Plastic Surgery has evolved into various subspecialities in the past six decades, thanks to the challenges posed by patients with different clinical problems. From what was conceived as a pure resurfacing specialty in the last century and before, the evolution has been slow but definite, thanks to the effort of innovative surgeons, who perfected the techniques over the years.
The availability of magnification for reconnecting small blood vessels was one of the many revolutions in 1950s and 1960s, brought about by many pioneering surgeons, one among them being Julius Jacobson, whom I was fortunate to meet in person in New York. This technique was perfected through repeated trials and technique and finer instruments and sutures.
Many responded to this call, among them Robert Acland ([Fig. 1]) and a galaxy of surgeons around the world: USA, China, Japan, Australia, and Europe. Marko Godina belonged to this era.
Fig. 1 Robert Acland, Marko and Abraham Thomas.
Born in the erstwhile Yugoslavia and trained in Zagreb in medical studies, he went for further training in Plastic Surgery in the UK and the USA, before returning to Yugoslavia, his motherland.
It was his stint in Canniesburn Hospital in the UK which drew him close to Robert Acland and later in the USA when he trained in the Hand Surgery Associate Group with Kleinert, Kutz, Lister, and others.
Those who knew Marko well realized his potential as a surgeon, thinker, and an innovator. Having returned to Yugoslavia, he got attached to the Klinical Center in Ljublijana, one of the largest hospitals in Slovenia.
His innovative spirit made him:
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Anastomose vessels of all dimensions
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Perfect the technique of suturing, with least trauma
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Perfect the needle and sutures with the companies
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Perfect the technique of working without too many assistants, considering the field of vision under the microscope
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Think and improve survival of limb/digits, often heavily contaminated, by early surgery
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Perfect the thought process of attaching a blood vessel to the side of a feeding vessel without sacrificing it so that the distal tissue does not suffer
(I still remember him telling me often that a hole/tear in the side of the vessel bleeds longer than at the end of the vessel.)
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To him also we must credit: atraumatic clamp and better tissue respectability
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The role of tunica media in vessel anastomoses
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The use of grafts in small vessel and
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The innovation of coupling devices then being evolved.
In addition to all this, there was the will to work hard, longer, and never to lose heart when difficulties arose. The salvage of tissues at all costs was important to him in order to better functional results.
In spite of a busy work schedule, research and education never lost its significance. He taught, lectured at meetings, traveled far and wide to explain what he did and to learn from others—yet he never criticized his colleagues. This aspect of his character endeared him to many across the world.
Marko Godina ([Fig 2]) spent some time Kuwait in to improve his financial needs. It was at this time that he met R.N. Bindra who was one of my senior professors on sabbatical in Kuwait. R.N. Bindra asked me to write to Marko and Zdravic, the Head of the Department, when he learnt the a microsurgery fellowship program was being planned. This was especially needed where I was working in Ludhiana, Punjab, with a large volume of accidents and amputations.
Fig. 2 Marko Godina.
I was fortunate to get the privilege of being selected as the first Fellow of Marko Godina in 1983 ([Fig 1]). I went over to Yugoslavia from Louisville, USA, where I had gone to the Hand Surgery Associates. I was in my early 30s and Marko was a decade older in his 40s. I found him to be a friend, a guardian, and a teacher. He made all the arrangements to make me comfortable in Ljubljana.
The main workhorse for free flaps was latissimus dorsi, often tailored by Marko without taking too much of muscle bulk. Other donor sites/flaps included groin flap, scapular flap, dorsalis pedis, and lateral arm flaps ([Fig. 3A, B]).
Fig. 3 (A). Crush injury—index finger. (B) Lateral arm flap.
Marko had visitors too, of whom an important one was Robert Acland, who was working along with S& T to help improve their sutures and instrumentation in Microsurgery. It was at this time Marko popularized the “double hook” to retract the tissue and facilitate anastomosis without having your assistants hold the retractor to do so. It was also common to use “Gentamycin beads,” after adequate debridement, in the wound to control infection.
Marko was very friendly with orthopaedics colleagues and also the neurosurgeons. Each day there were at least two free flaps and very often replants of fingers, hand, and arm.
I was attached to other senior plastic surgeons also during the day time, but 4 days were exclusively with Marko. The evening and till late night were spent in the laboratory on live mice models where Marko had taken on project on the use of Gortex grafts in vessels smaller than 1 mm in size. I remember working on over 30 mice during that period, having been trained by Marko, to anaesthetize the mice, expose the vessels, and complete the suturing.
The free flap days were heavy—on average around two a day—and often had emergency free flaps too. The time spent in the operation theater him was never boring as it was continuous work and later lunch at the nearby pub!
He took me to the mountains and showed me how to “ski.”
What struck me most was that he was loved by all, men, women, and children. I also had time to meet his lovely family.
His colleagues often took me out to see ice hockey and other sports in the city, a wonderful time in Yugoslavia/Slovenia.
My wife Rebecca joined me toward the end of my stay and Marko was keen that I showed her their beautiful country, Yugoslavia.
Marko wrote a note to the company, Springler and Tritt, to help me out with the instruments and they duly obliged. The parting gift from Marko was a lovely book on Yugoslavia/Slovenia and Marko wrote in it “to remind you the beautiful side of our country, other than free flaps and replantations!!.” Never did I realize that was a farewell forever.
Marko passed away in 1986 at the age of 43 after an unfortunate car accident. It was a great shock for many of us across the world and more for me for he made me realize my dream.
May his work, love for surgery and people live forever.
