The presentation of plastic surgery visual data from 1816 to 1916: The evolution of reproducible results  M. Felix Freshwater  Journal of Plastic, Reconstructive & Aesthetic Surgery  Volume 69, Issue 9, Pages 1165-1177 (September 2016) DOI: 10.1016/j.bjps.2016.05.027 Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons Terms and Conditions

Figure 1 Carpue case 1 post-operative views. Note how the fistula was clearly marked as ‘a’ in Figures 1 and 2 (Author's personal copy). Journal of Plastic, Reconstructive & Aesthetic Surgery 2016 69, 1165-1177DOI: (10.1016/j.bjps.2016.05.027) Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons Terms and Conditions

Figure 2 Carpue case 2 pre- and post-operative views. Note the realistic join of the flap to columella and cheek. (Courtesy of the Wellcome Library, London.) Journal of Plastic, Reconstructive & Aesthetic Surgery 2016 69, 1165-1177DOI: (10.1016/j.bjps.2016.05.027) Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons Terms and Conditions

Figure 3 Von Graefe's Germanic method. The post-operative result (right) shows a light reflex at the tip and more alae than existed beforehand (left). Von Gräfe Germanic (Von Gräfe, CF.: Rhinoplastik; oder, Die Kunst den Verlust der Nase organisch zu ersetzen, in ihren früheren Verhältnissen erforscht und durch neue Verfahrungsweisen zur höheren Vollkommenheit gefördert. Realschulbuchhandlung, Berlin, 1818). Journal of Plastic, Reconstructive & Aesthetic Surgery 2016 69, 1165-1177DOI: (10.1016/j.bjps.2016.05.027) Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons Terms and Conditions

Figure 4 Plate 9 from Bushnan's translation shows Dieffenbach's secondary revisions to reshape the nostrils using local flaps (Figures 1 and 2) and define the profile to avoid a “potato-like” shape (Figure 3). Bushnan, JS. Surgical observations on the restoration of the nose: and on the removal of the polypi and other tumours from the nostrils. Translated from Chirurgische Erfahrungen, besonders über die Wiederherstellung Zerstörter Theile des menschlichen Körpers nach neuen Methoden von Johann Friedrich Dieffenbach. London: S. Highley, 1833 (Courtesy of the National Library of Medicine). Journal of Plastic, Reconstructive & Aesthetic Surgery 2016 69, 1165-1177DOI: (10.1016/j.bjps.2016.05.027) Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons Terms and Conditions

Figure 5 Pre-operative view of a Mr. Groth, an attorney, who lost his nose in a duel and had a failed attempt at reattachment. Dieffenbach JF, XXI lithographirte Tafeln zu Dr. Dieffenbach's chirurgischen erfahrungen; Zweite Abth. Berlin: Bei Enslin, 1830 (Courtesy of the National Library of Medicine). Journal of Plastic, Reconstructive & Aesthetic Surgery 2016 69, 1165-1177DOI: (10.1016/j.bjps.2016.05.027) Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons Terms and Conditions

Figure 6 Groth, 3 weeks after flap elevation and inset, when Dieffenbach would form nostrils. Dieffenbach JF, XXI lithographirte Tafeln zu Dr. Dieffenbach's chirurgischen erfahrungen; Zweite Abth. Berlin: Bei Enslin, 1830 (Courtesy of the National Library of Medicine). Journal of Plastic, Reconstructive & Aesthetic Surgery 2016 69, 1165-1177DOI: (10.1016/j.bjps.2016.05.027) Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons Terms and Conditions

Figure 7 Final result of Mr. Groth, which Dieffenbach describes as “The best nose I ever made”. Dieffenbach JF, XXI lithographirte Tafeln zu Dr. Dieffenbach's chirurgischen erfahrungen; Zweite Abth. Berlin: Bei Enslin, 1830 (Courtesy of the National Library of Medicine). Journal of Plastic, Reconstructive & Aesthetic Surgery 2016 69, 1165-1177DOI: (10.1016/j.bjps.2016.05.027) Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons Terms and Conditions

Figure 8 Zeis describes a failing flap, but did not name the surgeon who was most likely either himself or Dieffenbach. Patterson translated the legend: “A reconstructed nose on the second day, which already looks likely to die. The flap is swollen, but the skin itself is not robust … in that small creases can be seen in it … It is paler than the rest of the face. The edges of the wound have not united, and it is only held together by the sutures (Figure 3). The same the next day. All is as good as lost. There is no union, and pus is pouring out. A narrow strip on the right side has been destroyed by dry gangrene. The rest of the nose is a sinister blue color, so that it will soon go the same way”9 (Courtesy of the Wellcome Library, London). Journal of Plastic, Reconstructive & Aesthetic Surgery 2016 69, 1165-1177DOI: (10.1016/j.bjps.2016.05.027) Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons Terms and Conditions

Figure 9 Pancoast nasal reconstruction (Courtesy of the Wellcome Library, London). Journal of Plastic, Reconstructive & Aesthetic Surgery 2016 69, 1165-1177DOI: (10.1016/j.bjps.2016.05.027) Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons Terms and Conditions

Figure 10 Pancoast nasal reconstruction (Courtesy of the Wellcome Library, London). Journal of Plastic, Reconstructive & Aesthetic Surgery 2016 69, 1165-1177DOI: (10.1016/j.bjps.2016.05.027) Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons Terms and Conditions

Figure 11 Mutter burn reconstruction using shoulder flap (Courtesy of Yale University, Harvey Cushing/John Hay Whitney Medical Library). Journal of Plastic, Reconstructive & Aesthetic Surgery 2016 69, 1165-1177DOI: (10.1016/j.bjps.2016.05.027) Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons Terms and Conditions

Figure 12 Buck post-op drawing (Courtesy of the National Library of Medicine). Journal of Plastic, Reconstructive & Aesthetic Surgery 2016 69, 1165-1177DOI: (10.1016/j.bjps.2016.05.027) Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons Terms and Conditions

Figure 13 Buck post-op photo. Notice how it is very similar to the drawing (Reproduced with the permission of Archives and Special Collections, Columbia University Health Sciences Library). Journal of Plastic, Reconstructive & Aesthetic Surgery 2016 69, 1165-1177DOI: (10.1016/j.bjps.2016.05.027) Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons Terms and Conditions

Figure 14 Kolle male rhinoplasty patient the text stated, “Uneventful recovery in fifteen days when photograph 491 was made; … at this time discharged; recovery complete.” (Courtesy of the Wellcome Library, London). Journal of Plastic, Reconstructive & Aesthetic Surgery 2016 69, 1165-1177DOI: (10.1016/j.bjps.2016.05.027) Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons Terms and Conditions

Figure 15 Kolle composite graft, figure 455 is described as “the result after the sutures were withdrawn on the sixth day” (Authors personal copy). Journal of Plastic, Reconstructive & Aesthetic Surgery 2016 69, 1165-1177DOI: (10.1016/j.bjps.2016.05.027) Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons Terms and Conditions