TH

E A

RT

OF

RE

CO

NS

TR

UC

TIO

N

An A

rts and

Hum

anitie

s Rese

arc

h C

ouncil fu

nd

ed

pro

ject

Lin

coln

School o

f Art a

nd

Desig

nFaculty o

f Art, A

rchite

ctu

re a

nd

Desig

nU

nive

rsity of L

incoln

Lin

coln

, Unite

d K

ing

dom

TH

E A

RT

OF

RE

CO

NS

TR

UC

TIO

N

AAn Arts and Humanities Research Council funded projectLincoln School of Art and DesignFaculty of Art, Architecture and DesignUniversity of LincolnLincoln, United Kingdom

The Art of Reconstruction

The Art of Reconstruction workshop was held inFebruary 2011 and was attended by 12 consultantsurgeons from a plastic surgery or general breastsurgery background. The 3 day workshop was splitinto taught modules investigating shape, form, spatialrelationships, contour and negative spaces. Initially itwas a little intimidating having our limited artistictalents exposed in front of a group of respectedpeers, but the workshop was conducted in a veryrelaxed, friendly atmosphere and very quickly itbecame apparent that we were improving andbeginning to understand a little more with eachexercise. The theories developed on the first 2 dayswere then put into practice on the final day when wehad an opportunity to sculpt both a head, and a torso.The torso models had been cast from mastectomypatients and we used the skills and knowledge gainedearlier in the course to create a symmetrical breast. Itwas fascinating that a variety of ‘breasts’ were createdwhich on first inspection would be considered to bevery acceptable results surgically and many of uswere quietly pleased with our efforts. However, oncloser assessment with the course Artist, asymmetrieswere obvious, and we discussed the best ways toidentify these. We learned to inspect the torso fromvarious angles and studied the effects of lighting thetorsos from different directions.

Post-workshop Experience in Theatre

After completing the workshop and returning to theoperating theatre, I have made several adjustments tomy operating procedure. Perhaps the most usefulpractical taught element that I learned was theimportance of examining breasts from the woman’sperspective ie looking straight down between thecleavages. This really highlights differences inprojection of the two breasts and most importantly,lack of lateral fullness. I have always sat the patient upon the operating table intra-operatively in order toassess breast shape, but I now use a step and standover the top of the patients head so that I can lookdown between the cleavage in order to see what the

patient will see postoperatively. The second mostuseful taught element is that I now turn the operatingtheatre ‘spot lights’ off whilst assessing shape – thesebright lights tend to ‘flatten’ the shape and certainlymask subtle differences. Controlling lighting and onesviewpoint was an important element of the taughtworkshop.

Overall, it was an excellent workshop experience anda very enjoyable 3 days, but most importantly it madea definite difference to my clinical practice. As withmost courses, I feel that I probably understood andretained only a small amount of what was on offer andI would be very keen to repeat and develop in thistype course at some stage in the future.

Guy SterneBirmingham City HospitalDudley RoadBirminghamWest MidlandsB18 7QH

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

Guy Sterne

Plastic Surgeons Who Attended the DrawingWorkshop in February 2011

V RamakrishnanLondon Broomfield Hospital

Jonathan StaianoBirmingham City Hospital

Michael IrwinCambridge Addenbrooke's Hospital

Sunil ThomasBirmingham Selly Oak Hospita

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

The Art of Reconstruction

A successful drawing and modelling workshop forseveral UK plastic surgeons,took place in LincolnSchool of Art and Design in February 2011. The Art ofReconstruction (AHRC) is a new research project withProfessor of Drawing Mike Esson, (Professor ofDrawing at University of Lincoln) who works within theCollege of Fine Arts (COFA) at the University of NewSouth Wales (UNSW), Australia. The AHRC Networkgrant essentially brings external internationalnetworking dialogue into developing The Art ofReconstruction here in Lincoln. Professor Esson hasrun drawing and modelling courses for plasticsurgeons in Australia for several years. The Networkaward also brings into the project Professor BelindaColston from Forensics in the Faculty of Health, Lifeand Social Science, University of Lincoln and GuySterne, a member of the UK Association of Plastic,Reconstructive and Aesthetic Surgeons (BAPRA) anda distinguished plastic surgeon, who is an advisor.

