stimulus to plastic surgery; many of his methods have not been improved upon and are still constantly used. He advocated the granulating flap in the Italian method of rhinoplasty and advised strongly against the use of the fresh flap suggested by Graefe.
A number of names may be mentioned in connection with the development of plastic surgery, among them being those of Dupuytren, Ricard, Velpeau, Labat, Blandin, Denonvilliers, Hoffacher, Schuh, Zeiss, Burggraeve, Serre, Liston, Verhaeghe, Jobert, von Ammon, Fergusson, Ph.-J. Roux, Denucé, Langenbeck, Gurdon Buck, Verneuil, Czerny, Pollock, König, Tiffany, Gerster, Nélaton, J. S. Stone, Finney, J. B. Roberts, Lexer, and many others.
J. Mason Warren of Boston was probably the first to introduce the successful application of plastic surgery in the United States. T. D. Mütter and Joseph Pancoast of Philadelphia were also pioneers in this work. To these three men is due the credit of introducing plastic methods into American surgery.
Szymanowski, a Russian, in 1867, in his Manual of Operative Surgery, collected the various operative procedures for the relief of deformities requiring plastic surgery and attempted to classify them. The portion of the book devoted to plastic surgery has yet to be surpassed.
The use of the pedunculated flap of skin and subcutaneous fat, based on the Indian or the Italian method, applied to the fresh or granulating wound, gradually became more common. Especially for the relief of contractures and in locations exposed to pressure and friction.
The transplantation of a pedunculated flap by successive migration was probably first employed by Ph.-J. Roux in supplying lost portions of the cheeks; the flap was taken from the thigh of the patient (Pancoast).
Blandin reported a case in which a part of the upper lip and a part of the cheek and ala of the nose had been destroyed. He raised a flap from the lower lip, attached it to the upper lip and then transferred it successfully to the cheek and nose.
The first report of the use of a pedunculated flap from adjacent tissue by an American surgeon, is that of J. Mason Warren of Boston in 1837. He was successful in constructing a nose by the Indian method with a pedunculated flap from the forehead. T. D. Mutter of Philadelphia, in 1842, reported three cases in which he successfully shifted large pedunculated flaps of skin and subcutaneous fat from the shoulder
