SPECIAL EDITORIAL
The Global Traveling Fellowship After Many Decades Ian Jackson, MD
FIGURE 1. Dr Ian Jackson.
This contribution is simply a collection of my thoughts and memories of how craniofacial surgery became my passion over the years I practiced. After receiving the ‘‘Locke Travelling Fellowship’’ in 1967 I had to make a decision. Where should I go to make the most of this award and have the best experience? I was working in Canniesburn Hospital in Glasgow, UK at that time. I was receiving an increasing number of cleft lip and palate cases. I was not impressed with the results I was seeing from around the UK. I researched the work being done by cleft surgeons around the world. I was impressed by the results produced by Tord Skoog, a plastic surgeon in Sweden. When I contacted him, he graciously invited me to visit him. I also wrote to several other
What Is This Box? A QR Code is a matrix barcode readable by QR scanners, mobile phones with cameras, and smartphones. The QR Code links to the online version of the article.
From the Beaumont Health System, Ian Jackson Craniofacial and Cleft Palate Clinic, Royal Oak, MI. Received January 31, 2015. Accepted for publication February 7, 2015. E-mail: [email protected] The author reports no conflicts of interest. Copyright # 2015 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000001696
The Journal of Craniofacial Surgery
plastic surgeons in Stockholm. I thought it would be interesting to see what was going on in different areas. I was accompanied by my wife and 3 young daughters. We rented a small apartment in the Wenner Gren Center for visiting Physicians and Scientists in Stockholm. We arrived in December, and I immediately made plans of how I could spend my time. Professor Skoog worked in Uppsala. Fortunately, this was a very short drive from Stockholm. I arranged to work 1 week in Uppsala and 1 week in Stockholm and alternated in this way for 6 months. In Stockholm, the plastic surgery department was a busy one. Erik Enghdal, one of the senior surgeons, invited me to work with him. He first explained to me how the health system worked. It was not at all like the system in Scotland. It was quite complicated. It seemed to work very well for the population. He talked a bit about how the plastic surgery department was set up and how the daily routine worked. It was all very efficient. Erik was a thoughtful and innovative surgeon and shared many seemingly unimportant little pieces of information, I fortunately noted. It only became truly appreciated when I got back to work and found how valuable they really were. Before I left for Sweden, I had already read all of Professor Skoog’s publications. I was fascinated with the methods he described for the reconstruction of primary unilateral and bilateral cleft lip and palate. His work however at that time was very controversial. When I got back to the UK, I began to carry out his methods in my cleft patients. Not surprisingly, I also received a fair amount of criticism. I believed in what I was doing and persevered. After many years of experience in cleft surgery, I was able to show that the early bone grafting, as taught to me by Skoog, produced excellent results. There are many different methods of repairing clefts being carried out and good results being achieved. In my hands, I found that the Skoog’s method worked well for me. I was able to prove my dedication to this by treatment of my first grandchild born with a very large unilateral cleft lip and palate in exactly the same way as I treated all my cleft babies. In the months I was assisting Skoog, I gained a great deal of respect for not only his ability in surgery, but also for obvious dedication to his little patients. In the operating room, he was a quiet surgeon. He expected his assistants to be fully prepared for the procedure. His demeanor demanded absolute concentration on the surgery. He was a brilliant teacher. At the end of the day, he sat with us making sure that we had understood every step of the surgery and answered every question asked. I could not have had a more worthwhile experience. My time with Skoog greatly exceeded my expectations. I am forever grateful to Tord Skoog. He was a very kind man and invited all of us to his home on many occasions. During my time in Sweden, I managed to spend a few days in Gothenburg with Bengt Johannsen. He was a brilliant man with a very sharp mind. We spent hours discussing the plastic surgery literature. He was extremely knowledgeable of what was going on in plastic surgery worldwide and curious about everyone I had met and what I had learned. I enjoyed him very much. After leaving Sweden, we had very little money since the cost of living there was very high compared with Scotland. We were continuing on through several countries and could not afford to rent apartments, so we bought a large tent and lived in campgrounds. I know this was much harder for my wife than me but she