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

Professor Mike Esson of

College of Fine Arts,

University of New South

Wales, Sydney, Australia

Professor Mike Healey

Objectives

The purpose of this research grant is to bring togethersome key players to an international network. Thisproject blurs the boundaries between art andmedicine. The research project sits within the faculty-wide drawing research group (art, design andarchitecture). Professor Healey is a founder memberof this faculty-wide, drawing research group, whileProfessor Mike Esson is the Director of theInternational Drawing Research Institute (IDRI) of theCollege of Fine Art, UNSW. Lincoln is a member of theIDRI and partners include: Glasgow School of Art,Central Academy of Fine Art, Beijing, China Lu XunAcademy of Fine Art, Shenyang, China, the FashionInstitute Dong Hua University, Shanghai, China,University of Lincoln UK, Indus Valley School of Art,Karachi (to be confirmed).

The ‘Art of Reconstruction Research Project’ is wherere-skilling of plastic surgeons by artists is already inan embryonic phase. In integrating the requirednetwork of associated skills, expertise andexperience, the research collaboration bringstogether artists within The Drawing Research Group ofThe Faculty of Art, Architecture and Design (AAD) andthe distinguished work of Professor Mike Esson,Director, The International Drawing Research Institute(IDRI). These will be working with members of the UKAssociation of Plastic, Reconstructive and AestheticSurgeons (BAPRA) and members of the Royal Collegeof Surgeons through a comprehensive workshop andseminar programme. Building from the success andfeedback of an initial provisional workshop forsurgeons in November 2009 this project is structuredas a pilot study to develop a new research networkthat will extend the application of the visual arts inmedicine enabling the development and treatise ofthe intersection of art and science in respect of thenew practice based ideas and concepts currentlyformulating in plastic surgery. This pilot studyrepresents the first “substantiation" stage within thisoverarching objective and 4 strategic activities areidentified:

Professor Mike Esson

1. Design and delivery of a three day comprehensiveworkshop for surgeons in the field of reconstructiveand cosmetic surgery; integrating both training andinvestigation of aesthetic principles, questioningcanons of proportion and beauty, together with theintroduction of practical skills through the languagesof drawing and sculpture. Through establisheddrawing and modelling disciplines and techniquessurgeons will be introduced to formal aestheticprinciples and strategies for dealing withinterpretation of structure and space. It will provide anaccessible, tactile and visual experience, the focus ofwhich deals with proportion, negative space, contour,methods of graphic representation, and in threedimensions; notions of deconstruction andreconstruction. There will also be an investigation ofthe dynamic geometric solids of facial features and anunderstanding visual tension.

2. A two weeks public exhibition following theworkshop, providing additional feedback andconsultation to provide the starting point of the criticalreview assessment. 6 month follow up and reviewphase enabling a qualitative analyses of the benefitsand outcomes of the thematic approaches adoptedwithin the workshop.

3. A one day seminar, inviting all workshopparticipants and invited specialists and academicsmidway through the review phase to assess anddevelop the thematic research questions in respect ofa roadmap for further progress and uptake.

4. This will be closely followed by a smaller workshopinvolving key partners and participants at the projectend to further develop the thematic areas and bestpractice indicators against the perceived benefits.

Right to left: Dr. Lisa Mooney Smith, Director of Research, Faculty of AAD,

Professor Mike Esson, Dr. Belinda Colston, Professor Mike Healey

These activities will enable many of the criticalresearch questions to be reviewed and analysed aswell as identify additional elements of importancearising that will inform and contribute to thesubsequent uptake and implementation of thisintegrative approach throughout the UK. Questionssuch as:

1. Is there added value applying ‘art based’ skills tothe understanding and implementation of aestheticconsiderations within the operating theatre?

2. Has each specialization moved away from acommon understanding of the human body?

3. On issues of symmetry and asymmetry accompanythe workshop exercises can we, in the seminar,discuss and assist in cultivating an ability to identifyfacial and body characteristics differing from thenorm?

4. Can surgeons who are introduced to a wide rangeof approaches further their observational andperceptual abilities to the benefit of their procedureoutcomes?

5. What is “Best Practice” in terms of new ways ofunderstanding and communicating complex visualinformation of service to the medical profession.

