The January 2016 death of Robert D. Acland, M.B.B.S., F.R.C.S. (Fig. 1), took a colorful, innovative microsurgical pioneer from the international stage. As professor of surgery in plastic surgery at the University of Louisville, Acland contributed greatly to the emerging field of microsurgery over the last quarter of the twentieth century. He developed key instruments, techniques, and teaching methods for more reliably joining vascular structures in the 0.5- to 1-mm-diameter range, and vigorously advocated broader microsurgery applications to reconstructive plastic surgery. Subsequently, he created a second career teaching anatomy by producing a seven-volume video atlas, which added greatly improved clarity and perspective to traditional teaching methods. His microsurgical tool designs and anatomical teaching aids gained international acclaim.
Acland was an exceptionally colorful character. In a surgical department filled with strong personalities, he stood out. Although sometimes viewed as a mad scientist (an image he found amusing and thus promoted), his contributions really came from an intense focus on his projects, with ability to exclude them from all distractions. Thomas Edison’s quote, “Genius is 1% inspiration and 99% perspiration,” applies, as Bob’s creative insights derived from his focused commitment of effort. He possessed an enormous curiosity, which ranged from small technical details of a surgical challenge to the outdoor, natural world. He was impishly irreverent, and always ready to aim a humor-tipped lance toward accepted conventions, errant principles, or pompous personalities. He was fiercely independent, with a proclivity toward the conspiratorial. He exuded infectious enthusiasm, and had a love of antique woodworking tools, old machines, creativity, and the absurd.
Acland’s individualism, distrust of authority, and purposeful informality were likely related to his unique familial background. His ancestry was rooted in British gentry aristocracy,1 similar to that depicted by the popular PBS series, Downton Abbey. Since the seventeenth century, Aclands held high titles and extensive ancestral lands. At peak extent, Aclandshire stretched sea to sea from Bristol Bay to the English Channel and exceeded 45,000 acres. The core estate was Killerton, with a great manor house and several thousand lush acres near Exeter (Fig. 2). Born in 1941, Robert was the second of three sons of Sir Richard Thomas Dyke Acland, the 15th Baronet Acland of Columb John, and his wife, Anne Alford, Lady Acland. Although the setting was aristocratic, with portraits of titled ancestors from over three centuries and paintings by Constable and Reynolds on the walls, a philosophical sea-change engulfed the Aclands as the family entered the twentieth century. In response to a society where 1.5 percent of people annually garnered one-fourth of national income, that era saw the rise of British socialism. Bob’s parents chose leading roles in that movement, which undoubtedly turned aristocratic ancestors and their gentry peers in their graves. Sir Richard became a member of parliament under the Labour banner, and then became a founding member of the far-left British Common Wealth Party, which advocated common ownership rather than private property. Consistent with their principles, Sir Richard and Lady Acland donated the ancestral estate to the National Trust in 1944, one of the largest such donations ever made. With the enormous resources of Killerton lands gone, the Acland sons were informed they would have to make it on their own by being better, not by heredity. Bob’s chosen path to such ends became medicine and plastic surgery.
Currently, Killerton remains beautifully preserved by the National Trust. The large manor house, formal gardens, and beautiful, game-filled countryside vividly represent the peak era of British gentry aristocracy. In sharp contrast, Bob loved informality and simple living, as illustrated by the rustic one-room cabin and outhouse he hand-built on Indiana forest land near Louisville, and which he cherished greatly. There, Bob took great joy in building, clearing land, and creating massive bonfires. In his parents’ footsteps, he has donated his “creekside estate” to the local Nature Conservancy.
Bob’s rebellious personality emerged periodically along his educational pathway, where he “developed great interest in breaking the rules” (his own description). He graduated from the London Hospital Medical College in 1964, with an M.B.B.S. from London University in 1969. After internships in the United Kingdom and in Tanzania, he entered a plastic surgery residency at Canniesburn in Glasgow, Scotland, which had then achieved leadership in flap research, with studies of axial pattern flaps and their circulation.2,3 There, Acland pioneered the transition from the conventional local flap transfers on axial or random circulation, to free tissue transfer distally by microvascular anastomoses. These new microvascular transfers would need substantial technical refinements to achieve reliability, and Bob’s enduring engagement with this frontier began.
