American Society of Plastic Surgeons
For Consumers

Evolution of Plastic Surgery in the United States Military

American Revolution (1775-1783)

Surgery in the American Colonies

  • Only 1 in 9 "doctors" had formal training
  • Surgeons distinct from and subordinate to physicians
  • No professors of surgery
  • No anesthesia

Colonel John Jones (1729-1791)

  • Colonial and Continental Army
  • Surgeon educated in colonies and Europe
  • First full professor of Surgery
  • Authored first manual of surgery (1775)

First Surgical Text in America

  • Plain, Concise, Practical Remarks on the Treatment of Wounds and Fractures
    • Always suture facial lacerations
    • Few sutures and remove as soon as possible
    • Stratification of burn wounds and treatment accordingly

American Civil War (1861-1865)

Chloroform for Anesthesia

  • Given on empty stomach
  • Pre-medicated with brandy

Rifle Injury Was Most Common

  • Union Army alone had 9,815 facial injuries
  • 4,914 soft tissue only without fracture

32 Reconstructive Procedures Performed

  • Primarily facial reconstruction
  • Increased collaboration across specialties

Private Carleton Burgan

  • B Company, Purnell's Maryland Legion, United States Army
  • Admitted to Hospital with Pneumonia
  • Given calomel (mercury chloride)
  • Apparently caused an ulcerative lesion at the roof of the mouth which enlarged and became infected

Dr. Gurdon Buck (1807-1877)

  • Auxiliary Corps, Volunteer Surgeons
  • MD from College of Physicians and Surgeons, NY
  • 18-month appointment at NY Hospital
  • 2.5 years studying in Europe
  • Surgeon, City Hospital in New York
  • Broad practice in fracture care, ENT, general and plastic surgery and urology

>5 Operations

  • Prosthetic to repair the oral cavity and loss of maxillary bone and afford "solid support to the soft parts"
  • Advancement flaps
  • Forehead flap

Dr. David Prince (1816-1889)

  • Surgeon, United States Army
  • Published book specifically on plastic surgery
  • Felt plastic surgery had no role in military medicine

Colonel Reed B. Bontecou (1824-1907)

  • Surgeon, 24th Infantry Regiment of the New York State Militia
  • Surgeon in Chief, Harewood U.S. Army General Hospital, Washington D.C.
  • Systematically photographed war wounded for future military surgeons


  • Start of reconstructive surgery in the U.S. military
    • Bringing multiple techniques to the injured soldier for purposes of reconstruction
  • Medical photography to document results and educate others
  • Codification of plastic surgery practice in at least two books

World War I (1914-1918)

Major Harold D. Gillies (1882-1960)

  • 1915 volunteered in France as a general surgeon
  • Learned from surgeons in theater about treating facial injuries (flaps, mandible fractures, etc.)
  • Established first military unit devoted to plastic surgery in Aldershot

Colonel Robert H. Ivy (1881-1974)

  • Born in England (1881)
  • Dental (1902) and Medical (1907) school at University of Pennsylvania
  • Works with Major Vilray Blair in SGs office coordinating care of maxillofacial injuries for U.S. military (1917)
  • WWI served as a surgeon at Base Hospital No. 115 in Vichy, France
  • Chief maxillofacial surgery, Walter Reed Army Medical Center (1919)
  • Importation of reconstructive surgery knowledge
  • U.S. military support and organization for the specialty

World War II (1939-1945)

  • Military now anticipates need for plastic surgery from the outset
  • LTC J. Barrett Brown serves as consultant
  • Establishment of U.S. military units
  • Efforts to standardize plastic surgery care

Captain Sterling Bunnell (1882-1957)

  • WWI: Surgeon, Base Hospital 47
  • Published "Repair of Tendons in the Fingers and Description of Two New Instruments"
  • MG Norman Kirk invites Sterling Bunnellto serve as consultant to the Army Surgeon General to "guide, integrate and develop the special field of hand surgery"
  • After touring Army Hospitals, felt the military was failing patients with hand injuries
    • Establishes 9 hospitals across U.S. focused on hand surgery
  • Patients with complicated hand injuries were funneled to these centers
  • Trains surgeons capable of treating all aspects of hand injury: soft tissue, orthopedic and neurological
  • Approximately 20,000 injured hands were treated in these hospitals

Korean War (1950-1953)


  • 1901-1910: Alexis Carrel describes vascular anastomoses
  • 1906: Goyanesperforms first arterial graft with popliteal vein
  • 1907: Lexerreplaces portion of axillary artery with saphenous vein


  • 1948: Willis Potts develops atraumatic vascular clamps
  • 1948: Kunlinperforms femoral-popliteal bypass with saphenous vein

Arterial Repair

  • Limb salvage rates were low
  • DeBakeyreviewed results of arterial repair from WWII and determined they often failed leading to amputation
  • His research informed an Army doctrine of ligating the majority of arterial injuries
  • Facing high rates of amputation, Army surgeons attempted repair
  • Equipment limitations:
    • Only 2-0 and 3-0 silk suture available
    • Penrose drains used as atraumatic vascular clamps
    • Surgeons scavenging Japan while on R&R to procure more instruments

Limb Salvage

  • Summer 1951
    • First repair performed at the 8055th
    • Subsequently, 8076th started performed reversed saphenous vein graft repairs of damaged arteries
  • Captains Otto Apel and John Coleman
    • US Army, 8076th MASH
    • Started teaching others to perform vascular repairs
  • Amputation rate decreased to 13%with vascular repair compared to 40% in WWII

Vietnam War (1955-1975)

Air Evacuation

  • Helicopters used with success during Korean War for medical evacuation
  • Vietnam
    • Stronger, customized aircraft
    • Improved communications
  • Time from being wounded to treatment decreased from 4-6 hours in Korea to <1-hr

The ASPS Military Plastic Surgeons Forum is operated by the American Society of Plastic Surgeons, a 501(c)(6) professional organization, and is not in any way affiliated with the United States or foreign military or government (or any branch or agency thereof), including the United States, the Department of Homeland Security, the Department of State, the Department of Defense nor any branch of the U.S. military (e.g. the Army, Navy, Air Force, Coast Guard, Marine Corps or Space Force). The views and opinions which appear in the Forum are those of the authors and do not reflect the official policy of the United States government, or any branch or agency thereof.