Essay: An Innovation of the Ages: The True Birth and Reception of the Tubed Pedicle Flap

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The tubed pedicle flap is a surgical procedure developed in the 1910’s that allows the movement of tissue from one part of the body to another in the reconstructive treatment of defects. It revolutionized the field of plastic surgery and led to the birth of procedures that are commonplace today. The development of the tubed pedicle flap, however, was not an anomaly. Rather it was the next step in a long history of progress towards autologous flaps that began 3000 years prior. The evolution that led to the tubed pedicle depended on several factors—a large volume of injuries from war and the industrial revolution, the development of medical and surgical knowledge, and the development of technology that stabilized trauma patients. Progress, in this case, was dependent on the innovations of individual surgeons as well as the tide of medical knowledge that stretches into antiquity. Furthermore, the reaction by the public and medical community to this procedure in the early 20th century and the field that it birthed was overwhelmingly positive and allowed for its quick adoption.

As will be seen to be the case for reconstructive procedures in antiquity, the tubed pedicle flap was developed in parallel by two separate surgeons in different countries. Vladimir Petrovich Filatov, and ophthalmologist in Odessa, was presented with a patient in 1916 that suffered a malignant tumor of the right lower eyelid and would need a mass of tissue to replace the deficit caused by removing the cancer. After attempting a tube pedicle on a rabbit, Filatov raised the first human tube pedicle, raising a piece of skin and tissue into a cylinder. After twenty days he lengthened the tube then detached the lower end and flipped it into the hole left by the tumor in a third operation four days later. He published articles on his “round pedicle” in Russian, German and French between 1917 and 1927:

‘This is a matter of a new principle which guarantees nourishment of the transplanted flap, and, in describing my case it is not so much the plastic procedure of the eyelid that I am proposing as it is a method for the formation of a nutrient pedicle. This is irrespective of the type of plastic procedure and its location, provided there is an evident need for a long pedicle flap. It can be used in various plastic procedures of the eyelid, lips, nose, etc. If future observations confirm my hopes as to the stalklike round pedicle (and every reason supports this) then plastic operations (not only ophthalmological but also some surgical ones) will be considerably simplified. Although I do not wish to predetermine the type of condition to which the round stalklike pedicle can be applied, I can already see some additional usages and modifications in its applications.’ (Wallace)

Sir Harold Gillies independently invented the tubed pedicle on October 3, 1917 to treat a patient with a severe facial burn (Figure 1) and subsequently taught the technique to others in Europe and America:

‘This poor sailor …

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