Dr. J. F. S. Esser and his influence on the development of plastic and reconstructive surgery

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 axialpattern 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. rehabilitation 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.