American Society of Plastic Surgeons
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Carl Hartrampf, MD, 1932-2019: Remembering a giant who helped the specialty move forward

On June 20, Carl Hartrampf Jr., MD, Atlanta, passed away. Although a time like this is one of great sadness, it's also a time to rejoice for a life filled with accomplishment and meaning. Furthermore, it provides an opportunity for reflection and thought about the many giants of our field and the impact they've had.

My assumption would be that every plastic surgeon in the world would know about Dr. Hartrampf. However, as I have greyed, I have found a necessity (and responsibility) to convey our specialty's history. Dr. Hartrampf is credited with the creation and use of the transverse rectus abdominus myocutaneous flap for breast reconstruction. We call this the TRAM flap, which appropriately is a portion of Dr. Hartrampf's name. The 1982 manuscript was the first to describe the technique of complete autologous breast reconstruction using the lower abdomen as a donor site.

At the time of submission, the impact of this article could not have been fully realized by either Dr. Hartrampf or his co-authors, Michael Scheflan, MD, and Paul Black, MD. However, their work proved to be groundbreaking. The TRAM flap technique is the basis of all fully autologous breast reconstruction modalities, leading to the free TRAM, free gluteal, abdominal perforator and thigh perforator flaps. The issue of PRS (Volume 69, Issue 2) in which this was published also contains manuscripts about breast-tissue expansion, salvage of tissue expansion, latissimus flaps for Poland's Syndrome and vertical rectus flap for breast reconstruction – truly an amazing issue. Although each of these articles still stand on their own in an impactful way, the work of Dr. Hartrampf and his colleagues proved to be monumental.

Look back to move forward

Most of us would consider Dr. Hartrampf to be one of our plastic surgery giants – a historically significant surgeon responsible for helping shape the specialty as we know it today. Why should we care about history? As I have told my residents many times, "You don't know where to go unless you know where you've been." The PSF President-elect C. Scott Hultman, MD, MBA, surely took this to task with his book, 50 Studies Every Plastic Surgeon Should Know, which details historic and groundbreaking publications in plastic surgery and their impact on our field.

The authors of these studies, when listed, is a virtual "who's who" of plastic surgery: Louis Argenta, MD (vacuum assisted closure); Vilray Blair (skin grafting); Harold Buncke, MD (microsurgery and toe-to-thumb transfer); Sydney Coleman, MD (fat grafting); Leonard Furlow, MD (double opposing Z palatoplasty); Harold Gillies (facial reconstruction, early breast reconstruction); Marko Godina, MD (lower extremity salvage microsurgery); Dr. Hartrampf (TRAM flap); Harold Kleinert, MD (flexor tendon repair, hand surgery); Ted Lockwood, MD (lower body lift); Paul Manson, MD (facial fractures); Stephen Mathes, MD (muscle and fasciocutaneous flaps); Joseph McCarthy, MD (distraction osteogenesis of the mandible); John McCraw, MD (vascular territories and flaps); Ralph Millard, MD (rotation advancement cleft lip repair); and Paul Tessier, MD (craniosynostosis and facial clefts), etc. Each of these surgeons provided contributions that moved our field forward by leaps rather than steps. Understanding the works of these plastic surgery stalwarts provides all of us a deeper comprehension not only of what we do, but why we do it. Without this comprehension, we risk practicing somewhat blindly – not fully knowing the foundations of our actions and movements. Absent of such knowledge, we can succumb to practicing plastic surgery by merely moving through the paces.

I consider myself fortunate to have had the opportunity to meet several of the aforementioned plastic surgeons who moved our specialty so far forward. I was able to meet Dr. Hartrampf – albeit only once at the faculty dinner during the 2015 Atlanta Breast Symposium. I recall being struck by his warm demeanor and humility – even as I was awed to be side-by-side with a giant who stands taller than the rest of us. Not only did he pioneer a transformative treatment, he worked to educate plastic surgeons so that care of breast cancer patients can continue to be improved beyond his immediate reach.

His enduring legacy is the Atlanta Breast Symposium, held every January. What began as a local symposium founded by Dr. Hartrampf to share and teach breast reconstruction techniques has grown into an international conference. Over the years, it expanded to encompass all aspects of breast surgery. Hundreds of participants each year now benefit from Dr. Hartrampf's vision, selflessness and passion. As I stated at the beginning, we should all rejoice for a life filled with accomplishment and meaning.

Editor's Note: The following message was sent to ASPS by Nancy Cadora, a long-time employee of Dr. Hartrampf, following his passing.

My first son was born with multiple birth defects and Dr. Hartrampf was asked to see him in the nursery because of syndactyly of both hands. He saw my child before I saw him – a fact he loved to tease me about. He eventually did some of the reconstruction on my son's hands. Today, my son is the pastor of a church in Cincinnati and has a master's degree from Georgia Tech. Dr. Hartrampf delighted in watching his progress and growth.

I was originally Dr. Hartrampf's office manager. Everything you have heard about him being kind and gracious is true. He was a very compassionate and generous man, always giving credit to his team instead of boasting of his own skills. I heard him tell a man from environmental services who was mopping the floor at the hospital that because he kept everything so clean, he was part of the success of his patients' reconstruction. Everyone on the team wanted to do even more for him because we knew how much he would appreciate a job well done.

Any surgeon who asked was welcome to observe Dr. Hartrampf's O.R. He delighted in sharing his knowledge with others. He always said, "We have all drunk from wells we didn't dig," and "We stand on the shoulders of giants."

He will be missed by all who knew and loved him.