[The first gender-changing operation from female to male in The Netherlands, 1959/'60]. / De eerste geslachtsveranderende operatie van vrouw naar man in Nederland, 1959/'60.

The first sex-change operation in a transsexual patient, i.e. the construction of a penis (so-called phalloplasty), took place in the Netherlands in Arnhem in 1959-1960. The operative technique had already been described in 1938 and was perfected after World War II. The discussion of this controversial procedure during a staff meeting in Arnhem Municipal Hospital was published at that time in the Nederlands Tijdschrift voor Geneeskunde [Dutch Journal of Medicine] and this resulted in a large number of protesting letters to the editor. Although the operation was carefully planned and proved to be a success, a judicial inquiry was started and questions were even raised in parliament. As a result of all the commotion, the plastic surgeon Woudstra who performed the first phalloplasty never again dared to perform this kind of surgery, but he had opened the way for the formation of the first gender teams to be established in Amsterdam, Groningen and Rotterdam during the 1970s, by which time sex-change operations were fully accepted.

[Fifty years of plastic surgery in the Netherlands. V. History]. / Vijftig jaar plastische chirurgie in Nederland. V. Geschiedenis.

For many centuries plastic surgical operations have been practised incidentally by general surgeons. Both World Wars combined with a multidisciplinary approach have been instrumental to the development of plastic surgery as a specialty. The Great War experience of maxillofacial surgery was for some surgeons in Europe a reason to dedicate their lives solely towards plastic surgery. A prominent Dutch surgeon in this field was J.F.S. Esser. With his systematic study and clinical application of arterial flaps in plastic surgery he proved to be far ahead of his time. Plastic surgery as such was established in the Netherlands after World War II in 1950 by the triumvirate Koch, Raadsveld and Honig. In the beginning, plastic surgery was strongly British influenced, while now, 50 years later, European cooperation on harmonization of the training in plastic surgery of a good quality is in progress.

[Microsurgery, a 'small' surgical revolution in the medical history of the 20th century]. / Microchirurgie, de 'kleine' chirurgische revolutie uit de medische geschiedenis van de afgelopen eeuw.

Microsurgery in the twentieth century enabled surgeons to operate on very fine structures, which was impossible before the advent of the microscope. Since 1860 loupe magnification was employed in rare cases. In 1921 Nylén from Sweden transformed an ordinary laboratory microscope into an operation microscope for ear interventions. The eye specialists were the second group of doctors who employed the microscope in the operating theatre during the years 40-50 of this century. Since 1953 Zeiss in Germany has produced highly professional operation microscopes. In the sixties experimental laboratory studies were taken up to develop microsurgical techniques, microinstruments and suture material. Both plastic and reconstructive surgeons and neurosurgeons continued to develop microsurgery and indeed transformed their disciplines a great deal. Microsurgery is here to stay and still experiments are going on with video-assisted systems in order to further miniaturize the instruments for magnification and to gain a more comfortable working position for the surgeon.

Digital surgery revisited. On the origin of digital transfer in reconstructive surgery.

A scarred donor site has been of secondary concern in reconstructive surgery, being the price one had to pay for the repair of a defect. In the 19th century reconstruction at the sacrifice of a little finger was contemplated and applied to difficult nasal repairs. The loss of a finger was sometimes preferred thus avoiding additional scars on the forehead and cheek. This so called 'Russian method' is of British origin, described in 1875 by James Hardie of Manchester.

Randomized trial comparing cryopreserved cultured epidermal allografts with tulle-gras in the treatment of split-thickness skin graft donor sites.

Cultured epidermal allografts have been successfully used to treat a wide variety of skin defects ranging from burns to leg ulcers. Their postulated mechanism of action is through release of multiple cytokines that stimulate epithelialization from the wound periphery as well as from remnant epidermal appendages. A randomized, controlled clinical trial was undertaken to compare the efficacy of cryopreserved cultured allograft dressings (CCAD) with tulle-gras dressings in the treatment of split-skin graft donor sites. Five patients were enrolled in the study and in each patient, half of the donor site was allografted and the other half was treated with tulle-gras control. The mean time to complete healing was 6.2 days for CCAD compared with 9.6 days (p = 0.035) for the tulle-gras controls. Patient assessment of pain with dressing changes was also significantly lower at the CCAD-treated sites than at the control sites (p = 0.001). The results indicate that cultured allografts offer greater patient comfort and earlier maturation of regenerated skin.