Volume 26, Number 4, June 2015
1011
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
Jackson
The Journal of Craniofacial Surgery
said there was not much housework so it was fine. It is not possible to talk about all of the surgeons I spent time. Many are still friends. In Innsbruck I met Hans Anderl. What a marvelous fellow he is. He is enthusiastic about all he does. He was untiring in wanting to know where I had been, who I saw and what did I learn. He encouraged me to tell him so that he too could take advantage of this experience. He is a fine technician. It was a pleasure to watch him operate. He is a deeper thinker and to listen to his observations and ideas about so many of the procedures we all carry out was a pleasure and a privilege. In Germany, I spent time with Professor Schuchart, Hans Riechart, Deiter Buckramko, and Edward Schmitt. I learned a great deal from each of those men. Conversations with them were always so interesting whether it was surgery-related or not. I learned not only how they were as surgeons but their philosophy of life and many things about their countries and ways of life. It was fascinating. Edward Schmitt, however, was a man I will never forget. He was a small man in stature and in my opinion, a giant in plastic surgery. He has an incisive mind. His knowledge of plastic surgery literature was truly impressive. His goal in life was to be the very best he could be for his patients. He was a kind and caring man. He was always pushing to learn more. He read and worked tirelessly. I believe that his research and work opened the door to craniofacial surgery. As I was traveling, I heard much about Paul Tessier and craniofacial surgery. This was a totally new concept and approach to reconstructive surgery of the skull and face. I thought how amazing it would be if before leaving Europe I could have the opportunity to meet him. I called him and explained that for the last 11 months I had been visiting plastic surgery centers in Europe and would very much like the opportunity to meet him. He graciously agreed to see me on my way back home. We spent time operating. At the end of the last case, Paul said ‘‘Ian, you have seen enough of this. Let’s go and drink some cognac and smoke a cigar.’’ As we were drinking and smoking, I told him that I would like to set up craniofacial surgery program in Glasgow. We talked about the possible obstructions I might have to deal with. As we were taking our leave of each other, Paul lifted up his cigar, pointed it at me, and said, ‘‘Ian, you can do it.’’ From that time on no matter where we met around the world, we would drink together, smoke a cigar, and talk about everything except plastic surgery. I expect that speaking French helped a little and of course after a little cognac my French became a great deal better. My experiences in Europe were both eye-opening and invaluable. Fascinating because of the diverse personalities and invaluable because of what they taught me. Their generosity is in allowing me to work with them in the operating room and for the time they spent discussing new ideas and how it would all develop over time. I believe that all of their inputs shaped my own way of thinking. Shortly after arriving back in Glasgow, I persuaded my good friend Rab Hide to join me in my new venture into craniofacial surgery. He and I had gone through University together. By that time he had become a very well-known neurosurgeon in the UK. We decided to get started and see how it all developed. As we became more proficient, we quickly realized that for this kind of surgery we needed more people to help. There were many areas of care and expertise required apart from the surgery itself. We gathered together doctors from the other specialties we thought necessary. With their help we became a team. Team approach is now simply a gold standard. Rab and I worked together for many years until I left the UK in 1979 to go to Mayo Clinic in Rochester, MN. I continued craniofacial surgery there along with general plastic surgery and of course cleft surgery about which I am passionate.
