Melbourne has had an illustrious history in the development of plastic surgery and St Vincent’s Hospital in particular played a major role. In 1899, William “Gerry” Moore, surgeon to St Vincent’s and the Melbourne hospitals wrote a textbook titled “Plastic Surgery”, probably the first time such a book was published in the English language. Moore is also credited with demanding the adoption of Listerian principles of antisepsis at the Melbourne hospital, 50 years after Lister had published his work, and in so doing reduced the death rate from abdominal surgery from 90% to less that 10%. He was a prime force for change in the process of appointment of hospital doctors from the notoriously corrupt public vote to an Electoral College system where university, hospital, and professional colleges were represented.
The horrendous maxillofacial injuries of the 1st world war and the fighter pilot’s burns in the 2nd posed reconstructive challenges never before encountered. Innovative solutions including the tube pedicle were pioneered by the New Zealanders Harold Gillies and Archibald McIndoe in the UK laying the foundations of modern plastic surgery. Benjamin Rank from Melbourne while training with Gillies in London in 1939 was commissioned to establish a military plastic surgery unit in the Middle East to care for the wounded Australians. He was subsequently repatriated to Melbourne to establish Australia’s first plastic surgery unit at the Heidelberg Repatriation Hospital to continue their care. Soon other Nubian units were formed at The Royal Melbourne, St Vincent’s and the Alfred hospitals. The Plastic Surgery unit at St Vincent’s Hospital germinated in the early 1960’s but it’s formal recognition as a specialist department was some years in the making because of the entrenched belief in the hierarchy of General Surgery. Its first head was Richard, “Dick”, Newing and each of the city hospitals participated in the creation of a training program sited on neutral territory at the former Preston and Northcote hospital, the Victorian Plastic Surgery Unit (VPSU).
Dick Newing trained at Mount Vernon in London and enlisted for naval service. He followed the UK plastics/maxillofacial model of appointing a dentist to his unit and his focus was the big picture rather that the detail. The caseload included major head and neck cancer, burns, cleft lip and palate and trauma. Bernard O’Brien had done science before medicine and trained in plastic surgery at Oxford and Salisbury in the UK and with Bill Littler, hand surgeon, in New York. There he was inspired with the work of Harold Buncke who was using the microscope to join small blood vessels and during his return in 1965 he visited Russian plastic surgeons who were pioneering micro-lymphatic surgery. He joined the St Vincent’s unit but faced hurdles with re- appointment. The newly appointed professor of surgery, Dick Bennett, gave him a stepping stone back with a research position and soon Bernard established the Microsurgery Research Centre (subsequently The O’Brien Institute) initially in a disused mortuary to develop the new field of microvascular surgery. Melbourne industry was booming, machinery confusing to non-English speaking migrants and industrial safety was in its infancy. Amputations and major wounds from industrial and car accidents were the grist for advancing the techniques and skills of microsurgery. A Fellowship training program was established that attracted young talented plastic surgeons from every corner of the globe. Melbourne was internationally recognized for microsurgery and O’Brien was a household name through his extensive research and clinical publications, overseas presentations and books. He was to become Victorian of the year, CBE, and presidents of the International Federation of Societies for Surgery of the Hand and the International Society of Reconstructive Microsurgery (WSRM) amongst other innumerable accolades.
In 1972 Alan MacLeod joined the unit after training at the Shriner’s Burns Institute in Boston sponsored by a Fullbright scholarship and in the UK at St George‘s and the Royal Marsden hospitals specializing in head and neck cancer surgery. Wayne Morrison was recruited in 1976 after training in Glasgow (Canniesburn), Paris in hand surgery (Tubiana) and in Miami (Millard). In 1977 David Jenner after completing a broad plastic training program in Norwich consolidated the unit as the 5th appointee. The unit prospered especially as it was at the forefront of international microsurgery but its growth was limited by hospital finances which restricted further appointment security. Julian Pribaz, a St Vincent’s graduate, was brought into the team but within 5 years with concerns of insecure tenure was lured to Harvard where he subsequently became one of the most distinguished surgeons of his time. The next plastic appointments would not be for more than 10 years.
