75 Years of Excellence: The Story of Reconstructive Surgery

Abstract

On December 11, 1940, Dr. John Staige Davis presented “The Story of Plastic Surgery” during his presidential address at the Southern Surgical Association meeting, highlighting lessons learned during the First World War in the management of traumatic injuries.1 He also proposed chronicling advances in plastic surgery, and in response to his call, the Plastic and Reconstructive Surgery journal was established in July of 1946. Since then, the Journal has become the most established communication method for advances in our field and has played a pivotal role in enabling subsequent generations of surgeons to continue to innovate and improve the field. It would be impossible to describe the immense progress in the field of plastic surgery over the last 75 years in detail here, so instead we highlight changes in our understanding of biology, improved techniques, and new technologies that have spawned advances in reconstructive surgery (Fig. 1).Fig. 1.: The current state of reconstructive surgery, brought about by the imagination, dedication, and hard work of our colleagues over the past 75 years, has surpassed the vision and goals for plastic surgery set forth by Dr. Davis in 1941. In parallel with these advances in reconstructive surgery, dramatic, accelerating advances in publishing, led by Plastic and Reconstructive Surgery, have allowed us to better communicate our ideas.The first major advancement in plastic surgery was the development of microsurgery, which was made possible by the triangulation method of microvascular anastomosis, discovery of heparin, and invention and refinement of the operating microscope.2–7 Microsurgical techniques were used initially by surgeons to replant amputated digits and limbs. Success with experimental microvascular tissue transplantation in animals prompted the application of microsurgical free tissue transfer in humans, starting with the first free tissue transfer of a temporal scalp flap by Harii et al.8 and a free groin flap by Daniel and Taylor9 in 1972. [See Figure, Supplemental Digital Content 1, which shows a line drawing of important anatomic landmarks for a groin flap (reprinted with permission from Daniel RK, Taylor GI. Distant transfer of an island flap by microvascular anastomoses. Plast Reconstr Surg. 1973;52(2):111–117), https://links.lww.com/PRS/E733.] Over the ensuing decades, multiple new free flaps were described, and free tissue transfer became an integral component of the reconstructive armamentarium.10 No aspect of reconstructive surgery was affected more by this development than head and neck reconstruction. For the three decades following the Second World War, reconstructive options were limited to rotational or pedicled flaps. Due to the lack of adequate available local tissue and the limitations of pedicle length, these options were insufficient to reconstruct many head and neck defects. The advent of microsurgical free tissue transfer opened a plethora of options for these patients. The description of the fibula flap and elucidation of peroneal perforator anatomy permitted the use of these flaps in reconstructing mandibular and other osseous defects.11,12 Use of the anterolateral thigh flap redefined soft-tissue reconstruction following glossectomies and laryngopharyngeal and other soft-tissue resections.13–16 Today, free tissue transfer is routinely used as the primary option for many skull base and craniofacial defects and for the reconstruction of the numerous components of the aerodigestive tract. The development of synthetic and biologic mesh material enabled surgeons to address the structural component of composite defects.17,18 Successful reconstruction of thoracic and abdominal wall defects is now achieved with the use of mesh for structural support and pedicled or free flaps for soft-tissue coverage.19,20 The capacity of biologic mesh materials to tolerate significant contamination has radically changed the face of complex abdominal wall reconstruction. Definiti