1012
Volume 26, Number 4, June 2015
During my time at Mayo, I set up a Fellowship in craniofacial surgery to train many young surgeons. In 1989, I moved to Michigan where I was able to set up my own craniofacial institute. My years there were very productive. We trained fellows from the United States and many other countries. Many of them have gone on to be very successful. Some have become chiefs of their own departments. It has really been a privilege to be allowed to carry out this kind of surgery and put the patients through long and arduous operations. From the satisfaction and pleasure we derive from this we should be paying them instead of them paying us. Meeting Joseph McCarthy was yet another highlight in my career. I was an admirer of his before our personal introduction. Joe and I became good friends. Over the years we would take great pleasure in talking together about our concerns and about all aspects of plastic surgery in general and craniofacial surgery in particular. As our friendship grew, I came to admire his forward thinking. Not all surgeons are innovative, but Joe was. He reminds me in so many ways of Schmitt. I have never met a more honest surgeon than Joe. His credibility is impeccable. His advances in craniofacial surgery since I started and even since I retired 4 years ago are impressive. It is exciting to see the enthusiasm for the specialty maintained in the younger craniofacial surgeons. Imagine the advances that will be made in the future. In colloquial terms, I think it will be ‘‘awesome.’’ With the publicity that reconstructive surgery receives in the newspapers, magazines, and television, society has become more informed and more aware of the tremendous problems facing individuals with serious problems. I believe people are now much more aware that deformity can happen to anyone whether by a defect at birth or by being involved in traumatic accidents. I think this has created a far more positive attitude within society and the media for people with deformities. Although craniofacial surgery has been a great part of my life’s work, I was never able to use it for the reconstructive surgery necessary for our adopted son David. Craniofacial surgery corrects abnormalities of the bone and tissue structures of the skull and face. It cannot replace destroyed bone and soft tissues. David was born in the high jungle areas of Peru and at only a few months of age he developed leishmaniasis. His entire maxilla was lost, as well as all of his nose. He also had complete loss of his hard and soft palate. This loss made it possible for him to physically place his lower teeth on his forehead. Although the groin flap developed by my mentor Ian McGregor and myself opened the way to the development of free tissue transfer, the specialty of microsurgery, these techniques came too late for David. I used all the old-fashioned tube pedicled flaps such as the deltopectoral and other flaps, which in fact did very well over the years. How much greater would it have been for David and for me if I could have used free tissue transfer procedures? David’s reconstruction was carried out over a long period of time. With some refinements over the years he has been able to lead a relatively normal life. He has a job, his own apartment, and he has just turned 40. His story over time has, I believe, given hope and comfort to many people with deformity. I think he is better known in Michigan for his salsa dancing for which he has received several awards.1 Thank you for the opportunity to contribute my experiences to the Journal of Craniofacial Surgery and thank you to all my colleagues who during my career have also been my friends.
REFERENCE 1. Jackson M. Boy David: The Story of the Fight to Save a Child’s Face London, UK: BBC Publications; 1986
#
2015 Mutaz B. Habal, MD
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
The Global Traveling Fellowship After Many Decades Ian Jackson, MD
FIGURE 1. Dr Ian Jackson.
This contribution is simply a collection of my thoughts and memories of how craniofacial surgery became my passion over the years I practiced. After receiving the ‘‘Locke Travelling Fellowship’’ in 1967 I had to make a decision. Where should I go to make the most of this award and have the best experience? I was working in Canniesburn Hospital in Glasgow, UK at that time. I was receiving an increasing number of cleft lip and palate cases. I was not impressed with the results I was seeing from around the UK. I researched the work being done by cleft surgeons around the world. I was impressed by the results produced by Tord Skoog, a plastic surgeon in Sweden. When I contacted him, he graciously invited me to visit him. I also wrote to several other
What Is This Box? A QR Code is a matrix barcode readable by QR scanners, mobile phones with cameras, and smartphones. The QR Code links to the online version of the article.
