August 1, 2005 -- An infant is born with a vascular malformation that threatens her vision. A teenager’s sled slams into a tree, breaking every bone in her face. A man survives surgery for esophageal cancer, but is barely able to swallow or speak. People suffering from devastating problems such as these are treated every day in the University of Virginia’s worldrenowned Department of Plastic and Maxillofacial Surgery.

Plastic surgery is a highly valued medical discipline that is sometimes isunderstood. Its practitioners, whose predecessors were treating facial injuries and using skin grafts hundreds of years ago, are now trained to restore both form and function to the human body. Some have been criticized, even by other physicians, for focusing on the enhancement of their patients’ appearance through aesthetic surgery, rather than on the correction of serious deformities.

Debate about the proper role of plastic surgeons is nearly as old as the field itself. Dr. John Orlando Roe, a nineteenth-century American physician, foresaw the importance of both reconstructive and aesthetic surgery when he speculated upon “how much valuable talent had been…lost to the world and society by reason of embarrassment…caused by the influence of some physical infirmity, deformity, or unsightly blemish.”

Plastic surgery gained greater acceptance during World War I, when surgeons developed techniques for repairing severe head and facial wounds and rebuilding noses and lips destroyed by modern weapons. During World War II and the Korean War, plastic surgeons further honed their craft, introducing stainless steel or metal alloys to repair facial fractures.

Plastic Surgery Is Introduced at the University of Virginia During the 1950s, American medical centers began hiring plastic surgeons, and medical schools
sought them for the training of general surgeons interested in acquiring specialized skills.

In those days, most plastic surgeons were appointed to part-time positions. Richmond native Dr. Claude C. Coleman, Jr., who graduated from the UVA School of Medicine in 1943, returned in 1954 as the first chief of its Division of Plastic and Maxillofacial Surgery. Now retired, he recalls hurrying between Charlottesville and Richmond, where he also served as attending plastic surgeon for the Medical College of Virginia.

The Edgerton Years

It was not until Dr. Milton T. Edgerton joined the faculty in 1970 that the University was able to claim its first—and the nation’s second—full-time plastic surgery appointment. Edgerton, who had trained at Johns Hopkins University and helped to organize a reputable program there, was lured to UVA with the promise of being able to set up his own department. “I could control my budget, research expenditures, and salaries,” he said. “It was an enormous advantage.”

In building the department, Edgerton recruited full-time faculty members, including Ph.D.-level researchers to maintain a laboratory for the physicians. He established a residency program and, in what was seen as an unusual move, added a full-time psychiatrist and a clinical psychologist to the group.

Edgerton is recognized as a pioneer in exploring the psychological aspects of plastic surgery and its use in the emotional rehabilitation of patients with poor selfimage.
“After World War II,” he said,“ when I was working with injured soldiers recovering in Valley Forge Army Hospital, I became intrigued with the significant difference plastic surgery can make in people’s lives. … I began to see the value of using the knife to build emotional stability and strength.”

By employing mental health professionals, Edgerton and his colleagues were able to study patients’ motives for seeking plastic surgery and to counsel them before
and after a procedure. The UVA team also contributed to a body of research that was educating the medical profession about the value of plastic surgery and changing the minds of many health care providers.Edgerton’s contributions to the concept of immediate reconstructive surgery for head and neck malignancies resulted in more prompt recovery and improved quality of life for many patients.

Edgerton brought together a professional staff—neurosurgeons, otolaryngologists,
dentists, oral surgeons, ophthalmologists, pediatric anesthesiologists, nurses, and social workers—to care for children with major congenital anomalies affecting the growth of their skull or facial bones. In 1970, he performed the first intracranial operation in the United States to correct orbital hypertelorism, a condition in which a child’s eyes are set too far apart.

Such surgical procedures to help children greatly enhanced UVA’s reputation for outstanding care. Soon, its plastic surgeons were receiving referrals from around the world, and volunteering their services through various international aid rganizations. In 1984, University graduate and plastic surgeon Dr. Charles E. Horton founded Physicians for Peace; its purpose, to assist health care providers in developing countries.