Summary

Rationale: Since Aristotle and Hippocrates in ancientGreece through Claudius Galen in the middle agesand Leonardo de Vinci in the renaissance art hasbeen inextricably entwined with medicine. Althoughmore often viewed in the context of illustrations, suchas from Max Brodel in the early 20th century, today’sadvances in modern plastic surgery now call for a farmore dynamic involvement directly supporting theproficiency, and thereby outcomes, of the surgeonstechnical skill. 21st Century plastic surgery is as muchconcerned with improving the perceived quality of lifeas it is, over and above, essential reconstruction. Thisrequires an aesthetic sensitivity and understanding of

art and form that is not part of a surgeon’s normaltraining. Building from the success and feedback ofan initial provisional workshop for surgeons inNovember 2009 this project is structured as a pilotstudy to develop a new research network that willextend the application of the visual arts in medicineenabling the development and treatise of theintersection of art and science in respect of the newpractice based ideas and concepts currentlyformulating in plastic surgery. Researchconsiderations: In integrating the visual andrepresentational skills of art to the reconstructivetechnical skills of a plastic surgeon there are anumber of key issue to address. - Is there an addedvalue applying ‘art based’ skills to the understandingand implementation of aesthetic considerations withinthe operating theatre? - Can we examine the intentionof the value of ‘art based’ skills to the understandingof aesthetic considerations within the operatingtheatre? - Can we improve on NHS pre and postoperative patient and surgeons perceptions of“success”? - Can we discuss and assist in cultivatingan ability to identify facial and body characteristicsdiffering from the norm? Applications andBeneficiaries: - Primary and initial beneficiaries will beparticipating NHS surgeons who acquire new skillsenabling a more informed and confident aestheticdecision-making process; investigating formal andpractical aesthetic principles to integrate into theirmedical practice. Surgeons who participate will alsopass on the benefits to NHS colleagues. - This projectwill test and develop strategies that explore therelationship between differing spheres of activitythrough a process of reciprocal interactionsreinforcing the intimately connected worlds of art andscience. The benefit follow up and qualitative analysisis thus central in order to validate the approachesused and identify routes to further progress anduptake. Ultimately, the major benefit is to the patientthrough improved outcomes and perceived quality oflife.

Impact

Outputs include : Workshops and seminars continueto develop and validate the central tenets. Academicanalysis of the projects findings and best practiceguidelines will be will be through website, filmrecordings, case study material, teaching materialand establishment of a new and importantinternational network for Art, Architecture, Design atUniversity of Lincoln. Additionally, this exhibition, withsupporting published catalogue, will offer wider publicdissemination. Opportunities exist for peer reviewedjournals as well as other journal articles. This initialnetwork will maintain contact and extend on asustainable basis through subsequent projects andimplementation. For example, the University had aplanned conference on “Drawing” in 2011 ìRectoVersoî. Key players in the network project deliveredpapers and interrelated directly with conferencedelegates. In addition a skills based workshop hasbeen run in New Zealand and Australia for surgeons.‘The Art of Reconstruction’ pilot project has begun todisseminate and formulate development andapplication roadmaps relevant to the NHS medicalspecialist in the UK. Thus contributing to both thedisciplines of medicine and the visual arts in the UK.

The main outputs of the research Journal article(refereed) Website Performance, film or recordingExhibition or installation Case Study Material TeachingMaterial Expertise gained through the application ofresearch in a non-academic environment

Ethical Information

When the project began in Australia, apart from a fewenthusiastic surgeons who felt the need, there wasantipathy as to what someone outside the medicalprofession could offer their professional expertise. Itwas important to establish a rigorous, ethical andpractical involvement where the newly acquiredknowledge could be identified, tested and applied tosurgical practice. Follow-up questionnaires stronglyvalidated the project and critical feedback was usedin refining both structure and content. Since 2000

approximately 70 of Australia and New Zealand’smost senior surgeons have completed a related skillscourse. Due to the success of the Australian project itwas introduced in Melbourne in 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, thisproject was submitted to the Faculty of Art,Architecture and Design ethics committee for reviewprior to start date and it was supported.

Academic Beneficiaries

The ambition of this research project is to contribute tothe disciplines of medicine and visual arts in the UKwhich will directly benefit the research interests ofProf. Mike Esson - Director, International DrawingResearch Institute COFA Australia (IDRI); Prof MichaelHealey Drawing Research Group, University ofLincoln; Prof. Belinda Colston, University of Lincoln;Mr Guy Sterne, consultant plastic surgeon Spire SouthBank Hospital; Dr. Baris Cakir, a cosmetic surgeonfrom Turkey(http://www.bariscakir.com/english/baris_cakir_kimdir.htm). All are members of the network. Thebenefits to the Art and Design sector and theUniversity of Lincoln in linking with a mature andestablished international network are immense. Theresearch collaboration will bring together keyinternational players in the visual arts. Medicine:Primary beneficiaries will be the surgeons whoacquire new skills enabling a more informed andconfident aesthetic decision-making process. Fromthe surgeon’s point of view, it is a genuine researchopportunity to investigate formal and practicalaesthetic principles to integrate into their medicalpractice. The development of new strategies inassessing aesthetic relationships, and the explorationof various methods of graphic representation willassist in transfer of visual knowledge to colleaguesand theatre assistants. Surgeons who participated inprevious courses were complimentary and pro-activein passing on the benefits to their colleagues.Surgeons gain confidence in communicating visual