From the Beaumont Health System, Ian Jackson Craniofacial and Cleft Palate Clinic, Royal Oak, MI. Received January 31, 2015. Accepted for publication February 7, 2015. E-mail: [email protected] The author reports no conflicts of interest. Copyright # 2015 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000001696
The Journal of Craniofacial Surgery
plastic surgeons in Stockholm. I thought it would be interesting to see what was going on in different areas. I was accompanied by my wife and 3 young daughters. We rented a small apartment in the Wenner Gren Center for visiting Physicians and Scientists in Stockholm. We arrived in December, and I immediately made plans of how I could spend my time. Professor Skoog worked in Uppsala. Fortunately, this was a very short drive from Stockholm. I arranged to work 1 week in Uppsala and 1 week in Stockholm and alternated in this way for 6 months. In Stockholm, the plastic surgery department was a busy one. Erik Enghdal, one of the senior surgeons, invited me to work with him. He first explained to me how the health system worked. It was not at all like the system in Scotland. It was quite complicated. It seemed to work very well for the population. He talked a bit about how the plastic surgery department was set up and how the daily routine worked. It was all very efficient. Erik was a thoughtful and innovative surgeon and shared many seemingly unimportant little pieces of information, I fortunately noted. It only became truly appreciated when I got back to work and found how valuable they really were. Before I left for Sweden, I had already read all of Professor Skoog’s publications. I was fascinated with the methods he described for the reconstruction of primary unilateral and bilateral cleft lip and palate. His work however at that time was very controversial. When I got back to the UK, I began to carry out his methods in my cleft patients. Not surprisingly, I also received a fair amount of criticism. I believed in what I was doing and persevered. After many years of experience in cleft surgery, I was able to show that the early bone grafting, as taught to me by Skoog, produced excellent results. There are many different methods of repairing clefts being carried out and good results being achieved. In my hands, I found that the Skoog’s method worked well for me. I was able to prove my dedication to this by treatment of my first grandchild born with a very large unilateral cleft lip and palate in exactly the same way as I treated all my cleft babies. In the months I was assisting Skoog, I gained a great deal of respect for not only his ability in surgery, but also for obvious dedication to his little patients. In the operating room, he was a quiet surgeon. He expected his assistants to be fully prepared for the procedure. His demeanor demanded absolute concentration on the surgery. He was a brilliant teacher. At the end of the day, he sat with us making sure that we had understood every step of the surgery and answered every question asked. I could not have had a more worthwhile experience. My time with Skoog greatly exceeded my expectations. I am forever grateful to Tord Skoog. He was a very kind man and invited all of us to his home on many occasions. During my time in Sweden, I managed to spend a few days in Gothenburg with Bengt Johannsen. He was a brilliant man with a very sharp mind. We spent hours discussing the plastic surgery literature. He was extremely knowledgeable of what was going on in plastic surgery worldwide and curious about everyone I had met and what I had learned. I enjoyed him very much. After leaving Sweden, we had very little money since the cost of living there was very high compared with Scotland. We were continuing on through several countries and could not afford to rent apartments, so we bought a large tent and lived in campgrounds. I know this was much harder for my wife than me but she
Volume 26, Number 4, June 2015
1011
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
Jackson
The Journal of Craniofacial Surgery
said there was not much housework so it was fine. It is not possible to talk about all of the surgeons I spent time. Many are still friends. In Innsbruck I met Hans Anderl. What a marvelous fellow he is. He is enthusiastic about all he does. He was untiring in wanting to know where I had been, who I saw and what did I learn. He encouraged me to tell him so that he too could take advantage of this experience. He is a fine technician. It was a pleasure to watch him operate. He is a deeper thinker and to listen to his observations and ideas about so many of the procedures we all carry out was a pleasure and a privilege. In Germany, I spent time with Professor Schuchart, Hans Riechart, Deiter Buckramko, and Edward Schmitt. I learned a great deal from each of those men. Conversations with them were always so interesting whether it was surgery-related or not. I learned not only how they were as surgeons but their philosophy of life and many things about their countries and ways of life. It was fascinating. Edward Schmitt, however, was a man I will never forget. He was a small man in stature and in my opinion, a giant in plastic surgery. He has an incisive mind. His knowledge of plastic surgery literature was truly impressive. His goal in life was to be the very best he could be for his patients. He was a kind and caring man. He was always pushing to learn more. He read and worked tirelessly. I believe that his research and work opened the door to craniofacial surgery. As I was traveling, I heard much about Paul Tessier and craniofacial surgery. This was a totally new concept and approach to reconstructive surgery of the skull and face. I thought how amazing it would be if before leaving Europe I could have the opportunity to meet him. I called him and explained that for the last 11 months I had been visiting plastic surgery centers in Europe and would very much like the opportunity to meet him. He graciously agreed to see me on my way back home. We spent time operating. At the end of the last case, Paul said ‘‘Ian, you have seen enough of this. Let’s go and drink some cognac and smoke a cigar.’’ As we were drinking and smoking, I told him that I would like to set up craniofacial surgery program in Glasgow. We talked about the possible obstructions I might have to deal with. As we were taking our leave of each other, Paul lifted up his cigar, pointed it at me, and said, ‘‘Ian, you can do it.’’ From that time on no matter where we met around the world, we would drink together, smoke a cigar, and talk about everything except plastic surgery. I expect that speaking French helped a little and of course after a little cognac my French became a great deal better. My experiences in Europe were both eye-opening and invaluable. Fascinating because of the diverse personalities and invaluable because of what they taught me. Their generosity is in allowing me to work with them in the operating room and for the time they spent discussing new ideas and how it would all develop over time. I believe that all of their inputs shaped my own way of thinking. Shortly after arriving back in Glasgow, I persuaded my good friend Rab Hide to join me in my new venture into craniofacial surgery. He and I had gone through University together. By that time he had become a very well-known neurosurgeon in the UK. We decided to get started and see how it all developed. As we became more proficient, we quickly realized that for this kind of surgery we needed more people to help. There were many areas of care and expertise required apart from the surgery itself. We gathered together doctors from the other specialties we thought necessary. With their help we became a team. Team approach is now simply a gold standard. Rab and I worked together for many years until I left the UK in 1979 to go to Mayo Clinic in Rochester, MN. I continued craniofacial surgery there along with general plastic surgery and of course cleft surgery about which I am passionate.
