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OBITUARY
Year : 2021  |  Volume : 8  |  Issue : 2  |  Page : 91-95

In memory and tribute to Kenneth E. Salyer MD: 1936-2020. A great surgeon with a passion for excellence


Division of Plastic Surgery, Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA

Date of Submission12-May-2021
Date of Acceptance12-May-2021
Date of Web Publication7-Jun-2021

Correspondence Address:
Prof. Akira Yamada
Division of Plastic Surgery, Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, 225 E, Chicago Ave, Box 93, Chicago 60611, IL
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jclpca.jclpca_17_21

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How to cite this article:
Yamada A. In memory and tribute to Kenneth E. Salyer MD: 1936-2020. A great surgeon with a passion for excellence. J Cleft Lip Palate Craniofac Anomal 2021;8:91-5

How to cite this URL:
Yamada A. In memory and tribute to Kenneth E. Salyer MD: 1936-2020. A great surgeon with a passion for excellence. J Cleft Lip Palate Craniofac Anomal [serial online] 2021 [cited 2021 Jun 22];8:91-5. Available from: https://www.jclpca.org/text.asp?2021/8/2/91/317781



Dr. Kenneth E Salyer, a world-renowned expert on craniofacial surgery and cleft surgery, passed away on December 30, 2020. Kenneth Everett Salyer was born on August 18, 1936, in Kansas City, Kansas. He was the son of Everett and Laurene Salyer [Figure 1]. He passed away at the age of 84 years. Until the day before he had a massive stroke, he was very energetic as usual, went to the gym, went to World Craniofacial Foundation office, and talked about his vision and future plan. Even after he had a stroke in the morning the next day, Luci pointed out to him that he had a stroke, he told Luci that he did not believe he had a stroke. Because of COVID-19, no one was able to say goodbye to him except for his family.
Figure 1: Portrait of Dr. Kenneth E. Salyer in 1957, at Age 21

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Sudden disconnect from the great mentor for 25 years was something I was not prepared for. He is my mentor, coach for cleft and craniofacial surgery, guided me to become cleft/craniofacial surgeon, and he is my American father. I still cannot get over his death.

One day, 4 months after his passing, I received Dr. Salyer's surgical loupe from Luci, Dr. Salyer's widow. On that night, Dr. Salyer showed up in my dream: We were riding on the boat together, with other people. Blue sky on a sunny day, it was not a huge river, a relatively small river. All I can see was a blue sky, a river, tall river grass, and lots of people on the boat. The boat stopped by the bank, and I was leaving the boat. Before leaving the boat, Dr. Salyer and I hug each other, crying each other. I felt him while hugging him. Then I got off the boat. Then I woke up. This was a farewell to Dr. Salyer.

For >50 years, Dr. Ken Salyer was active in clinical surgery performing thousands of cases on patients with cleft lip and palate, cleft-related orthognathic problems, and the more complex craniofacial deformities. From 1969 to 2006, Dr. Salyer operated on 5770 craniofacial patients and 5479 cleft lip and palate patients. He always sought excellence and would not settle for mediocrity. He was also committed to teaching and research. He published over 200 peer-reviewed articles and book chapters; he authored, co-authored, or edited 11 books. He was a member of over 50 national and international professional organizations and held leadership roles in many of them. He was President of the American Society of Maxillofacial Surgeons, Chair of the Plastic Surgery Research Council, founder/chair of the American Academy of Pediatrics/Plastic Surgery Section, founder/president of the International Society of Craniofacial Surgery, president of the American Craniofacial Society and the Texas Society of Plastic Surgeons. He received many honorary degrees and awards including the Lifetime Achievement Award from the Friends of the National Institutes of Health.

In 1969, Dr. Salyer became the youngest chief of plastic surgery at the University of Texas Southwestern (UTSW) Medical School in Dallas Texas, at the age of 32 years, at a time when modern plastic surgery began to flourish. He was often frustrated, however, to turn away many patients with craniofacial deformity because he felt he could not provide satisfactory results. Dr. Salyer was a perfectionist, and he was still looking for a solution when he was invited to New York University in 1971 to observe Dr. Paul Tessier's 13 h of surgery on a Crouzon's disease patient. Dr. Salyer was electrified by this experience and it changed his life.

When Dr. Salyer hosted the Symposium on Plastic Surgery of the Orbital Region, held in March 1974 in Dallas, giants of plastic surgery such as Drs. Tessier, Joseph Murray, John M. Converse, Milton Edgerton, Donald Wood-smith, and Mutaz Habal attended. While in Dallas, Dr. Tessier scrubbed in on six of Dr. Salyer's craniofacial cases at Children's Medical Center in Dallas. Dr. Salyer later wrote that “the experience was a bit like taking a piano lesson from Beethoven,” and from that moment on he devoted himself more and more to craniofacial surgery.

