HX19 Anticipating modern practice: a comparative study of Johannes Esser’s reconstructive principles and contemporary skin surgery

Abstract

Johannes Esser (1877–1946) was a Dutch surgeon and pioneer of reconstructive surgery whose work during and after World War I contributed substantially to the evolution of modern facial reconstruction. Despite his influence, his contributions remain underexamined within dermatological historiography. Through extensive wartime experience, Esser developed systematic approaches that improved both functional and aesthetic outcomes, many of which remain relevant to contemporary skin surgery. This study aims to evaluate the extent to which Esser’s reconstructive principles align with, anticipate and inform modern dermatological and Mohs surgical practice. Primary source material relating to Esser’s work was systematically reviewed, including published monographs, peer-reviewed articles and archived surgical case reports from the early twentieth century. Key reconstructive principles were extracted, including flap vascularity, tissue selection, tension management, scar placement and graft fixation techniques. These principles were compared with current skin surgery practice using current clinical guidelines and review literature relating to facial reconstruction and Mohs surgery. A thematic analysis was performed to identify areas of convergence and divergence. Comparative analysis demonstrated strong concordance between Esser’s reconstructive principles and current dermatological surgery practice. Key similarities included intentional vascular planning, preference for like-for-like local tissue replacement, layered closure with appropriate tension distribution, strategic scar concealment and techniques for graft immobilization. His description of the bilobed flap and emphasis on perforator-based reconstruction remain highly relevant in modern practice. Differences were primarily attributable to technological and experiential advances, including modified flap design, advanced vascular imaging and the use of synthetic wound support materials. This study demonstrates that the foundations of modern skin surgery originate in Esser’s early reconstructive work. His emphasis on vascular reliability, aesthetic unit preservation and meticulous planning closely parallels current standards. Recognition of these historical origins provides important context for current practice and highlights the enduring relevance of Esser’s contributions to dermatological surgery.