HISTORY OF PLASTIC SURGERY IN EUROPE IN TWO LETTERS

HISTORY OF PLASTIC SURGERY IN EUROPE IN TWO LETTERS

This is an unusual post, for the history buffs. Those who love to know how it all started. We know Plastic Surgery started in India in 600 BC in the city of Varanasi by a sage surgeon called Sushruta. One of these days I am going to tell his story. Today I am trying to recount how Plastic Surgery started in Europe and doing so by reproducing two letters. The first letter is written to our Plastic Surgery yahoo group by my favorite story teller Prof. Hirji Adenwalla from Trichur and the other is my response to his story, which depicts the next generation and carries forward the story from where he left.

We have all known about Harold Gillies and rightly so. He deserves to be called the father of modern Plastic Surgery. But there were others too. In these letters we describe two real giants. We hope to come back with a few more in future including Harold Gillies for sure!

H.S. Adenwalla

Emeritus Professor of Surgery
Head of the Dept. Of Plastic Surgery, Burns & 

The Charles Pinto Centre for Cleft Lip, Palate
and Craniofacial Anomalies.
Jubilee Mission Medical College and Research Institute

Trichur-680005

Member, Smile Train Medical Advisory Board (South Asia)

Gustavo Sanvenero- Rosselli (1897-1974)

A man of medium height and slim build with a broad forehead beneath which was a long face with a classical Italian nose and a strong chin. It is said that he was always immaculately dressed, loved good clothes and good food. His wardrobe was extensive, a large collection of perfectly cut suits, shoes and a collection of more than 700 neck ties. At work he wore an over sized white hospital coat in which it was said that he looked rather drowned. Rosselli looked every inch an aristocrat. He deeply read the classics such as Dante and Cicero and loved quoting from them. Besides Italian he spoke perfect French and could be understood in both German and English. In 1947 Rosselli received the shocking news that his sister and her husband were killed in a car accident. Their six month old son Riccardo Mazzola, had survived. Rosselli went and picked up the child and brought him back to Milan and brought him up as his own. The boy grew up to be one of Italy’s prominent plastic surgeons.

            Although a bachelor, Rosselli was very fond of children and he was often seen sitting on their beds, talking and reading to his little patients. Though he had an elegant home he rarely entertained there and preferred to go out to dine. Though he said he had no time for marriage, he was very popular with women of high society and was often seen at their dinner parties. Milan was known for its good food and this he enjoyed immensely. There was one thing he never missed. He was always in his box for the premiere at La Scala. This was Sanvenero Rosselli the man -a picture so incongruous from Rosselli the surgeon. He came from a family of lawyers. Rosselli broke tradition when he decided to take up medicine and become a surgeon. He began his medical studies at the University of  Genoa in 1915. For lack of money for three years he served as a medical orderly at the front during the First World War In spite of this he took his exams on time and graduated in 1921. From 1921-1926 he worked as an assistant to Professor Gavello in the ENT department of the University of Turin. Essentially like so many pioneers in plastic surgery he was an ENT surgeon. As an ENT surgeon with Professor Gavello he saw a lot of facial trauma which became his prime interest in life. To further his training he moved to Paris where he came under the influence of Pierre Sebileau and Fernand Lemaitre and it is with them that he entered the realms of maxillofacial surgery. It was here that he met the men who were the reconstructive surgeons of the day; men like Victor Veau, Gillies, Ferris Smith, Ivy, Blair and of course Jacques Joseph. Sanvenero always acknowledged that it was Ferris Smith and Sheehan who inspired him to turn from ENT to plastic surgery.

In 1929 he started a clinic in Milan consisting of 25 beds and two operating tables in one room. Slowly patients started pouring in. These were facial deformities from the first World War, burns and congenital deformities of the face. He treated about 180 new cases of cleft lip and palate and over another 100 secondary cleft cases every year. As the cases poured in Rosselli visited Lexer, Gillies, Joseph, Sheehan and Kazanjian in order to broaden his armamentarium. It is said that his work was so variegated that he even operated on trachea-oesophageal fistulae and other deformities. In 1934 it was in a book that he first described the superiorly based pharyngeal flap for the treatment of nasality in cleft palate cases. It stands today as a cart horse for various modification of his operation. Hogan and Philip Chen devised ways to line his pharyngeal flap. It is strange that only for this, is this Italian surgeon remembered today.