Benjamin Rank had established Hand Surgery well within the province of plastic surgeons but it was clear that the skills of the orthopaedic trained surgeons would be essential for its further development especially as the mysteries of carpal mechanics and their role in the understanding of wrist injuries began to be elucidated. Indeed the wrist was to become the preoccupation of the specialty for the next decade. At the forefront of this field were Damien Ireland and Tony Berger who had trained at the Mayo and Louisville respectively. They were encouraged to break rank with their orthopaedic colleagues where there was little support for hand surgery and join the St Vincent‘s Plastic/Hand Unit. Damien took the initiative of establishing the Victorian Hand Surgery Associates (VHSA), a private hand surgery clinic comprising plastic and orthopaedic derived specialists collocated with the St Vincent’s unit. It has a combined Fellowship program and the unit is now preeminent in Australia under the leadership of Tony Berger. Subsequent orthopaedic trained members include Stephen Tham and James Thomas. Ireland, Berger along with O’Brien and Morrison were all to become Presidents of the Australian Hand Surgery Society.
Ironically despite his fame and leadership O’Brien was never appointed head of unit nor given academic title and on Dick Newing’s retirement Alan MacLeod became head of unit. Through his unparalleled charisma and influence a strongly bonded next generation of plastic surgeons were eventually appointed to St Vincent’s. They included the talented Jamie Burt (Houston trained), Tim Bennett (Leeds), and Tony Penington (Oxford) who brought new ideas from internationally recognized centres. David McCombe (Leeds) soon followed. They had strong academic credentials most having completed post graduate degrees through the O’Brien Institute. Tham and Thomas had also followed this pathway. Zohreh MacLeod and George Dimitroulis formed the maxillofacial branch of the team. In 1991 Morrison was appointed Professor of Surgery at St Vincent’s succeeding Dick Bennett. He also became Director of the O’Brien Institute on Bernard’s retirement and Head of Plastic Unit in 1999. In 2001 he was awarded an AM and became President of the World Society of Microsurgery (WSRM). The Institute also flourished ably supported by Tony Penington as deputy director, with a greater academic focus centred on Tissue Engineering and it attracted scientists, as well as national and international fellows, many undertaking post graduate degrees. Major competitive grant funding and Foundation support has been continuous throughout and at its peak the institute had almost 70 staff. Notable clinical highlights of the Plastic team during this period included the replantation of a degloved face and scalp, an extremely rare injury, and Australia’s first and only hand transplant which has led to St Vincent’s being recognized as the lead for The Australian Transplant Society’s deliberations on non-vital organ transplants under the direction of Jamie Burt. In 2010 Tony Penington became Head of the Plastics Unit and subsequently was recruited to the newly created Chair of Plastic Surgery at the Royal Children’s Hospital because of his work on vascular malformations. Currently Tim Bennett is the Head of Unit and he has restructured the department into a dedicated team with a focus on targeted subspecialties.
Most recent additions to the St Vincent’s unit include Angela Webb (breast surgery), the first female appointee and currently also Head of Plastic Surgery at Peter McCallum Cancer Institute, Eldon Mah (sarcoma surgery), Damian Grinsell (head and neck), Sophie Ricketts, Matt Lee, Michael Lo, Ed Ek(now Alfred hospital) (general microsurgery), Ramin Shayan (head and neck, lymphoedema), James Finkemeyer, Satomi Koide and Joseph Gunn. Ramin with a strong background in research now directs the O’Brien Institute which has recently amalgamated with the St Vincent’s Institute. His research laboratory is investigating the molecular mechanisms involved in the development of lymphoedema. St Vincent’s plastic/hand/maxillofacial unit currently has 2 accredited plastic and one maxillofacial trainees, 1 unaccredited registrar, 1 plastics fellow, 2 hand fellows and 3 residents.