Dr. Belinda Colston

Guy Sterne

Plastic Surgeons WhoAttended the DrawingWorkshop in February 2011

V RamakrishnanLondon Broomfield HospitalJonathan StaianoBirmingham City HospitalMichael IrwinCambridge Addenbrooke'sHospitalSunil ThomasBirmingham Selly OakHospitaStephen McCulleyNottingham UniversityHospitalGraham OfferLeicester Royal InfirmaryJoe O'DonaghueNewcastle Royal VictoriaInfirmaryTuabin RasheedkNottingham City HospitalAnzors GvaramadzeLincoln County HospitalJ S K KhooCharing Cross HospitalKenneth GrahamMerseyside Whiston Hospital

information to their patients. The results of thisresearch experience will add to the confidence thepatients feel towards the surgeons in fulfilling what isexpected from a surgical procedure. Only asubjective qualitative analysis is enabled within thispilot validation study. However future research andinvestigations, with artist, surgeon and patient, willinclude clinical trials that investigate, on a quantitativebasis, the comparison between the expectation andresult as perceived by the patient, providing essentialstatistical information. Ultimately, it is of course thebenefit to the patient where the real value andsatisfaction is experienced through improvedoutcomes and perceived quality of life. Art andDesign: For the artist and art educator this is anopportunity to test and develop pedagogicalstrategies that explore the relationship betweendiffering spheres of activity. Drawing functions acrossvarious disciplines, not only within the visual arts, butin other areas, particularly those dependent on visualcommunication and understanding. For the purposesof this research, drawing and modelling are presentedas ‘an art of making’ rather than the act of viewing.Teaching visual awareness to those outside artistic

backgrounds adds insights that help the evolution ofnew and challenging research through practice. Anincreasing number of artists are inspired by the bodyand the proliferation of new biomedical techniques tovisualize it. The project establishes the basis forfurther research into the benefits of ‘visual art studies’for other professions. This goes beyond the directvalue it offers the aesthetic medical specialist, andprovides avenues of exploration into how other areascan complement their professional activities with theassistance of training in visual communication.Specifically, some academics and network memberswill have the opportunity to evaluate the ways in whichthis pilot workshop could be extended toprofessionals working in the heritage science sector.

Impact Summary

Network Benefits: The research project underscoresthe significant nexus between art and scienceprofessions in such a way that both academiccollaborative practices are considerably expandedand enriched. It is appreciated that this collaborationrepresents an acknowledgement of shared respect forour practices, research and the associated expertisewithin these disciplines. Art and Design HE Educationin the UK is acknowledged to be world class. Drawingfunctions across various disciplines and this researchproject establishes the basis for further research intothe benefits and implications of ‘visual art studies’ forother professions. This goes beyond the direct value itoffers the aesthetic medical specialist, and providesavenues to explore into how other areas cancomplement their professional activities with theassistance of training in visual communication andcreative problem solving. For example, thedevelopment of drawing for conservation/heritagescience will be piloted at Lincoln University, in theSchool of Natural and Applied Sciences. Impact onsurgeons åand patients in the UK: The benefitsaccrued through this project will have a direct impacton the field of reconstructive and aesthetic surgery. Itis through their training that surgeons approach theiractivity from a formal surgical methodology butusually evaluate the results from an aesthetic point of

view. This dichotomy can present difficulties in boththe expectations of surgeon and patient. Through theresearch project surgeons will acquire new skillsenabling a more informed and confident aestheticdecision-making process for public medical practice.It is also anticipated that surgeons will continue toseek to upgrade and develop these skills (as theyhave done in Australia). The University will look intothis provision as part the workshop outcomes. TheInteractive website and future associated events willfacilitate continued dialogue and communication withkey players. Similarly the engagement of art and theuse of life study classes within the undergraduatemedical curriculum is being tentatively developed byseveral prestigious Medical Schools, such as theUniversity of Nottingham. This project will furtherdevelop the rationale for such approaches. Impact onvisual arts in the UK with relevant experience andtrack record:

