Leadership in the Field: Plastic Surgery at Johns Hopkins

Surgeons have been devising reconstructive procedures since at least 500 B.C., but in the United States, among the first to dedicate his entire medical career to that endeavor was John Staige Davis.

An 1889 graduate of the Johns Hopkins School of Medicine, Davis was named an attending physician at The Johns Hopkins Hospital by William Stewart Halsted—creator of what would become the model for all U.S. surgical training programs. Early on, Davis decided that mastering “the care of wounds and treatment of acquired and congenital deformities” would require all his time and energy. When the hostilities brewing in Europe erupted into World War I, Davis was still America’s only plastic and reconstructive surgeon. His plainly titled Plastic Surgery, the first English-language textbook on the subject, is still considered a valuable resource on using local flaps in the repair of unusual defects.

Davis, in fact, helped build the foundation for the entire discipline of plastic surgery in America. He pioneered the tissue transfer technique known as z-plasty and the use of small, deep grafts to heal chronic wounds. He was a founding member of the American Board of Surgery and the American Board of Plastic Surgery.

In 1944, a fourth-year medical student at Johns Hopkins had the chance to observe the then 72-year-old master surgeon. “I watched him do a cleft lip repair,” says Milton Edgerton. “As he proceeded through the operation, one thing was obvious: He was very gentle in the way he handled the tissue.”

After graduation, Edgerton joined the Army and served at Valley Forge General Hospital in Pennsylvania. He was one of the few surgeons treating thousands of men returning from World War II with disfiguring wounds and burns whose repair finally gave rise to a new and important specialty in medicine. Bringing his hard-won expertise back to Johns Hopkins, Edgerton became the first resident in the newly established Division of Plastic Surgery and was its chief from 1951 to 1970. Among his many achievements, he was the first plastic surgeon to correct hypertelorism and initiated the practice of immediate reconstruction at the time of head and neck cancer surgery.

Edgerton’s successor, Jack Hoopes, continued to revolutionize how defects were reconstructed. Early microsurgeries were performed on his watch, he oversaw the education of surgeons who later become leaders in the field, and he nurtured the combined plastic surgery residency program with the University of Maryland Medical Center.

In 1990 Paul Manson, renowned for revolutionizing the repair of mandible and facial fractures, was tapped to head the plastic surgery division, a position that he, too, would hold for 20 years. “He had a very robust division,” says Julie Freischlag, former William Halsted Professor and Director of the Department of Surgery at Johns Hopkins. “He and Dr. Edgerton helped convince me that departmental status for plastic surgery would lead to even more greatness.”

John Staige Davis didn’t live to see plastic surgery become either a division or a department, but his pioneering work paved the way for it. Today, the profession that reshapes lives has itself been reshaped at Johns Hopkins with the formation, in 2010, of the Department of Plastic and Reconstructive Surgery. With each new resident, original idea and innovative technique, the history that began here will continue its path-breaking trajectory far into the future.