprocess; investigating formal and practical aesthetic principles to integrateinto their medical practice. Surgeons who participate will also pass onthe benefits to NHS colleagues. - This project will test and developstrategies that explore the relationship between differing spheres ofactivity through a process of reciprocal interactions reinforcing theintimately connected worlds of art and science. The benefit follow upand qualitative analysis is thus central in order to validate the approachesused and identify routes to further progress and uptake. Ultimately, themajor benefit is to the patient through improved outcomes and perceivedquality of life.

AHRCArts and Humanities Research Council (AHRC) International Network Grant 2011

Objectives

The purpose of this research grant is to bring together some key playersto an international network. This project blurs the boundaries betweenart and medicine. The research project sits within the faculty-widedrawing research group (art, design and architecture). Professor Healeyis a founder member of this faculty-wide, drawing research group, whileProfessor Mike Esson is the Director of the International DrawingResearch Institute (IDRI) of the College of Fine Art, UNSW. Lincoln isa member of the IDRI and partners include: Glasgow School of Art,Central Academy of Fine Art, Beijing, China Lu Xun Academy of FineArt, Shenyang, China, the Fashion Institute Dong Hua University, Shanghai,China, University of Lincoln UK, Indus Valley School of Art, Karachi (tobe confirmed).

The ‘Art of Reconstruction Research Project’ is where re-skilling ofplastic surgeons by artists is already in an embryonic phase. In integratingthe required network of associated skills, expertise and experience, theresearch collaboration brings together artists within The DrawingResearch Group of The Faculty of Art, Architecture and Design (AAD)and the distinguished work of Professor Mike Esson, Director, TheInternational Drawing Research Institute (IDRI). These will be workingwith members of the UK Association of Plastic, Reconstructive andAesthetic Surgeons (BAPRA) and members of the Royal College ofSurgeons through a comprehensive workshop and seminar programme.Building from the success and feedback of an initial provisional workshopfor surgeons in November 2009 this project is structured as a pilotstudy to develop a new research network that will extend the applicationof the visual arts in medicine enabling the development and treatise ofthe intersection of art and science in respect of the new practice basedideas and concepts currently formulating in plastic surgery. This pilotstudy represents the first “substantiation" stage within this overarchingobjective and 4 strategic activities are identified:

1. Design and delivery of a three day comprehensive workshop forsurgeons in the field of reconstructive and cosmetic surgery; integratingboth training and investigation of aesthetic principles, questioning canonsof proportion and beauty, together with the introduction of practicalskills through the languages of drawing and sculpture. Through establisheddrawing and modelling disciplines and techniques surgeons will beintroduced to formal aesthetic principles and strategies for dealing withinterpretation of structure and space. It will provide an accessible, tactileand visual experience, the focus of which deals with proportion, negativespace, contour, methods of graphic representation, and in three dimensions;notions of deconstruction and reconstruction. There will also be aninvestigation of the dynamic geometric solids of facial features and anunderstanding visual tension.

2. A two weeks public exhibition following the workshop, providingadditional feedback and consultation to provide the starting point ofthe critical review assessment. 6 month follow up and review phaseenabling a qualitative analyses of the benefits and outcomes of thethematic approaches adopted within the workshop.

3. A one day seminar, inviting all workshop participants and invitedspecialists and academics midway through the review phase to assessand develop the thematic research questions in respect of a roadmapfor further progress and uptake.

4. This will be closely followed by a smaller workshop involving keypartners and participants at the project end to further develop thethematic areas and best practice indicators against the perceived benefits.These activities will enable many of the critical research questions tobe reviewed and analysed as well as identify additional elements ofimportance arising that will inform and contribute to the subsequentuptake and implementation of this integrative approach throughout theUK. Questions such as:

1. Is there added value applying ‘art based’ skills to the understandingand implementation of aesthetic considerations within the operatingtheatre?

2. Has each specialization moved away from a common understandingof the human body?

3. On issues of symmetry and asymmetry accompany the workshopexercises can we, in the seminar, discuss and assist in cultivating an abilityto identify facial and body characteristics differing from the norm?