The drawing research group at University of Lincoln,embedded within Art, Design and Architecture,fosters drawing as a process of reciprocal interactionsreinforcing the intimately connected worlds of art andscience. Drawing functions across various disciplines,not only within the visual arts, but in other areas,particularly those dependent on visual communicationand understanding. Similar projects for reconstructive,cosmetic and maxillofacial surgeons have been heldin Australia and New Zealand. The classes originatedfrom drawing classes run at The Royal College ofSurgeons, Edinburgh in 1993/94 when Esson was anArtist in Residence and Healey was the Head of theDesign School at Glasgow School of Art.Subsequently, in Australia, the project was extendedwith the most prominent surgeons in the field enrolled.They expounded the value of the project experienceto their colleagues. Since 2000 approximately 70 ofAustralia and New Zealand’s most senior surgeonshave completed the evolving project. Due to thesuccess of the course it was introduced in Melbournein 2008 to 80 registrars with the possibility of it beingadopted as a regular component. Economic Impact:The introduction and development of this project intothe UK will impact on the potential for enhancement of

UK medical economic competitiveness by deliveringbetter results for patients who are undergoing pre andpost operative plastic surgery. The enhancement anddevelopment of the field of NHS cosmetic andmaxillofacial surgeons would be a powerful outcome.General enhancements of quality of life, health andcreative output will also follow.

Pathways to Impact Communications andEngagement

Connections between projects for reconstructive,cosmetic and maxillofacial surgeons have been heldin Australia and New Zealand through ProfessorEsson. The workshop classes originated from drawingclasses run at The Royal College of Surgeons,Edinburgh in 1993/94 when Esson was an Artist inResidence and Healey was a Head of School atGlasgow School of Art. Subsequently, in Australia, theproject was extended with the most prominentsurgeons in the field enrolled. They expounded thevalue of the project experience to their colleagues.Since 2000 approximately 70 of Australia and NewZealand’s most senior surgeons have completed theevolving project - although no follow-up academicresearch, debate and dissemination has beenundertaken. In the UK we have engagement with: DrAlasdair McKechnie, consultant maxillofacial surgeonand a research fellow at the University of Lincoln, andthrough him The British Association of AestheticPlastic Surgeons (BAAPS); Professor Ian Hutchinsonof ‘Saving Faces’ the UK Facial ReconstructionOrganisation;’ Mr Guy Sterne, consultant plasticsurgeon and senior tutor at the Royal College ofPhysicians in London In addition, as a result of thefeedback arising from the provisional trainingworkshop in November 2009. This networking itselfhas provided the impetus for this project but will alsoprovide a major dissemination vehicle - providingdirect outreach to the Surgeons themselves. It is alsoimportant to realise that the ongoing dialogue withthese bodies will also facilitate the direction andshape of the projects training and research activitiesto ensure that efficacy and applicability is integratedinto the scholarly research aspects of the programme.

Guy SterneThis exhibition is important in enabling engagementand feedback from the attendees; including thepublic, artists and associated media disciplines,medical practitioners as well as potential subsequentbeneficiaries such as conservation and heritagescience practitioners. It may provide opportunities forsubsequent distance learning, e-learning and webinarpresentations tailored as a result of additionalfeedback from the attendees and supportingorganisations. As such it will contain a recording ofthe key workshop presentations on film together with apublic exhibition of all drawings, photographs of 3Dmodels and supporting visual research. Thesesubsequent activities are not part of this initial pilotstudy but will form the basis for subsequent outreachand communication tools within ensuing projects andprogrammes building on the outcomes of this project.

Collaboration

An informal but dedicated outreach and exploitationteam that includes University PR is established at theUniversity comprising Healey, Esson, and Colstontogether with research and knowledge transferspecialists from the University’s Research Office, PRand Enterprise departments. The network team areresponsible for most outreach, exploitation,engagement and dissemination activities. In respectof Intellectual property all results arising from thisstudy will be in the public domain but noting thatProfessor Mike Esson, of COFA and UNSW holdsownership of the Art of Reconstruction name. Thenature of the relationships between networkparticipants are established and yet still developingand this research collaboration brings together artistswithin The Drawing Research Group of The Faculty ofArt, Architecture and Design (AAD) and TheInternational Drawing Research Institute (IDRI).

International Drawing Research InstituteCollege of Fine ArtUniversity of New South WalesSydneyAustralia

University of LincolnBrayford PoolLincolnLN6 7TS

www.lincoln.ac.uk

ISBN 978-1-86050-230-9

THE ART OFRECONSTRUCTION

University of LincolnBrayford PoolLincolnLN6 7TS

www.lincoln.ac.uk

ISBN 978-1-86050-230-9

Printed by Ruddocks, Lincoln