AAPS, American Association of Plastic Surgeons
AAPS, American Association of Plastic Surgeons
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2008 Annual Meeting Abstracts

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J.F.S. Esser’s grand conception of “Structive Surgery“ as the foundation for modern flap surgery
John B. McCraw, M.D1, Shushan Jacob, M.D.1, David Black, M.D.2.
1University of Mississippi Medical Center, Jackson, MS, USA, 2University of Tennessee, Memphis, TN, USA.

PURPOSE:
Johanness Fredericus Samuel Esser was undoubtedly the most fascinating character in all of continental European surgery during the period between WWI and WWII. He coined the term “Structive Surgery” during World War I, and performed thousands of operations as the principle plastic surgeon for the German, Austrian, and Hungarian Ministries of War. He was the leading proponent of
“Biological” or “Artery Flaps”, which today would be called island flaps. He developed a split skin graft inlay technique for oral lining, which he termed “Epithelial Inlay.” Although the history of his work and life are known in Europe, this is the first review in the American literature of his remarkable surgical contributions.
METHODS:
Esser’s magnum opus is his book “ Biological Flaps”, published in 1935. His book and publications were reviewed in detail, in addition to historical studies of his work and life.
RESULTS:
Esser employed island flaps based on the temporal, frontal, occipital and facial arteries to reconstruct war injuries of the eyelids, nose, cheek, chin, lips and palate. He introduced the concept that arteries and their accompanying veins form independent “Named Territories,” more than 50 years before this was re-discovered. Esser attempted to develop an internationally neutral “Institute of Structive Surgery,” and became known as the “Apostle of Plastic Surgery” in the international press for his efforts. He gained support for his notion from the governments of Italy, Spain, and Greece, but in the end no country would permit strict neutrality in the use of their territory. Esser was one of the shrewdest financial speculators of all times, and he owned numerous hotels, castles, and theaters, as well as the finest art collection in the Netherlands. Although he was one of the wealthiest men in Europe in the 1930’s, he died alone and penniless in Chicago in 1946.
CONCLUSION:
In the words of Professor Jean Louis Faure who wrote the preface of Esser’s book in 1935: “ He (Esser) has changed the fundamental rules of the character of pedicled skin flaps. To create a surgical center which aims to treat those suffering from congenital deformities or from the terrible injuries of war, a man was needed, who had not only given proof of his high surgical mastership, but who possesses the necessary energy to overpower the innumerable difficulties and obstacles which accumulate such grand enterprises. Esser is this man!"
Pre and postoperative photographs of two of Esser's patients-



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