The Legacy of Vilray Blair

Vilray P. Blair, MD — the first division chief of plastic and reconstructive surgery at Washington University School of Medicine — played a prominent role in the development of plastic surgery as a surgical subspecialty in the United States.

Born in 1871, Blair earned his medical degree and began surgical training before the turn of the century — at a time when only a few U.S. surgeons incorporated any “plastic surgery-like” procedures into their practices. During his career, he excelled in many areas that helped set the course for plastic surgery in the 20th Century and is recognized by many as the premier American pioneer in plastic surgery.

Early career

After receiving his medical degree, Blair served a two-year surgical preceptorship at Mullanphy Hospital in St. Louis. During this time, he developed an interest in anatomy and was appointed an anatomy instructor at Washington University. Blair served in this role until 1897, when he left for England to study surgery of the head, neck and oral cavity at St. Bartholomew’s Hospital. When the trip depleted his savings, he was forced to turn to other employment — first in small clinics and then as a surgeon for the African Royal Mail Steam Ship Company of London. Later, he served as a troop surgeon for the British Army in the Ashanti War.

In 1902, Blair returned to Washington University as an associate professor of surgery and anatomy. There, he continued to study reconstruction of the head and neck, and in 1912, he wrote "Surgery and Diseases of the Mouth and Jaws," the first definitive publication on the treatment of oral and maxillofacial diseases in the United States.

In these early years on the faculty, he also saw the medical department of Washington University develop into a modern medical school. In 1909, under the leadership of philanthropist Robert Brookings, this transformation began with the introduction of full-time faculty, the building of an adequate endowment and the use of modern laboratories and associated teaching hospitals (Washington University School of Medicine and Barnes Hospital became partners in 1911).

Wartime experience

Blair_WWIVilray Blair in uniform during World War I.When the United States entered World War I, Blair was chosen to lead physicians in the treatment of craniofacial injuries caused by trench warfare. As commander of the U.S. Army Corps of head and neck surgeons, Blair worked with assistant Robert Ivy to set up teams of surgeons and dentists to treat complex jaw injuries using Blair’s 1912 book as the standard operating manual.

Blair also traveled to other parts of Europe where he learned new concepts from surgeons such as Harold Gillies and Kelsy Fry. When Blair returned to the United States after the war, he formed one of the largest U.S. multidisciplinary teams for the care of complex maxillofacial injuries at Walter Reed Hospital. For these efforts, he was known as a leader in posttraumatic reconstruction.

Outstanding clinical achievements

Blair in ORVilray Blair in the operating room.Blair contributed many outstanding clinical advances. Although other surgeons had performed reconstructive operations using the delay phenomenon, Blair first defined the “delay” process in a 1921 article entitled “Reconstructive Surgery of the Face.” The following year, his paper on “Reconstructive Surgery of the Face,” based on his war experience, set the standard for craniofacial reconstruction.

In 1929, Blair joined with James Barrett Brown, MD, to report the first cleft lip repair that could be reproduced accurately. This article was the first to provide accurate details on measurements needed to perform cleft lip repairs. That same year, Blair and Brown developed a split-thickness skin drafting technique that is still being used. Blair also created a surgical tool for treatment of burn victims and had expertise in many other facets of plastic and reconstructive surgery.

Blair OR ArtworkBlair operating room was painted by Gisella Loeffel.Yet Blair’s efforts in developing plastic surgery as a specialty may have been even more important than his clinical contributions. Blair was one of the two first non-oral surgeons elected to the American Association of Oral and Plastic Surgery, providing impetus for renaming the organization the American Association of Plastic Surgeons (AAPS). At an AAPS meeting in 1937, Blair laid the foundation for the American Board of Plastic Surgery (ABPS), which oversees residency training and faculty qualifications. Originally a subsidiary of the American Board of Surgery, the ABPS received independent specialty board status in 1941.

Blair’s Successors

Blair served as chief of the Division of Plastic and Reconstructive Surgery at Washington University from 1925 until 1955, the year he died. Brown — one of his brightest pupils, who later became a collaborator — succeeded him. Since then, many talented surgical successors to Blair at Washington University have led in the development of new training concepts and ideals and gone on to become international leaders in the field of plastic surgery.

Sources: “Vilray Blair, His Surgical Descendants and Their Roles in Plastic Surgical Development” (June 1999) and “The Plastic Surgeon of the 20th Century (April 1, 2001),” both in Plastic and Reconstructive Surgery.