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Dr. JFS Esserand His Influence on the Development of Plastic And DR. J.F.S. ESSERAND HlS INFLUENCE ON THE DEVELOPMENT OF PLASTIC AND RECONSTRUCTIYE SURGERY Madrid, 1935 Dr. J.F.S. Esserand his influence on the development of plastic and reconstructive surgery Dr. J.F.S. Esseren zijn invloed op de ontwikkeling der plastische en reconstructieve chirurgie PROEFSCHRIFT TER VERKRIJGING VAN DE GRAAD VAN DOCTOR IN DE GENEESKUNDE AAN DE ERASMUSUNIVERSITEIT ROTTERDAM OP GEZAG VAN DE RECTOR MAGNIFICUS PROF. DR. J. SPERNA WEILAND EN VOLGENS BESLUITVAN HET COLLEGE VAN DE KANEN. DE OPENBARE VERDEDIGING ZAL PLAATSVINDEN OP WOENSDAG 9 NOVEMBER I983 TE 14.00 UUR DOOR BAREND HAESEKER geboren te Amerongen PROMOTOREN: PROF. DR. J.C. VAN DER MEULE"' PROF. DR. D. DE MOUUN Contents Preface VII PART ONE: A biography of Johannes Fredericus Samuel Esser ( 1877-1946) Introduetion 5 Early chiidhood and schoollife of Jan Esser. 8 Involvement in the development of chess in Holland I 0 Medica! studies: Leiden and Utrecht (1896-1903) 12 Medica! career. 15 Short historica! review of plastic surgery . 21 Esser's training in general surgery 28 Plastic and reconstructive ·surgery in Paris 31 Plastic surgery in Rotterdam . 35 World War I (1914-1918). 37 War surgery in Brünn 40 Vienna . 46 Budapest 53 Berlin (1917-1925) 60 Revolutionary movements in Russia and Germany 66 Plastic surgery in the First World War on the Allied side 74 Esser's plan for an international centre of plastic and reconstructive surgery 77 France 79 Soulh-America 82 Monaco. 85 Italy . 88 Crusade through Europe 96 Institut Esser de Chirurgie Structive 99 Greece (1937) 104 Sojourn in the United Statesof America . 111 Notes. 114 V PART TWO: Specific techniques and principles of plastic and raonstructive surgery. The contributions of Dr. J. F. S. Esser. General observations by Esser on wound repair related to facial injuries in World War I 119 The Esser-inlay 123 Surgical technique of the split skin graft inlay technique. 125 Biologica! or artery Oaps and island Oaps 128 Principles and technique of the biologica! Oap 132 Rotatien of the cheek 141 Specific prob!ems of the amputee 145 Esser's description and ideas of the technique of the cross-leg Oap 147 Cineplastic operations 148 Toe-to-hand transfers 149 Pedicled breast Oap . 154 The treatment of burns and frostbite 157 Fire and Oame burns 158 Radialion burns 159 Electrical burns 160 Chemica! burns 161 Frostbite 162 Plastic surgery applied to ophthalmology. 163 PART THREE: The injluence of Esser's most fundamental techniques on modern plas­ tic and reconstructive surgery. Introduetion 169 Impact on modern plastic surgery 169 Oral surgery and the Esser-inlay. 171 The arrerial Oap . 172 The rotatien Oap of the cheek in eyelid repairs . 176 The bilobed Oap 176 SuM~YIARY AND Cor-:cLusioNs 181 SAMENVATTING EN CONCLUSIES 184 ZUSAMMENFASSUNG UND SCHLUSSFOLGERUNGEN . 188 RÉSUMÉ ET CONCLUSIONS 191 ACKNOWLEDGEMENTS 194 BIBLIOGRAPHY OF DR. J. F. S. ESSER 197 RIFERENCES. 203 1::-.JDEX OF NAMES 221 CuRRICULUM VITAE AucTORIS 224 VI Preface Jan F.S. Esser (1877-1946) was a remarkable and gifled Dutch surgeon whose contributions to plastic and reconstructive surgery, made long befare this specialty was recognised as a branch of surgery, are part of our surgical heritage. His interest in the bloodsupply of skin flaps was the !are-runner of the clinical and anatomical research that lead to the defînîtion of the axial­ pattern flap, the island flap, and later the work on myocutaneous flaps. Esser was one of the first physicians in Holland to have studied bath denlistry and medicine, a unique and fortunate combination that lead him to in vent the skin graft inlay technique: an operation that is still named alter him. His dexterity and love lor manual craftmanship is reflected in his beautiful leatherbound collection of atlases of war injuries, made by the old master baak-binders in Antwerp. He was an eminent chess player and at one time chess champion of Holland. He was also dedicated to the arts and a very shrewd busînessman. He was a tireless and energetic worker, but at the sa me time a rugged individualist, and at times hopelessly unrealistic. His suspicious attitude. hotheadedness, and ocassional stinginess were among bis other weaknesses. In the international literature on plastic surgery he is quoted as being one of the pioneers and in ventors of reconstructive surgery, of the sa me stature as Joseph and Lexerin Germany, Gillies and Kilner in Great-Britain, Morestin in France, Burian in Czechoslovakia and Staige Davis in the United Statesof America. Yet in bis native country, Holland, he was barely noticed. He travelled all over the world with the aim of spreading, on the basis of his personal experience, the possibilities of plastic and "structive" surgery. especially in Europe and both Americas. lor the surgical treatment. rehabili­ tation and