            In 1953 and 1955 he was appointed as lecturer in plastic surgery at the Universities of Turin and Milan. In 1962 the first chair of plastic surgery in Italy was created for him in the Universities of Turin and Milan. In 1967 he was Minister of Magic of the Fourth International Congress of Plastic Surgery, which was held in Rome.

            One of his assistants who wrote his obituary said “Professor Gustavo Sanvernero- Rosselli was not an easy man to work for. His day till the end of his life began with an operating session at 7 AM and the Professor worked straight through until 7 PM. He broke for lunch for 15 Minutes when he would eat a ham sandwich and wash it down with a small glass of red wine. He was once asked why he ate so frugally. He explained that when he was a young man his father insisted that he learn fencing. It was his fencing master who told him that when one needs both physical and mental sharpness to perform a task, one should remain hungry for “hunger sharpens the wits” and makes the body agile. Surgery is like fencing- you try and find the weakness of your enemy and then strike home. For this you have to be both mentally and physically agile. He went home at 7.30 Pm for dinner and returned to the hospital at 8.30 PM when he photographed patients till 11 PM. He expected all his assistants to attend these sessions during which he would teach in an informal manner. For all who worked for this man it was a 16 hour day. On Saturdays he operated in private and would finish by 2 PM. On Sundays he began a ward round at 10 AM and photographed out-patients until 3.30 PM at that point he would leave the hospital and would say to his assistance “I wish you a good Sunday Gentlemen”. This left his assistants smiling. (In this respect he reminds me of our own –Raja Sabapathy). Once a year he took a holiday for 15 days he went to Solda in the South Tyro and staid in the same room in the same hotel. His nephew Ricardo Mazzola also a plastic surgeon would accompany him in a hired station Wagon full of books and his favorite Olivetti potable typewriter. After his sister’s accident and death he never ever drove a car. Early every morning while on these holidays he and his nephew would go on a climbing expedition in the mountains. They would return for lunch and then there would be articles to write and lectures to prepare until late into the night.

            In his 75^th year this remarkable man was as active an ever planning the next issue of the clinics in plastic surgery. In the following year he had accepted an invitation from Converse to deliver a series of lectures in New York. However, before he could go he was diagnosed to be suffering from a cerebral tumor for which he was operated. He developed a post operative pneumonia form which he never recovered, he died on the 17^th of March 1974 at the age of 77.

            All my professional life I have used Rosselli’s superiorly based pharyngeal flap in its various forms , first unlined and then lined as modified by Hogan and then later by Philip Chen and all these years I knew nothing about the man, this often happens with the lives of great innovators. On a whim I decided to research into the life of Gustavo Sanvenero Rosselli and was surprised to find that he stood on a par with the great path finder of plastic surgery and was as versatile as the best amongst them. He deserves to be remembered for more than just his superiorly based pharyngeal flap, which no doubt was a remarkable innovation and has stood the test of time (nearly a hundred years). It remains me of what Claude Bernard said “Genius lies in seeing what everybody has seen and thinking what nobody has thought”

Hirji Adenwalla

Respected Prof. Adenwalla,

I do not have to tell you once again that I am the President of the Adenwalla Fan Club. My friends tell me that may training is incomplete and I will have to visit you to bring it to completion. I am trying. Today I am about to tell you about a generational shift. I am today going to introduce to you and our group members another genius whose name you just mentioned, the nephew Prof. Riccardo Mazzola. I have known him from his work on history of plastic surgery and aesthetic surgery for quite some time but it was in Berlin during the IPRAS meeting and later on in Santiago, again during the IPRAS meeting that I had the opportunity to interact with him in person and was most impressed by his fathomless ocean of knowledge of the history of our speciality, the one which we practice, live and love. The IPRAS had designated him as the official historian of the International Association and he richly deserved the honour. Unfortunately today we don't have IPRAS!

