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Mar/Apr 2012

In Memoriam: D. Ralph Millard Jr, MD

Arch Facial Plast Surg. 2012;14(2):142. doi:10.1001/archfacial.2011.1557

The year 2011 saw several advances in the field of reconstructive surgery, but as we recognize the growth of our field, it is fitting to reflect on the life of D. Ralph Millard Jr, MD, who died on June 19, 2011, at the age of 92. The surgical innovator, pioneer, and teacher enjoyed a career that spanned over 50 years. His impact extended to reconstructive surgeons across specialties, and his teachings are drawn on regularly by facial plastic surgeons.

Dr Millard was born in St Louis, Missouri, but was raised in Asheville, North Carolina. He attended Yale University and was a successful student athlete as a member of the Yale football and boxing teams. One of the elements he believed to be important among resident applicants was participation in athletics at the college level.1 Dr Millard enrolled at Harvard Medical School and then served as a surgical intern at Boston Children's Hospital. He served in the Navy for a year during World War II after his intern year. He then began his general surgery residency at Vanderbilt University in 1946. While Dr Millard was a junior resident, he met Sir Harold Gillies, who was visiting Nashville during a meeting of the American Association of Plastic Surgeons. He secured an invitation to study with Gillies, arriving in London in 1948. Gillies had developed many techniques for reconstruction of posttraumatic head and neck deformities incurred by soldiers in the 2 World Wars and was able to provide Dr Millard with exposure to a wide range of challenging reconstructive problems.2 Gillies's clinic drew students and physicians from the United States and throughout Europe, many of whom Millard met, and some later became valuable colleagues. Among the surgeons Millard met during his time with Gillies were Wardil, Aufricht, Kilner, Veau, and Mustardé.1

D. Ralph Millard Jr, MD (photograph copyright 2009 by University of Miami Leonard M. Miller School of Medicine, reproduced here with permission, all rights reserved)

Dr Millard returned to the United States and completed his residency training. He accepted an assignment from Dr Michael DeBakey at the University of Texas in Houston to develop the plastic surgery division there, a position that lasted for 1 year. He returned to London to work with Gillies to publish a plastic surgery textbook that was a collection of the cases from Gillies's long career. At the end of this writing experience, he was called to serve in Korea in the Marines. He began a plastic surgery service in a MASH unit that allowed him to operate on both wounded soldiers and local villagers. He believed that the opportunity to address the untreated congenital anomalies of the local children could serve as a means of international goodwill for the United States. This philosophy seems to have been a guiding principle that drove the extended humanitarian surgical trips in which Dr Millard participated later in his career. It was in Korea that Millard was able to develop the technique for which he is best known—the rotation advancement flap repair of the unilateral cleft lip defect. He was frustrated with the limitations of other surgical answers to the deformity that used straight-line closures that could contract and resulted in an unnatural appearance of cupid's bow. Millard's technique was born from studying life-size photographs of patients, and he first used the procedure on a 10-year-old Korean boy. Dr Millard presented a paper describing the technique at the first International Congress of Plastic Surgery in Stockholm in 1955.3

Dr Millard began a private practice in Miami in 1956 and became affiliated with Jackson Memorial Hospital. Dr Millard was made chief of the plastic surgery service in 1967, a position he held for the next 25 years. Though Dr Millard was most honored for his contributions to cleft surgery, his clinical work included the treatment of burn scars, postablative reconstruction of the head and neck, nasal reconstruction, and a wide range of cosmetic procedures of the face and body. Dr Millard wrote 150 journal articles, numerous book chapters, and 9 books, including The Principles and Art of Plastic Surgery4 with Sir Harold Gillies in 1957 and the landmark 3-volume Cleft Craft5 detailing the history of the cleft surgery.3

Dr Millard's dedication to humanitarian work involved frequent trips abroad, especially to the Caribbean. Among his many honors was the Order of Distinction from Jamaica in appreciation for years of surgery that he performed there and the teaching of surgical colleagues there in techniques he had pioneered. Other honors included honorary fellowship in the Royal College of Surgeons and the formation of the Millard Society.3

Through Dr Millard's teachings, presentations, and writings, he outlined fundamental surgical principles that serve as a legacy for all reconstructive surgeons who aim to understand and manage the reconstructive challenges presented by patients with orofacial clefting and laid a foundation for the approach used in many other head and neck reconstructive techniques.

Millard DR Jr. Saving Faces: A Plastic Surgeon's Remarkable Story. Fort Lauderdale, FL: Write Stuff Enterprises; 2003
Crumley RL. Some pioneers in plastic surgery of the facial region.  Arch Facial Plast Surg. 2003;5(1):9-15PubMedArticle
Lehman JA. Memoriam: D. Ralph Millard, Jr, MD.  Cleft Palate Craniofac J. 2011;48(5):924
Gillies H, Millard DR  Jr. The Principles and Art of Plastic Surgery. Boston, MA: Little Brown; 1957
Millard DR  Jr. Cleft Craft: The Evolution of Its Surgery. Vol 1. Boston, MA: Little Brown; 1976