Plastic Surgery at the University

Today There are currently more than 5,000 board-certified plastic surgeons practicing in the United States.

Many employ new techniques, including microsurgery, through which they ndertake intricate operations using special microscopes and miniature precision instruments.

Dr. Raymond F. Morgan, who trained at Johns Hopkins and arrived at the University in 1982, was named Milton T. Edgerton Professor and chair of the Department of Plastic and Maxillofacial Surgery in 1988.

Morgan was chosen to lead a department of significant strength. Four endowed professorships, more than are found in any other academic plastic surgery department in the nation, provide financial support of faculty members. One of these is the Charles E. Horton Professorship in International Surgery. Established in 2004 by the University’s Board of Visitors, it will support a plastic surgeon to carry on Horton’s international work through Physicians for Peace.

The Department of Plastic and Maxillofacial Surgery’s broad mission includes patient care, research, and service. Its plastic surgeons are on call 24 hours a
day at the University Hospital, where they respond to emergencies, common in a
tertiary care center, such as severed limbs, facial and head injuries, and burns.

The department serves its patients through a number of clinics, each with a separate purpose, such as aesthetic surgery, craniofacial surgery, chronic wound and burn care, hand surgery, oral surgery, and hyperbaric oxygen treatment.

The department’s research is considered to be hugely successful. Faculty members
have published many papers, articles, and books devoted to wound healing, wound closure, tissue engineering, and microcirculation—concepts developed in their plastic surgery laboratories during the last three decades.

Finally, educating the next generation of plastic surgeons remains an important goal. According to Dr. Morgan, the residency program is highly competitive. “With more than 250 applicants for each position, we have a difficult time choosing
residents,” he said.

The department offers two models for training plastic surgeons. In the first, general
surgeons come to the University as residents in need of necessary additional instruction. In the second, students decide, while still in medical school, that they wish to become plastic surgeons. They pursue six years of integrated training in one of the first accredited programs of its type— after which many of them are offered leadership positions in our country’s most prestigious academic institutions.

The Future of Plastic Surgery

Highly skilled practitioners, employing sophisticated techniques, have enabled plastic surgery to become increasingly accessible to patients across the United States and around the world. In this country, many plastic surgeons are prepared to accommodate members of an aging American population, as well as others who seek a variety of aesthetic surgical treatments. The University of Virginia is doing its part to meet patient needs. During the winter holidays, Dr. Thomas J. Gampper, vice chair of the Department of Plastic and Maxillofacial Surgery, scheduled an unusual number of surgical procedures. “We worked all day, every day, so our patients would have more time to recover before returning to their jobs,” he said.

A high activity level is typical of the department. As Dr. Morgan said, “We are here to do whatever we can to improve the quality of life for everyone who requires our help.”

Charles E. Horton, M.D., ’47

Through medicine, we make friends for our country,” said Dr. Charles E. Horton 47. “When discussing it anywhere around the globe, we share a common language and experience no barriers.”

Dr. Horton should know. As founder and chairman of Physicians for Peace, a onprofit medical service organization based in Norfolk, Virginia, he has spent more than two decades sending teams of American medical experts to developing countries for the delivery of quality health care.

Physicians for Peace volunteers, including some UVA doctors, routinely travel to areas, worldwide, where their skills are most needed. In 2003, the organization arranged 30 trips, provided nearly 350 medical programs in 44 countries, and donated equipment from U.S. hospitals valued at $5 million.

Plastic surgery expertise has been especially important. “Children suffer 90 percent of the burns in these countries, yet there are no burn centers,” Horton said.

Physicians for Peace assists countries with sustainable projects, having “helped to build medical schools and hospitals, a prosthesis center, and a manufacturer of burn garments.”

The UVA Board of Visitors recently established an endowed professorship in honor of Dr. Horton, which many believe will strengthen the ties between his School of Medicine and Physicians for Peace.

Raymond F. Morgan, M.D.

Dr. Raymond Morgan became interested in plastic surgery as a child, after his eldest brother was badly burned in a fire.

