Fig. 3 Acland’ s Video Atlas of Anatomy and The Acland Microvascular Clamp and fine suture used in anastomosing a 1-mm. vessel.
Fig. 2: Bob Acland, Bette Levy, the rustic cabin, outhouse and bridge.
Bob’ s rebellious personality emerged at times along his educational pathway, where he“ specialized in breaking the rules”( his own description). He graduated from the London Hospital Medical College in 1964, with an MBBS from London University in 1969. After internships in the UK and in Tanzania, he entered a plastic surgery residency in Glasgow, Scotland, which had then achieved world leadership in studies of flap tissue transfers. There, Acland pioneered the transition from conventional local flap transfers on intact blood vessels to free tissue transfer by microvascular anastomoses to vessels at remote sites of the body. These new techniques of microvascular anastomoses would need substantial refinement to achieve reliability, and Bob’ s enduring engagement with this frontier technology began.
In Louisville, Dr. Harold Kleinert and Dr. Joseph Kutz had similar interests, and they invited Bob and his wife, Dr. Sarah Acland, to immigrate and bring his interests, microfabrication skills and teaching talent. Bob set up the microsurgery laboratory in the Division of Plastic Surgery at the University of Louisville. His teaching protocol and the many discoveries generated in the lab contributed greatly to the academic leadership of U of L Plastic Surgery and the Kleinert-Kutz Hand Care Center, which both built international reputations that resonate to this day. Using Acland’ s teaching methods, the lab is currently managed by Dr. Gustavo Perez-Abadia, and it continues to serve University Plastic Surgery, the Kleinert-Kutz Hand Fellowship and other students of microsurgery. Although reduplicated, no finer microvascular teaching program has emerged in any other world facility.
Standout contributions from Acland’ s early work include the Acland Microvascular Clamp( Fig. 3), an ingenious device for occluding and stabilizing tiny arteries and veins so they could be sewn into receiving vessels. Also, he engineered an unprecedented tiny needle and attached nylon thread for substantially enhanced microsuturing reliability. As a demonstration, the needle and 10-0 thread can be passed through the center of a human hair.
In the early 1980s, a door opened that would serve many and profoundly change Acland’ s career. Dr. Harold Kleinert was looking for unembalmed upper extremities to best teach his fellows hand anatomy; I was looking for fresh cadaver tissues to identify new flap transfers based on muscle and skin units; and Bob was looking for sources of new microvascular flaps. A retired surgeon and passionate anatomist, Dr. Herbert Wald, asked each of us to contribute $ 1000 from our research funds to construct a large, walk-in refrigerator to preserve unembalmed anatomic specimens essential for our interest. Thus, the U of L Fresh Tissue Laboratory was born. Although immediately serviceable, it initially resembled a dungeon cell deep in the basement of a U of L medical instructional building. However, upon Dr. Wald’ s full retirement, Dr. Acland assumed the directorship and energetically pursued support for substantial expansion and improvements. His relentless efforts created a spectacular facility, which is now directed by the U of L anatomist, Nicole Herring, Ph. D. Like the microvascular laboratory, the Fresh Tissue Lab has been a model for reduplication elsewhere. However, neither facility has been surpassed and they remain treasures for teaching and research at U of L.
For Dr. Kleinert and his associates, the facility gave hundreds of hand fellows greatly enhanced anatomic knowledge. The facility also provided me with research opportunities that resulted in over 60 medical publications on new flaps, a priceless gift for beginning an academic career. For Acland, however, the facility ultimately changed his entire career, as he became inspired to pursue a transition from microvascular surgery to new vistas in anatomic instruction.
As Acland became progressively engaged in anatomic studies, he conceived of a teaching breakthrough that would reach far beyond the conventional pictures and drawings in books, and beyond dissections of tissues embalmed to extreme and unnatural rigidity. He embarked upon producing a video-taped anatomic atlas that would present human anatomy in much improved dimensional perspective, with the realistic appearance of tissues and structures capable of natural motion appropriate to show function. He pursued this goal with the same intense focus as in his previous microsurgical projects, and he produced an elegant, 7-volume video atlas( now converted to DVD), which he considered to be his“ Sistine Chapel”. It has become an acclaimed anatomic teaching tool in over 200 institutions worldwide.
The historic conjunction of a unique person in a place of great opportunity at a most favorable time generated enormous contributions to the fields Acland embraced and enhanced. Bob Acland left indelible memories among his friends, colleagues and students, and his efforts created enduring legacies in microsurgery and anatomic teaching that will serve many generations.
- Gordon Tobin, MD
MAY 2016 15