During that same symposium, Dr. Salyer suggested to a group of young surgeons he met in Paris 2 years before that they form an international craniofacial club, which would allow them to rendezvous at least once a year, present to each other their most challenging cases, their newest techniques, and advances, and solicit help with the problems they couldn't yet solve, as well as enjoy some recreational time together. This was an era that was preemail and preInternet, and the group often called by Dr. Salyer the “band of brothers” included Drs. Linton Whitaker, Fernando Ortiz Monasterio, Ian Munro, Ian Jackson, and Daniel Marchac. This Band of Brothers [Figure 2] opened new territory in infant craniofacial surgery, where Dr. Tessier never ventured, and together with the group ultimately trained more than 250 craniofacial fellows.
Figure 2: Band of Brothers of Craniofacial Surgery: Upper Left to Right; Drs. Fernando Ortiz Monasterio, Ian Jackson, Ian Munro, Daniel Marchac. Bottom Left to Right; Drs. Kenneth Salyer and Linton Whitaker

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In 1978, Dr. Sam Noordhoff, the father of plastic surgery in Taiwan, invited Dr. Salyer to Chang Gung Memorial Hospital in Taipei. Dr. Salyer performed the first craniofacial surgery in Taiwan, including three hypertelorism cases and as a result of that trip, craniofacial surgery in Taiwan was successfully launched. Two residents assisted Dr. Salyer's surgery: Drs. Yu-Ray Chen and Fu-Chan Wei. Dr. Chen later became the first Kenneth Salyer fellow, then emerged as a world-renowned expert in craniofacial surgery. Dr. Fu-Chan Wei became an equally renowned expert in microsurgery, and Chang Gung Hospital became perhaps the center for the education of surgeons from around the world in these disciplines.

After 10 years as chief of plastic surgery at the UTSW Medical School, Dr. Salyer moved to private practice. He convinced several experts to join him, including Drs. Derek Bruce (pediatric neurosurgeon), Kenneth Shapiro (pediatric neurosurgeon), Ian Munro (craniofacial surgeon), Ed Genecov (orthodontist), and Grady Crosland (pediatric anesthesiologist) at Medical City Dallas where together they established a unique, private, multidisciplinary institute dedicated to craniofacial surgery with great administrative support.

Dr. Salyer recognized the importance of imaging in craniofacial surgery. He brought in Mike Lorfing from UTSW Medical School and developed a first-class imaging studio. The “International Craniofacial Institute Cleft Lip and Palate Treatment Center” flourished; his charisma and skill attracted patients from 75 countries worldwide. Medical City Dallas allowed international patients a 50% reduction in hospital charges something virtually impossible to obtain now. To care for even more indigent children with craniofacial deformities, Dr. Salyer established the World Craniofacial Foundation in 1989. Educating the next generation surgeons became Dr. Salyer's secondary passion, and the World CF craniofacial fellowship, begun in 2000, was one of the first ACGME-accredited craniofacial fellowships in the United States. One of the fundamental aims of the World CF was to support the development of new craniofacial centers and improve existing centers, helping throughout the developing world, including centers in India.

I first met Dr. Salyer in 1996, and he was my mentor for the past 25 years. After I completed my plastic surgery residency in 1994, I was looking for a subspecialty I could embrace for the rest of my professional life. However, the only clues I could find were in books, journals, and at meetings. I was very interested in craniofacial surgery, but there was no official craniofacial training in Japan. Then, I happened to read Richard Faltin's symposium summary in the Scandinavian Journal: “Craniomaxillofacial Reconstruction: How to Do It.” (1995, supplement, Scandinavian University Press) In that journal, all-star craniofacial surgeons presented excellent outcomes of many kinds. Among them, I was especially attracted to one who talked about balance and harmony as the keys to excellence. I wanted to become his disciple, but for a new attending surgeon at a university hospital in the countryside of Japan, there was no way I could imagine ever meeting him. Yet in 1996, I became a disciple of Dr. Satoru Nagata, the preeminent microtia surgeon. It seemed like a miracle, but through his introduction, I was able to meet Luci and Dr. Salyer in the Philippines at an International Craniofacial Meeting.

I spent 3 years with Dr. Satoru Nagata from 1997 to 1999. During that period, I spent my entire energy on ear-reconstruction surgery. Then, I began a craniofacial fellowship with Dr. Salyer. I was one of over 25 fellows Dr. Salyer trained. Dr. Salyer told me, “you are meant to be here.” In the operating room, Dr. Salyer initially cut our patient's left side to demonstrate his techniques, and then, he let me cut the right side, carefully watching as I worked. We ultimately performed more than a hundred intracranial procedures together. These were life-changing experiences for me. Dr. Salyer's skill in cranial vault remodeling was beautiful and fascinating. He was often in a “flow state,” as he called it [Figure 3]. Dr. Salyer and I did more than 300 cleft cases together, including primary lip/nose repair, palatoplasty, secondary rhinoplasty, and over 50 cases of orthognathic surgery.
Figure 3: Dr. Salyer was Remodeling Bone for Craniosynostosis Case in 2005