4. Can surgeons who are introduced to a wide range of approachesfurther their observational and perceptual abilities to the benefit oftheir procedure outcomes?

5. What is “Best Practice” in terms of new ways of understanding andcommunicating complex visual information of service to the medicalprofession.

Right to left Dr Lisa Mooney-Smith, Director of Research, Faculty of Art, Architecture and Design UL, Professor Mike Esson, College of Fine Arts, University of New South Wales, Australia,

Professor Belinda Colston of Forensic Science UL and Professor Michael Healey UL Principal Investigator (PI) of the AHRC Network Grant 2011/12

Impact

Outputs include : Workshops and seminars continue to develop andvalidate the central tenets. Academic analysis of the projects findingsand best practice guidelines will be will be through website, film recordings,case study material, teaching material and establishment of a new andimportant international network for Art, Architecture, Design at Universityof Lincoln. Additionally, this exhibition, with supporting published catalogue,will offer wider public dissemination. Opportunities exist for peerreviewed journals as well as other journal articles. This initial networkwill maintain contact and extend on a sustainable basis through subsequentprojects and implementation. For example, the University had a plannedconference on “Drawing” in 2011 ìRecto Versoî. Key players in thenetwork project delivered papers and interrelated directly with conferencedelegates. In addition a skills based workshop has been run in NewZealand and Australia for surgeons. ‘The Art of Reconstruction’ pilotproject has begun to disseminate and formulate development andapplication roadmaps relevant to the NHS medical specialist in the UK.Thus contributing to both the disciplines of medicine and the visual artsin the UK.

The main outputs of the research Journal article (refereed) WebsitePerformance, film or recording Exhibition or installation Case StudyMaterial Teaching Material Expertise gained through the application ofresearch in a non-academic environment

Ethical Information

When the project began in Australia, apart from a few enthusiasticsurgeons who felt the need, there was antipathy as to what someoneoutside the medical profession could offer their professional expertise.It was important to establish a rigorous, ethical and practical involvementwhere the newly acquired knowledge could be identified, tested andapplied to surgical practice. Follow-up questionnaires strongly validatedthe project and critical feedback was used in refining both structure andcontent. Since 2000 approximately 70 of Australia and New Zealand’smost senior surgeons have completed a related skills course. Due tothe success of the Australian project it was introduced in Melbournein 2008 to 80 registrars. So far a course has been run in Sydney,Melbourne, Adelaide and Hobart with no ethical problem.

As per the University of Lincoln regulations, this project was submittedto the Faculty of Art, Architecture and Design ethics committee forreview prior to start date and it was supported.

Academic Beneficiaries

The ambition of this research project is to contribute to the disciplinesof medicine and visual arts in the UK which will directly benefit theresearch interests of Prof. Mike Esson - Director, International DrawingResearch Institute COFA Australia (IDRI); Prof Michael Healey DrawingResearch Group, University of Lincoln; Prof. Belinda Colston, Universityof Lincoln; Mr Guy Sterne, consultant plastic surgeon Spire South BankHospital; Dr. Baris Cakir, a cosmetic surgeon from Turkey(http://www.bariscakir.com/english/baris_cakir_ kimdir.htm). All aremembers of the network. The benefits to the Art and Design sectorand the University of Lincoln in linking with a mature and establishedinternational network are immense. The research collaboration willbring together key international players in the visual arts. Medicine:Primary beneficiaries will be the surgeons who acquire new skills enablinga more informed and confident aesthetic decision-making process. Fromthe surgeon’s point of view, it is a genuine research opportunity toinvestigate formal and practical aesthetic principles to integrate intotheir medical practice. The development of new strategies in assessingaesthetic relationships, and the exploration of various methods of graphicrepresentation will assist in transfer of visual knowledge to colleaguesand theatre assistants. Surgeons who participated in previous courseswere complimentary and pro-active in passing on the benefits to theircolleagues. Surgeons gain confidence in communicating visual informationto their patients. The results of this research experience will add to theconfidence the patients feel towards the surgeons in fulfilling what isexpected from a surgical procedure. Only a subjective qualitative analysisis enabled within this pilot validation study. However future researchand investigations, with artist, surgeon and patient, will include clinicaltrials that investigate, on a quantitative basis, the comparison betweenthe expectation and result as perceived by the patient, providing essentialstatistical information. Ultimately, it is of course the benefit to the patientwhere the real value and satisfaction is experienced through improvedoutcomes and perceived quality of life. Art and Design: For the artistand art educator this is an opportunity to test and develop pedagogicalstrategies that explore the relationship between differing spheres ofactivity. Drawing functions across various disciplines, not only withinthe visual arts, but in other areas, particularly those dependent on visualcommunication and understanding. For the purposes of this research,drawing and modelling are presented as ‘an art of making’ rather thanthe act of viewing. Teaching visual awareness to those outside artisticbackgrounds adds insights that help the evolution of new and challengingresearch through practice. An increasing number of artists are inspiredby the body and the proliferation of new biomedical techniques tovisualize it. The project establishes the basis for further research intothe benefits of ‘visual art studies’ for other professions. This goes beyondthe direct value it offers the aesthetic medical specialist, and providesavenues of exploration into how other areas can complement theirprofessional activities with the assistance of training in visualcommunication. Specifically, some academics and network members willhave the opportunity to evaluate the ways in which this pilot workshopcould be extended to professionals working in the heritage sciencesector.