“The plastic surgeon who saved his life became my role model,” he said.

Morgan, a graduate of the medical school at West Virginia University, received his training at Johns Hopkins University. He also completed fellowships in hand surgery and microsurgery at Union Memorial Hospital’s Raymond Curtis Hand Center in
Baltimore.

Recognizing Morgan’s promise, the chair of the plastic surgery department at Johns Hopkins encouraged him to accept a faculty position at the University of Virginia, where several of the field’s luminaries have practiced.

“My chairman, Dr. John E. Hoopes, was very impressed with the training he had received from Dr. Claude Coleman, Jr., a former division chief of plastic surgery at UVA,” Morgan said.

During his 22 years at UVA, Morgan has further enhanced the department’s renown. He is an expert in reconstructive procedures for individuals with congenital hand deformities and crippling rheumatoid arthritis. He also is known for his skills in breast reconstruction, microsurgery, laser surgery, and aesthetic surgery.

In 1988, Dr. Morgan was selected as department chair and awarded the Milton Edgerton endowed professorship in a decision that not only confirms his place among the University’s most illustrious plastic surgeons, but also acknowledges his many important contributions to the profession.

Thomas J. Gampper, M.D.

In a corner of Dr. Thomas Gampper’s office, the floor is covered with neat stacks of paper. Each stack contains applications from surgeons-intraining who hope to be selected for the residency program in the University of Virginia’s Department of Plastic and Maxillofacial Surgery.

As vice chair of the department, it is Gampper’s job to keep the interview process moving forward. “We receive literally hundreds of applications for just one position,” he said. “Ours is an incredibly competitive program.”

It is a program with which Gampper is intimately familiar. He won the coveted
residency spot at UVA in 1990 after finishing medical school and a residency in general surgery at the University of Kansas. He also completed a fellowship in craniofacial surgery at the University and joined its plastic surgery department the next year.

Gampper directs UVA’s laser surgery program and its center for aesthetic surgery.
He treats children and adults alike, focusing on reconstructive, laser, and aesthetic surgical procedures. As codirector of the University’s hyperbaric medicine service, he supervises the treatment of difficult-to-heal wounds with highly concentrated oxygen.

Like other members of the department, Gampper volunteers his services overseas. He has led teams to India and Haiti for the care of children with birth defects or burns. Recently, he returned from Ghana, where he updated physicians on advances in plastic surgery.

Dr. Gampper seems energized by his wide-ranging responsibilities. “I entered this field to help people, and, at UVA, I have plenty of opportunities to do so,” he said.

Kant Y.K. Lin, M.D.

Dr. Kant Y.K. Lin was attracted to UVA by the reputation of its Department of Plastic and Maxillofacial Surgery.

“As one of the oldest and most respected departments in the nation, it has supported the work of internationally recognized physicians,” said Lin, citing Dr. Milton Edgerton and Dr. John Jane as examples. He became part of this legacy in 1992 when he arrived in Charlottesville to lead the Division of Craniofacial Surgery.

Lin was a logical choice for the position. After earning his medical degree from Mount Sinai School of Medicine, he completed a residency in general and plastic surgery at the University of Pennsylvania and a fellowship in craniofacial surgery at the Hospital for Sick Children in Toronto.

As associate professor of plastic and maxillofacial surgery and clinical pediatrics,
he spends one day each week helping children afflicted with congenital deformities who come to him from around the world. He began treating his youngest patient when the child was only four days old.

“After removing a large tumor from the child’s head, we completely rebuilt his face and skull,” he said.

Lin’s other surgical specialties include breast and facial reconstruction and various aesthetic procedures.

Clinical activities may monopolize his time, but Lin is not complaining. In addition to the weeks that he spends in China, volunteering his services through Operation Smile, he always finds challenges close to home. “In the University Hospital, we have the luxury of taking care of anybody and everybody,” he said.

David B. Drake, M.D.

It was not difficult to persuade Dr. David Drake to leave private practice and join the University of Virginia’s Department of Plastic and Maxillofacial Surgery in 1995. He was already familiar with the department, where he had completed his plastic surgery residency and a fellowship in burn and microvascular surgery just four years earlier.