1012
Volume 26, Number 4, June 2015
During my time at Mayo, I set up a Fellowship in craniofacial surgery to train many young surgeons. In 1989, I moved to Michigan where I was able to set up my own craniofacial institute. My years there were very productive. We trained fellows from the United States and many other countries. Many of them have gone on to be very successful. Some have become chiefs of their own departments. It has really been a privilege to be allowed to carry out this kind of surgery and put the patients through long and arduous operations. From the satisfaction and pleasure we derive from this we should be paying them instead of them paying us. Meeting Joseph McCarthy was yet another highlight in my career. I was an admirer of his before our personal introduction. Joe and I became good friends. Over the years we would take great pleasure in talking together about our concerns and about all aspects of plastic surgery in general and craniofacial surgery in particular. As our friendship grew, I came to admire his forward thinking. Not all surgeons are innovative, but Joe was. He reminds me in so many ways of Schmitt. I have never met a more honest surgeon than Joe. His credibility is impeccable. His advances in craniofacial surgery since I started and even since I retired 4 years ago are impressive. It is exciting to see the enthusiasm for the specialty maintained in the younger craniofacial surgeons. Imagine the advances that will be made in the future. In colloquial terms, I think it will be ‘‘awesome.’’ With the publicity that reconstructive surgery receives in the newspapers, magazines, and television, society has become more informed and more aware of the tremendous problems facing individuals with serious problems. I believe people are now much more aware that deformity can happen to anyone whether by a defect at birth or by being involved in traumatic accidents. I think this has created a far more positive attitude within society and the media for people with deformities. Although craniofacial surgery has been a great part of my life’s work, I was never able to use it for the reconstructive surgery necessary for our adopted son David. Craniofacial surgery corrects abnormalities of the bone and tissue structures of the skull and face. It cannot replace destroyed bone and soft tissues. David was born in the high jungle areas of Peru and at only a few months of age he developed leishmaniasis. His entire maxilla was lost, as well as all of his nose. He also had complete loss of his hard and soft palate. This loss made it possible for him to physically place his lower teeth on his forehead. Although the groin flap developed by my mentor Ian McGregor and myself opened the way to the development of free tissue transfer, the specialty of microsurgery, these techniques came too late for David. I used all the old-fashioned tube pedicled flaps such as the deltopectoral and other flaps, which in fact did very well over the years. How much greater would it have been for David and for me if I could have used free tissue transfer procedures? David’s reconstruction was carried out over a long period of time. With some refinements over the years he has been able to lead a relatively normal life. He has a job, his own apartment, and he has just turned 40. His story over time has, I believe, given hope and comfort to many people with deformity. I think he is better known in Michigan for his salsa dancing for which he has received several awards.1 Thank you for the opportunity to contribute my experiences to the Journal of Craniofacial Surgery and thank you to all my colleagues who during my career have also been my friends.
REFERENCE 1. Jackson M. Boy David: The Story of the Fight to Save a Child’s Face London, UK: BBC Publications; 1986
#
2015 Mutaz B. Habal, MD
Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