Professor Mike Esson University of Lincoln,Professor of Drawing also Director, International DrawingResearch Institute COFA Australia (IDRI)

TH

E A

RT

OF

RE

CO

NS

TR

UC

TIO

N

Impact Summary

Network Benefits: The research project underscores the significantnexus between art and science professions in such a way that bothacademic collaborative practices are considerably expanded and enriched.It is appreciated that this collaboration represents an acknowledgementof shared respect for our practices, research and the associated expertisewithin these disciplines. Art and Design HE Education in the UK isacknowledged to be world class. Drawing functions across variousdisciplines and this research project establishes the basis for furtherresearch into the benefits and implications of ‘visual art studies’ forother professions. This goes beyond the direct value it offers the aestheticmedical specialist, and provides avenues to explore into how other areascan complement their professional activities with the assistance oftraining in visual communication and creative problem solving. Forexample, the development of drawing for conservation/heritage sciencewill be piloted at Lincoln University, in the School of Natural and AppliedSciences. Impact on surgeons åand patients in the UK: The benefitsaccrued through this project will have a direct impact on the field ofreconstructive and aesthetic surgery. It is through their training thatsurgeons approach their activity from a formal surgical methodologybut usually evaluate the results from an aesthetic point of view. Thisdichotomy can present difficulties in both the expectations of surgeonand patient. Through the research project surgeons will acquire newskills enabling a more informed and confident aesthetic decision-makingprocess for public medical practice. It is also anticipated that surgeonswill continue to seek to upgrade and develop these skills (as they havedone in Australia). The University will look into this provision as partthe workshop outcomes. The Interactive website and future associatedevents will facilitate continued dialogue and communication with keyplayers. Similarly the engagement of art and the use of life study classeswithin the undergraduate medical curriculum is being tentatively developedby several prestigious Medical Schools, such as the University ofNottingham. This project will further develop the rationale for suchapproaches. Impact on visual arts in the UK with relevant experienceand track record:

The drawing research group at University of Lincoln, embedded withinArt, Design and Architecture, fosters drawing as a process of reciprocalinteractions reinforcing the intimately connected worlds of art andscience. Drawing functions across various disciplines, not only withinthe visual arts, but in other areas, particularly those dependent on visualcommunication and understanding. Similar projects for reconstructive,cosmetic and maxillofacial surgeons have been held in Australia andNew Zealand. The classes originated from drawing classes run at TheRoyal College of Surgeons, Edinburgh in 1993/94 when Esson was anArtist in Residence and Healey was the Head of the Design School atGlasgow School of Art. Subsequently, in Australia, the project wasextended with the most prominent surgeons in the field enrolled. Theyexpounded the value of the project experience to their colleagues. Since2000 approximately 70 of Australia and New Zealand’s most seniorsurgeons have completed the evolving project. Due to the success ofthe course it was introduced in Melbourne in 2008 to 80 registrarswith the possibility of it being adopted as a regular component. EconomicImpact: The introduction and development of this project into the UKwill impact on the potential for enhancement of UK medical economiccompetitiveness by delivering better results for patients who areundergoing pre and post operative plastic surgery. The enhancementand development of the field of NHS cosmetic and maxillofacial surgeonswould be a powerful outcome. General enhancements of quality of life,health and creative output will also follow.