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After Dr. Salyer retired from daily clinical activities in 2006, he devoted his entire energy to his World Craniofacial Foundation and improving craniofacial centers worldwide. Triumph of separation of conjoined twin from Egypt in 2003 made his reputation even higher [Figure 4]. His passion for teaching, demonstrating surgery, and lecturing continued until his death. For the past 15 years, Dr. Salyer and his World CF team, including Drs. Bruce, Raul Barcelo, Diego Steinberg, Joe Michienzi, and I traveled to perform complex intracranial craniofacial cases in countries such as Libya [Figure 5], Egypt, South Africa [Figure 6], Argentina, Mexico, China [Figure 7], Russia [Figure 8], Uganda, Oman, Laos, India, and Colombia.
Figure 4: Dr Salyer and Successfully Separated Conjoined Twin in 2010.

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Figure 5: Dr. Salyer saw the Child with Apert Syndrome at Tripoli Burns Hospital in Tripoli, Libya; 2009

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Figure 6: World Craniofacial Foundation Craniofacial Team at Tygerberg Hospital, Cape Town, South Africa, in 2016: From Left to Right; Drs. Derek Bruce, Akira Yamada, Kenneth Salyer

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Figure 7: Drs. Salyer and Yamada Demonstrated Primary Cleft Lip/Nose Repair at Shanghai 9th Hospital, Shanghai, China; 2010

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Figure 8: Dr. Salyer and His Team with, Dr. Topolnitsky of Moscow State University, Moscow, Russia; in 2016

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Dr. Salyer had a strong relationship with India. He visited India many times for meetings and mission trips to demonstrate his surgical techniques. 'In 2009, Drs. Salyer, Gosain, Arnaud visited India. This site visit was performed to identify means of providing craniofacial care of consistent quality to children with craniofacial anomalies in India and subsequently use this as a model for delivering craniofacial care to children in need throughout the developing world. The sites chosen consisted of (1) the Sri Ramachandra Medical Center, a private hospital in Chennai (southern India); (2) King George Medical College, a state-run government hospital in Lucknow (central India); and (3) the Postgraduate Institute of Medical Education and Research, a federally supported hospital in Chandigarh (Northern India).

Dr. Salyer was also attracted to Indian cultural heritage, including Yoga. Dr. Salyer had severe neck pain from long career of surgery. I taught him several Yoga poses and it tremendously helped to relieve his neck pain. I gave him the Iyengar Yoga textbook. The pose of plow (Halasana) was his favorite pose.

Dr. Salyer was invited to 10th World Cleft Lip, Palate and Craniofacial Anomalies Congress [Figure 9], Chennai, India, in February 2017, organized by late Dr. Jyotsna Murthy and others. In the meeting, Dr. Salyer was happy to meet the famous Yoga guru Sadhguru [Figure 10].
Figure 9: Dr. Salyer Is Giving a Talk at Pre-Conference Live Surgery at Balaji Dental and Craniofacial Hospital, at 10th World Cleft Lip, Palate and Craniofacial Anomalies Congress in Chennai, India; 2017

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Figure 10: Dr. Salyer and Sandhguru in Chennai, India; 2017

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In Cleft 2019, as a president of International Cleft Palate Foundation, he visited Nagoya, Japan [Figure 11]. He was the key figure of cleft meeting as usual. Dr. Salyer gave a presidential lecture and several other talks. Dr. Salyer and I organized a microtia hands-on workshop together. Attendee includes notable surgeons from India such as Drs. Karoon Agrawal, S. M. Balaji [Figure 12].
Figure 11: Drs. Salyer and Yamada at ICPF Congress at Nagoya, Japan; 2019

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Figure 12: Attendees of Microtia Hands-on Workshop at ICPF 2029 at Nagoya, Japan; in 2019

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During the meeting, Dr. Salyer, Luci, and I ate very fresh and delicious sushi that was the last time we ate sushi together.

The last trip Dr. Salyer planned to visit was also India. The virtual planning session was performed for a difficult facial cleft patient with Dr. Salyer and Dr. Balaji of Chennai. Dr. Salyer looked forward to visiting India in April 2021 that did not happen.

Dr. Salyer's passion for excellence influenced surgeons globally.

“Ambition is undoubtedly needed to provide the necessary energy and power to act, fight, and eventually win the fight against deformity. However, humility should always be present as a companion of ambition and success. It is a quality of the true great figures of history to carry humility and keep humble.” (Salyer 2009 Journal of Craniofacial Surgery).

Dr. Salyer had ambition and humility that made him a true great figure in the history of plastic, cleft, and craniofacial surgery.




    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12]



 

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