In the mid-1970s, Dr. Harold Kleinert and Dr. Joseph Kutz of Louisville, Kentucky, had similar interests, and they invited Bob and his first wife, psychiatrist Sarah Acland, M.D., to immigrate and bring his microfabrication skills and teaching talent. Here, Bob founded the Microsurgery Teaching Laboratory of the University of Louisville Division of Plastic Surgery, where his methodical approach was expressed in a well-known manual and teaching tapes. He then expanded his program by creating the University of Louisville Plastic Surgery Microsurgical Fellowship, which trained a generation of microsurgical leaders, and which performed over 100 clinical reconstructions annually. His teaching protocol, fellowship, and discoveries generated in the laboratory contributed greatly to the academic leadership of University of Louisville Plastic Surgery and the Kleinert-Kutz Hand Care Center, which together built international reputations that resonate to this day. Using Acland’s teaching methods, the laboratory continues to serve University of Louisville Plastic Surgery, the Kleinert-Kutz Hand Fellowship, and other students of microsurgery. Although widely reduplicated, no finer teaching program has subsequently emerged.
Standout contributions from Acland’s early work include the Acland microvascular clamp,4 an ingenious device for occluding and positioning tiny vessels so they can be reliably anastomosed (Fig. 3). Also, he engineered a then unprecedented tiny needle (70 μm) and attached 10-0 nylon thread for substantially enhanced microsuturing reliability.5,6 A favorite demonstration of Bob’s was to pass his suture through the center of a human hair.
In the early 1980s, a door opened that would serve many and profoundly change Acland’s career. Harold Kleinert was looking for unembalmed upper extremities to best teach his fellows natural hand anatomy; I was looking for unembalmed tissues to identify new muscle-skin flaps; and Bob was similarly looking for new microvascular flap donor sites. A retired general surgeon and passionate anatomist, Dr. Herbert Wald, asked us each to contribute to construct a large, walk-in refrigerator for unembalmed cadaver preservation. Thus, the University of Louisville Fresh Tissue Laboratory was born. Although immediately serviceable to us, it resembled a dungeon cell deep in the basement of a University of Louisville medical building. However, on Dr. Wald’s full retirement, Acland assumed directorship and energetically pursued support for substantial expansion and improvements. His relentless efforts created a spectacular facility, which is now named in his honor. For Harold Kleinert and associates, the facility gave dozens of hand fellows greatly enhanced anatomical knowledge, and it provided me with research opportunities resulting in over 60 medical publications on new flaps and refinements, 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 microsurgery to new vistas in anatomical instruction. Like the microsurgery laboratory, the Fresh Tissue Laboratory has been a model for reduplication elsewhere, and they remain treasures for teaching and research at the University of Louisville.
As Acland became progressively engaged in anatomical studies, he conceived of a teaching breakthrough that would reach far beyond conventional textbook drawings and photographs, and beyond dissections of tissues embalmed to unnatural rigidity. He embarked on producing a videotaped anatomical atlas that would present human anatomy with natural tissue appearance and structures capable of normal motion to appropriately show function by using a light embalming technique that he developed. He also created rotary visual techniques to give much improved dimensional perspective. He pursued this goal with the same intense focus as in previous microsurgical projects, and he thus produced an elegant, seven-volume video atlas, which has been converted to DVD and online access7 (Fig. 4). It has become an acclaimed anatomical teaching tool in over 200 institutions worldwide, and Bob considered this work to be his “Sistine Chapel.” Bob continued to apply his innovative visual techniques to specific anatomical projects until contracting cholangiocarcinoma. He is survived by his brother, Henry; first wife, Sarah Acland, M.D., and their children, Beatrice and Daniel; second wife, Susan Bishop, and their children, Emily and Benjamin; and third wife, Bette Levy.
The conjunction of a unique person, at a most favorable time, in a place of great opportunity generated substantial contributions to the surgical and anatomical fields Acland embraced. Bob Acland left indelible memories among his friends, colleagues, and students, and his efforts created enduring legacies in microsurgery and anatomical teaching that will continue to serve generations of physicians and surgeons.