return to society of the mutîlated war victims who were regarded as outcasts of societv in those days. (Aufricht, 1946b). The development of the Esser-inlay. publisbed in both the German and American surgical journals, marked the beginning of an era in plastic surgery and was used extensively tbraughout the First and Second World War. His discovery of the "biologica!" arterial flap, used then as a pedicled flap and more recently as a free flap has revolutionized reconstructive surgery. Another of his innovations, the bilobed flap, it still used extensively lor the reconstruction of certain facial and nasal defects. Esser did not invent surgical instruments, but restated and defined surgical principles instead. VII In the succeeding pages the writer bas attempted to find the answer to the following questions: 1. Who was the Dutchman Jan Esser, and why and how did he become a renowned plastic surgeono 2. What bas been the influence of bis publisbed work on modern plastic surgery? 3. What is the explanation of his relative obscurity in his native country Holland0 4. What part did Esser play in the development of plastic surgery in Europe. between 1910 and 1940° VIII PART ONE A BIOGRAPHY OF JOHANNES FREDERICUS SAMUEL ESSER (1877-1946) ... Plastic surgery was known til! recently as the Cin­ derella among the bratherbood of surgical specialities. It was considered undignified for any wellqualified man to be a plastic surgeon. How \\Tong was thîs vie\\' was demonstrated by bath world \vars. The more civilisation progressed and the more powertul the weapons of war became the more bideaus the injuries. Only then people realised that plastic surgery means more than beauty treatment. It was nat enough to save the life of a burnt airman or the disfigured ar maimed soldier of a tank unit. It was necessary to make him normal in appearance as well, and bere plastic surgery came into its own .. George BankalL 1947 Introduetion to Part One An incomplete and rough draf! of the autobiography of Dr. J.F.S. Esser bas been used as a guideline for this biography. These memairs were cammeneed on September 28, 1941 in Chicago, when Esser was temporarily bedridden, due to a !all from a ladder. This unhappy even! gave him the opportunity to dielate bis life-story to two of bis ex-patients Robert Hart and David Tucker, who assisted in typing the manuscript. Since at that time he was without notes or photographs. Esser had to rely on bis memory. The life story was written in great detail, butsome mistakes in dates and spelling of narnes did occur. The typewritten pages also contained many iterations and moreover were incomplete. The autobiography stops abruptly in 1928. Many original documents and letters, coming from the family archives have been studied, and helped to correct the mistakes and ambiguities in the original draft. Information of a doubtful nature that proved difficult to substantiate from further studies of documents, municipal and war archives, institutes of medica! history and University libraries. bas been omitted. Discussions and correspondence with Esser's rclatives, acquaintances, sec­ retaries, and colleagues interested in the history of plastic surgery. have clarified and confirmed many events. Visits to the Dutch towns and villages, like Amsterdam, Rotterdam, Pols­ broek, Utrecht and Leiden, and to Paris and Faye-la-Vineuse in France, proved to be invaluable to understand specific local situations. 3 Abridged genealogical table of Dr. J.F.S. Esser N1artinus Henricus Esser x Voske Elisabeth Hendriks 19-02-1809 (Amsterdam) 01-04-1800 (The Hague) 04-06-1891 (Leiden) 29-06-1886 (Leiden) 1. Martirrus Henricus Volgueres Esser 18-10-1840 (Leiden) 12-03-1864 (Leiden) 2. Johannes Fredericus Esser x Jannetje Boekee 30-01-1843 (Leiden) 01-05-1843 (Rijnsburg) 18-01-1891 (Leiden) 3. Agatha Elisabeth Esser 14-12-1845 (Leiden) 16-02-1849 (Leiden) 1. Elisabeth Henriette Esser 17-07-1876 (Leiden) 05-03-1952 (Katwijk) 2. Johannes Fredericus Samuel Esser 13-10-1877 (Leiden) 03-08-1946 (Chicago) 4 Introduetion The second French Revolution starled in Paris on July 27, 1830, one day alter the proclamation of a new act announcing the abolition of parliament, the end of freedom of the press and a reduction in the electorale. The French King Charles X (1757-1836) left lor Great-Britain and was replaced by the Duke of Orléans, Louis-Philippe ( 1773-1850). nicknamed the ''Citizen King ... The revolution had an effect on the neighbouring countries and the first signs were seen in the Kingdom of the Netherlands a few weeks later. Belgium was then still a part of the Kingdom of the Netherlands. The Belgian part of the population was mainly Catbalie and the Dutch Provinces Protestant. William (Willem) I (1772-1843) King of the Uniled Provinces si nee 1813. was Dutch and Protestant, but he recognised religious liberty. The official language was Dutch.
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