Prof. Riccardo Mazzola

While his research on the history of our speciality is documented in this article which I invite you to read: History of Reconstructive and Aesthetic Surgery: https://plasticsurgerykey.com/ history-of-reconstructive-and- aesthetic-surgery/  the history of European Plastic Surgery which he narrated to me in his inimitable style of story telling is what most impressed me. He said that by the end of WWI, plastic surgery had reached unexpected heights. The high quality of the work done for soldiers with facial injuries and burns, either as an emergency or as a delayed procedure, demonstrated that this new discipline was honourable, worthwhile and socially crucial, thus deserving official recognition and independence. The establishment of new plastic surgery centres, scientific societies and specialised journals were the key to success for the achievement of this goal.

In 1936, the Belgian Maurice Coelst (1894–1963) founded the Société Européenne de Chirurgie Structive, the first supranational society, with the aim of gathering once a year all those interested in this new branch of surgery and favouring confrontation of ideas by showing innovative clinical procedures. Prof. Riccardo then mentionned that a very successful first Congress with a large international participation was held in Brussels, with Coelst as the president, the second in London, in 1937, organised by Kilner and the third in Milano, in 1938, arranged by his uncle Sanvenero Rosselli. Even live surgery was performed during the meetings. The beginning of the WWII stopped the Societé's activities, which were never resumed.53 years after the foundation of the Société Européenne de Chirurgie Structive, a new European Society of Plastic Surgery was formed in 1989 to stimulate research and education at a European level and it was named the European Association of Plastic Surgeons (EURAPS). 

Though very reluctant to talk about himself Prof. Riccardo said that after obtaining his Medical Degree at the University of Pavia, a Mecca of Surgical training then, in 1967, he completed his full residencies in ENT in 1970 at the University of Ferrara and Plastic Surgery at the University of Milan in 1974 where his uncle Prof. G. Sanvenero Rosselli was the chief and the hardest task master. He was appointed the Assistant Professor of Plastic Surgery at the University of Milan in 1971. He currently runs the Plastic and Reconstructive Surgery training program of the Postgraduate School of ENT and Maxillo-Facial Surgery at the Milan University School of Medicine.

In April 1975, Prof. Mazzola established the Fondazione G. Sanvenero Rosselli for Plastic Surgery, as a tribute to his late uncle Gustavo Sanvenero Rosselli, founder of Plastic Surgery in Italy. This internationally reputed institution promotes various forms of teaching, fulfilling a continuous postgraduate training program, by arranging meetings, seminars and courses in the field of Plastic Surgery. Directed by a Board of Trustees, the Fondazione has coordinated more than 150 meetings/seminars and organized 53 courses with live surgery over the years. The Fondazione, of which Prof. Mazzola is currently President, houses one of the most important rare books collections on Plastic Surgery, with more than 3000 volumes, dating from 1490.

Founding member, Secretary General and President of the EURAPS (European Association of Plastic Surgeons). Secretary of the Italian Society of Plastic Surgery (SICPRE)  from 2001 to 2004 and President, Riccardo Mazzola is a member of over 15 national and international societies, among them the prestigious American Association of Plastic Surgeons (AAPS).

He presented his work innumerable invited panels, lectures, conferences, courses at National or International Meetings and Congresses. He has himself organized 55 Congresses and Courses. Keynote speaker in numerous International Congresses, he has been awarded the Maliniac lecturer at the 2006 ASPRS Congress in San Francisco.

He is co-Author of 3 textbooks (“Craniofacial Malformations, Churchill Livingstone 1990; “Velopharyngel Incompetence”, Masson 1995, in Italian, “Fat Injection, from Filling to Regeneration”, Quality Medical Publishing, 2009), 12 book chapters and 115 publications, 40 of them in peer reviewed scientific journals.

His primary interests includes Cleft Lip and Palate, Head and Neck reconstruction, Nasal Reconstruction, Rhinoplasty and the History of Plastic Surgery. A very simple man, he has that old world charm and is a great story teller, just like you Sir.

Regards,

Surajit Bhattacharya