“I liked the idea,” he said, “of going to a department whose members enjoyed
a cooperative working relationship. I knew that we could build an organization
of great stability and strength.”

Drake is seen as an important addition to the group for his skills in hand surgery, microsurgery, limb reconstruction, body re-contouring, and the healing of wounds through treatment with hyperbaric oxygen. He is an associate professor of plastic surgery and clinical otolaryngology as well as medical director of UVA’s DeCamp Burn and Wound Center.

A graduate of the medical school at the University of Kentucky, Drake is deeply invested in educating the next generation of plastic surgeons. He coordinates the University’s Integrated Plastic Surgery Training Program, and serves as co-director of the Orthopedic and Plastic Surgery Hand Fellowship Program.

“I welcome the challenge of dealing with patients who have experienced severe trauma,” he said. “I’ve found that appropriate and well-timed reconstructive surgery can make a huge and positive difference in their lives.”

Adam J. Katz, M.D.

Dr. Adam Katz’s desire for a career that combines clinical care and research led him to the University of Virginia in 2001, when he joined its Department of Plastic and Maxillofacial Surgery as an assistant professor.

Katz, a graduate of the medical school at the University of Michigan, completed his residency in general and plastic surgery at the University of Pittsburgh. While in Pennsylvania, he helped to pioneer the identification and isolation of adult stem cells from adipose tissue that plastic surgeons discard following surgery. He brought this highly promising research interest with him to UVA, and has since received funding in support of his efforts from the National Institutes of Health,
American Association of Plastic Surgeons, Plastic Surgery Educational Foundation, and retired UVA dermatology professor Dr. Peyton Weary.

“Surgery has evolved over the years simply from extirpation, or removal, to reconstruction; from reconstruction to replacement; and now, from replacement to regeneration,” Katz said. “Here at UVA, we understand the pivotal role plastic surgeons can play in translating stem cell and tissue engineering therapies to the clinic, and we want to be part of that future.”

When not in his lab or the clinic, Dr. Katz can be found in the operating room, where his skills are applied to reconstructive surgery, wound healing, breast and body contour surgery, and aesthetic surgery.

“I went to medical school because I want to take care of patients and think on multiple levels about the problems doctors face,” he said. “Working as a physician-scientist is helping me to fulfill that dream.”

George T. Rodeheaver, Ph.D.

Although not a physician, Dr. George Rodeheaver has been working with surgeons for years. In 1972, he was hired to provide full-time research support to UVA’s Department of Plastic and Maxillofacial Surgery.

“I was brought here to assist any faculty member who wanted a better understanding of clinical problems,” Rodeheaver said. “I’m driven to advance the science of clinical care.”

Early in his career, he was asked to develop more effective methods for the repair and management of burns and open wounds. His research led to an important discovery: a novel chemical compound from which he created a new type of wound cleanser. When Rodeheaver’s tests indicated that his cleanser is safer and works better than the harsh, tissue-damaging treatments used in most hospitals, University physicians took notice and introduced it in all operating rooms. The substance is now commercially available.

Rodeheaver also identified another application for his chemical compound. When antibiotics are added, it becomes a highly effective anti-microbial agent for burns and wounds. Tests show that it makes patients more comfortable, shortens their hospital stays, and reduces costs. The only treatment of its type used in the University Hospital Burn Center for more than twenty years, it is now protected by a patent.

Soon, others may benefit from Rodeheaver’s ingenuity. When Dr. Adam Katz joined the plastic surgery faculty and began using the burn treatment, he was so impressed that he offered to help Rodeheaver bring it to the marketplace. After consulting with experts in the University’s Patent Foundation and the Darden Graduate School of Business Administration, Katz and Rodeheaver decided to establish a company to commercialize the product. Their firm, PluroGen Therapeutics, is currently negotiating a contract with a national distributor of health-care products.

Meanwhile, Dr. Rodeheaver continues to support the department’s research needs. “I’m always seeking new ways to bring science to the art of medicine,” he said.