Guy Sterne

Professor Belinda Colston, of Forensic Science, University of Lincoln,

TH

E A

RT

OF

RE

CO

NS

TR

UC

TIO

N

TH

E A

RT

OF

RE

CO

NS

TR

UC

TIO

N

Pathways to Impact Communications andEngagement

Connections between projects for reconstructive, cosmetic andmaxillofacial surgeons have been held in Australia and New Zealandthrough Professor Esson. The workshop classes originated from drawingclasses run at The Royal College of Surgeons, Edinburgh in 1993/94when Esson was an Artist in Residence and Healey was a Head of Schoolat Glasgow School of Art. Subsequently, in Australia, the project wasextended with the most prominent surgeons in the field enrolled. Theyexpounded the value of the project experience to their colleagues. Since2000 approximately 70 of Australia and New Zealand’s most seniorsurgeons have completed the evolving project - although no follow-upacademic research, debate and dissemination has been undertaken. Inthe UK we have engagement with: Dr Alasdair McKechnie, consultantmaxillofacial surgeon and a research fellow at the University of Lincoln,and through him The British Association of Aesthetic Plastic Surgeons(BAAPS); Professor Ian Hutchinson of ‘Saving Faces’ the UK FacialReconstruction Organisation;’ Mr Guy Sterne, consultant plastic surgeonand senior tutor at the Royal College of Physicians in London In addition,as a result of the feedback arising from the provisional training workshopin November 2009. This networking itself has provided the impetus forthis project but will also provide a major dissemination vehicle - providingdirect outreach to the Surgeons themselves. It is also important torealise that the ongoing dialogue with these bodies will also facilitatethe direction and shape of the projects training and research activitiesto ensure that efficacy and applicability is integrated into the scholarlyresearch aspects of the programme. This exhibition is important inenabling engagement and feedback from the attendees; including thepublic, artists and associated media disciplines, medical practitioners aswell as potential subsequent beneficiaries such as conservation andheritage science practitioners. It may provide opportunities for subsequentdistance learning, e-learning and webinar presentations tailored as aresult of additional feedback from the attendees and supportingorganisations. As such it will contain a recording of the key workshoppresentations on film together with a public exhibition of all drawings,photographs of 3D models and supporting visual research. Thesesubsequent activities are not part of this initial pilot study but will formthe basis for subsequent outreach and communication tools withinensuing projects and programmes building on the outcomes of thisproject.

Collaboration

An informal but dedicated outreach and exploitation team that includesUniversity PR is established at the University comprising Healey, Esson,and Colston together with research and knowledge transfer specialistsfrom the University’s Research Office, PR and Enterprise departments.The network team are responsible for most outreach, exploitation,engagement and dissemination activities. In respect of Intellectual propertyall results arising from this study will be in the public domain but notingthat Professor Mike Esson, of COFA and UNSW holds ownership ofthe Art of Reconstruction name. The nature of the relationships betweennetwork participants are established and yet still developing and thisresearch collaboration brings together artists within The DrawingResearch Group of The Faculty of Art, Architecture and Design (AAD)and The International Drawing Research Institute (IDRI).

International Drawing Research InstituteCollege of Fine ArtUniversity of New South WalesSydneyAustralia


Back Row: Mike Healey, Guy Sterne, Tuabin Rashid, Graham Offer, Jonathan Staiano, Steve McCulley, Anzors Gvaramadze, Michael Irwin

Front Row: Ken Graham, Jackie Lewis, Mike Essen, Sunil Thomas

Consultant Plastic Surgeon Guy Sterne, Royal College of Surgeons








Professor Mike Esson University of Lincoln, Professor of Drawing also Director, International Drawing Research Institute COFA Australia (IDRI)

Health & Medicine

The Art of Reconstrcution workshop