Abstract
September 2014 marked the bicentennial of the birth of modern plastic surgery. It was then that Carpue began a prospective observational study of nasal reconstruction that culminated in his 1816 monograph, which caused an explosion of interest in reconstructive surgery throughout Europe. In conducting his study, Carpue demonstrated ethical standards and the power of planning a procedure. His methods to document his results accurately would remain unsurpassed until photography was adopted at the end of the 19th century. Carpue took an apocryphal story of surgery performed in India more than twenty years earlier and transformed it into the beginning of modern plastic surgery. He succeeded in a number of unrecognized tasks that are themselves landmarks not only in plastic surgical history, but surgical history: devising the first prospective observational study, using exclusion criteria, maintaining appropriate patient confidentiality, setting a standard for preoperative disclosure and ethical approval over a century before these measures were codified, having independent documentation of his preoperative and postoperative findings, devising a method to objectively monitor and document the forehead flap, and describing the potential value of tissue expansion. He shared his experience by publishing his results and by lecturing in Europe. His contemporaries recognized him for his contributions and he was honored by election to the Royal Society. Carpue launched the modern era of plastic surgery in an ethical, logical, and objective manner. While plastic surgery has changed in the last two centuries, the principles that Carpue followed remain valid.
Highlights
Most modern plastic surgeons recognize the name Gaspare Tagliacozzi even if they cannot pronounce it properly
The American Board of Plastic Surgery’s (ABPS) seal contains Tagliacozzi’s face and the American Association of Plastic Surgery’s (AAPS) seal depicts a patient immobilized in a jacket while his arm flap is provided for nasal reconstruction from his 1597 book De Curtorum Chirgica per Institionem
Martha Gnudi and Webster wrote the definitive biography of Tagliacozzi for which they won the Welch Medal from the American Association of the History of Medicine in 1954.2 They concluded that Tagliacozzi’s historical importance was not because he developed anything new, but because he shared knowledge.[3]
Summary
How do we know that Carpue believed that he was conducting a prospective study? Carpue did the noun trial and specified an exclusion criterion. Carpue had received assurances from two independent surgeons, Heaviside and John Pearson, that the nasal loss was from “the injudicious use of mercury” rather than from syphilis and he published their certificates in his book’s appendix.[15] (pp99-100) Carpue was wary that his patient’s healing abilities had been impaired, and he needed visual proof that his patient did not have problems healing wounds: “The question to be decided was, is this a fair case for trial. Carpue’s first patient had thought that Carpue had previously done a nasal reconstruction. Carpue’s description of their meeting in September 1814, mirrors modern informed consent in its forthrightness and disclosure of dangers and alternative operations:. I readily consented; but, at the same time, apprized my patient, that what he had previously heard, was founded in mistake. I added, that I considered it as by no means dangerous, and that it might be practiced in either of two methods: the one, the Italian, or, as it is commonly called, the Taliacotian, in which the part is supplied from integuments of the arm; the other, the Indian, in which it is taken from the forehead.15(pp81-2)
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