The significance of Eiselsberg and the Viennese school of surgery for the development of reconstructive surgery in Europe.

The development of surgery in the second half of the nineteenth century was strongly influenced by the introduction of anaesthesia, asepsis and, last but not least, scientific experimentation. Outstanding in the last respect were the German surgeon Theodor Billroth and his pupils in Vienna. One of them, Anton Freiherr von Eiselsberg, became the spiritual father of the largest surgical school ever founded in Europe. He showed a special interest in plastic surgery. As Eiselsberg started his professorial career in Holland at the University of Utrecht, his relationship to Dutch surgical history has particular significance.

[Esser (1877-1946) and the dawn of maxillofacial prosthetics in The Netherlands]. / Maxillofaciale prothetiek. Esser (1877-1946) en het begin van de maxillofaciale prothetiek in Nederland.

A short historical review is presented of the development from simple facial plates towards complex maxillofacial prostheses. There was an impetuous demand for extended development of this type of prostheses during World War I. The Dutch plastic surgeon Esser developed the skin-graft-inlay technique facilitating in a relative easy way extensive maxillofacial reconstructions. The technique was published in English and German and was soon used by surgeons on both sides. The combined training of Esser in medicine and dentistry was advantageous for the development of the technique.

1891-1991: the centenary of innovative reconstructive hand surgery by Carl Nicoladoni.

Austrian surgeons, trained at the famous surgical school in Vienna, played a very important role in general and reconstructive surgery at the end of the 19th century. Nicoladoni introduced original ideas in reconstructive hand surgery, including a tubed pedicle flap and, later, a toe-to-hand transfer to replace amputated parts of a thumb.

Digits in the mouth; a peculiar chapter in cleft lip and palate surgery.

In 1901 von Eiselsberg reported closing a fistula of the hard palate using the patient's little finger. The case is reviewed here and set in the context of its time.

A brief history of the development of plastic surgery in The Netherlands East-Indies from World War I until the independence of Indonesia (1914-1950).

This study of surgical operations published in the Medical Journal of the Netherlands East-Indies over the period 1914-1950, supplemented with a series of interviews with retired Dutch East-Indian surgeons and their relatives, shows a vivid interest in plastic surgery from World War I until the independence of Indonesia. One can conclude that plastic surgery was performed more frequently and on a larger scale than in Holland, due to a larger number of patients, specific tropical pathology and often a longer patient delay, requiring extensive reconstructive procedures. The East-Indian publications on plastic surgical topics outnumber the Dutch ones enormously.

Mr. Job van Meekeren (1611-1666) and surgery of the hand.

Job van Meekeren of Amsterdam was a surgeon, respected by outstanding contemporary medical doctors for his knowledge of medical literature and his skills, who made a definite link between anatomy and surgery. He showed a great interest in hand surgery, and interesting is a demonstration of flexor tendon repairs on corpses by one of his pupils. It is still a great joy to read his book today, which also gives a good representation of the state of the art of surgery in the seventeenth century in Amsterdam (Fig. 11). Names and addresses of patients are fully mentioned, so even today we know exactly where they lived and where the events took place. On the other hand, we also know quite well what the surgeons and doctors looked like through the efforts of many excellent painters who depicted anatomy lessons. In Amsterdam, barber-surgeons' guilds were very eager to sit for group paintings, centered around the teaching medical doctor (Table I). The painter Aert Pietersz in 1603 painted Dr. Sebastiaan Egberts surrounded by 29 surgeons, and in 1619, Dr. Egberts was painted once more, this time with five learning surgeons, by Thomas de Keyzer. Nicolaes Eliasz, named Pickenoy, painted Dr. Johan Fonteyn in 1625, and Rembrandt is well known for the Anatomy Lesson of Dr. Tulp (1632) and Dr. Deyman (1656). It is peculiar that a portrait of van Meekeren could not be traced.