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Excerpt
And so I say to Dr. Carstens: “Welcome to the Club!” By the Club, I refer to that select number of individuals who have changed plastic surgery for the world. I will limit my frame of reference to the years of my training in surgery and subsequent practice. I remember the enthusiasm of my chief, Dr. William C. Grabb, at the announcement of the concept of the musculocutaneous flap. I remember the rekindled interest in anatomy and the cascade of free flap operations that emerged, some obvious and some not so obvious. Replantation came of age. Tissue expansion added to the repertoire of new reconstructive procedures. Liposuction soon followed to become the most commonly performed operation in North American operating rooms.
The last decade has been one of relatively lesser advances. We plastic surgeons have had our flings with endoscopes and lasers. Regrettably growth factors have never achieved a significant utility in our practices. The major advance in patient care in the last decade may be the use of negative pressure dressings (vacuum assisted closure). Now with the widespread dissemination of Dr. Carstens' ideas, we are poised to enjoy a host of new concepts and new approaches to helping our patients. His contributions may usher in a new integration of basic science into plastic surgery. The changes ahead should fill us with eager anticipation.
Dr. Carstens has painstakingly taught himself modern embryology, neuroanatomy, and the molecular biology of embryogenesis. He has entered these disciplines as a serious scholar and now counts many of the basic scientists who lead these disciplines as working colleagues. He has had his ideas reviewed by a host of critical minds and has formulated his ideas into lectures. The material is not easily absorbed: it represents a major departure form the vocabulary and concepts that we are comfortable using. I am reminded of a description of the late Nobel Laureate in physics Professor Julian Schwinger: “Other people publish to show you how to do it, but Julian Schwinger publishes to show you that only he can do it.”1 In fact Dr. Carstens' goal is precisely the opposite; he works tirelessly as a visitor to teach us how to do it ourselves. But be prepared, the going is not easy.
Drawing on the advancements of modern embryogenesis, Dr. Carstens has synthesized the theory of developmental fields and organized it for us cutting surgeons. The defects we describe as those of cleft lip and palate have been described as division, deficiency, displacement, and distortion. Using the knowledge of the embryonic fields and their blood supply, our surgery can be modified to respect these fields, thereby improving the long-term results of surgery. Indeed, these concepts can be applied to the entire craniofacial skeleton and its investing soft tissues. The excellent accompanying editorial of Dr. Hardesty summarizes in greater detail the concepts and some of their surgical implications.
