The Washington University (WashU) School of Medicine Division of Plastic and Reconstructive Surgery has played critical roles in developing the specialty in the United States and the world abroad. It is a Division rich in history, discovery, and research. It is part of a historic Department of Surgery lead by Timothy Eberlein, MD, the Director of the Alvin J. Siteman Cancer Center, the Spencer T. and Ann W. Olin Distinguished Professor and Bixby Professor. The Division of Plastic and Reconstructive Surgery program in 2020 was 100 years old. Plastic Surgery has come of age during the 20th century and will further help transform medicine in the 21stcentury and beyond.
The WashU Division of Plastic and Reconstructive Surgery sat atop leadership in the early origins of the specialty in the United States. Vilray P. Blair, MD, served as the first chief of the Division at the Medical School from 1925–1955. Blair treated soldiers in World Was I with complex maxillofacial injuries, and his paper on “Reconstructive Surgery of the Face” set the benchmark for facial reconstruction. Blair’s visionary leadership helped transform the American Association of Plastic Surgery and led to the American Board of Plastic Surgery formation as an independent specialty board. James Barrett Brown, MD, became the chief of Plastic Surgery in 1955 and served until 1968. He pioneered work using large skin grafts to treat severe burns in wounded warriors; his work also led to hand surgery innovations. ohn E. “Jack” Hoopes, MD, served as chief of the Division of Plastic and Reconstructive Surgery from 1968 until 1970. He then became Chief of Plastic Surgery at Johns Hopkins University School of Medicine in Baltimore, Maryland. There he trained generations of trainees carrying on the WashU legacy. Following Hoopes, Paul M. Weeks, MD, was the Chief of Plastic and Reconstructive Surgery from 1970–1996. In addition to being a leader in hand trauma and tendon repair, Weeks helped promote plastic surgery residency training at Washington University and nationwide. His groundwork fostered the development of a truly integrated plastic surgery residency. Susan Mackinnon, MD, took over in 1996 and ran the Division for 23 years until 2019. Dr. Mackinnon lead a Division that focused on all aspects of Plastic and Reconstructive Surgery, specifically Nerve Surgery. Clinical, basic, and translational research involved advances in peripheral nerve surgery culminating in the first human nerve cadaveric transplant.
In the last several decades, the WashU Division of Plastic Surgery program has continued to advance the field with the highest quality graduates. These graduates have populated academic and private practices across North America and the globe. We train three categorial integrated Plastic Surgery residents per year over six years. We also teach hand and microsurgical fellows and offer additional peripheral nerve fellowship training. Shortly we will be offering a microsurgical fellowship. Our program has adopted the mantra of clinical, educational, research, and innovation excellence.
In February 2020, I started as the Shoenberg Professor and Chief, Division of Plastic and Reconstructive Surgery in the Department of Surgery at Washington University in St. Louis. Before this, I spent the last decade at Johns Hopkins School of Medicine, where I was the Vice-Chair of Clinical Operations and Director of Oncological Reconstruction. Before Johns Hopkins, I was on faculty at the MD Anderson Cancer Center in Houston, Texas, and completed fellowships and training at the University of Pittsburgh Medical Center and Mount Sinai School of Medicine in New York City. My practice encompasses head to toe cancer, trauma, and aesthetic reconstruction. My training and previous experience inform the path of the future state of the WashU Plastic and Reconstructive Division moving forward.
The Washington University School of Medicine was founded in 1895. The main medical campus encompasses Barnes Jewish Hospital and St. Louis Children’s Hospital, which has over 1,300 beds. There are 15 hospitals within the BJC healthcare system with over 3,000 beds. NIH funding is over $500 million per year, and the school of medicine is continually ranked in the top 10.
We currently have 16 full-time faculty. Our Division is committed to clinical education research and innovation. We have 10 core clinical programs within the Division of Plastic Surgery that we are currently growing: aesthetic surgery, breast surgery, adult craniofacial, pediatric and craniofacial plastic surgery, general reconstructive surgery, hand surgery, limb salvage, lymphedema surgery, nerve surgery, and transgender surgery. Each clinical program has a leader who is responsible for clinical, educational, and research initiatives. We have a separate freestanding aesthetic surgery facility called West County Plastic Surgery, which caters to aesthetic surgery in an academic environment. We have expanded outside Barnes Jewish Hospital into the community at Alton Northeast Hospital, Christian Northeast Hospital, Progress West and are looking to expand throughout the BJC Health Care system.
New novel programs have begun such as Lymphedema Surgery, managing patients with upper and lower extremity lymphedema. This center of excellence will offer the full host of conservative management, including imaging, medical therapy, and surgical optimization. Specifically, patients requiring lymphatic rewiring with lymph node transfer and/ or lymphovenous bypass will be studied over time. The basic science of lymphedema will be investigated in the lab, and clinical outcomes research will be initiated with a prospectively managed database. This novel collaboration for lymphedema care involves a multi-disciplinary team of infectious disease, bariatric surgery, primary care, hematology/oncology, physical medicine and rehabilitation, physical and occupational therapy, and orthopedic surgery.
A novel collaboration between Acute and Critical Care Surgery, Vascular Surgery, and Plastic Surgery for Limb Preservation has started. This specific service focuses on treating patients with peripheral vascular disease to preserve limb form and function using sophisticated limb salvage and free tissue transfer. Transgender surgery will also be expanding for both facial reconstruction, top, and bottom surgery. Future programs will involve Vascularized Composite Allotransplantation involving the abdominal wall, face, and hand. We will have a concerted effort between immunology, transplant surgery, and our Division.
Our plastic surgery residency program will continue to expand. It routinely recruits medical students from around the country and world. We will continue to advance the education platform and explore competency-based learning and novel ways to train residents in the future. Our Plastic Surgery Research Laboratories is led by Matthew Wood, MD, an NIH-funded basic science researcher who focuses on nerve regeneration. The research laboratory contains over 2,000 feet of wet lab space and 4,000 feet of office space. We have five operating microscopes and a full host of research infrastructure to perform basic science at the highest level in tissue engineering, immunology, and nerve physiology. It is an exciting time to be part of the Division of Plastic and Reconstructive Surgery in the Department of Surgery at Washington University School of Medicine. These articles highlighted by our faculty reveal our exciting clinical, basic science, and translational research projects.
Footnotes
Justin Sacks, MD, MBA, FACS, is the Shoenberg Professor and Chief, Division of Plastic and Reconstructive Surgery in the Department of Surgery at Washington University in St. Louis.