As March is the birthday month of Dr. Thomas Dent Mütter, founder of The Mütter Museum, it is an opportune time to highlight the revolutionary surgical technique Mütter pioneered in 1841, called the Mütter Flap, which surgeons still used today.
At the time of Mütter’s birth in 1811, fashion and modesty put women at an alarming risk of their clothing catching fire. Light-weight, highly flammable fabrics such as bobbinet or tulle became prominent by the early 19th century. As fashion trends evolved, crinoline rose to prominence in the 1850s, and the risk of burn accidents continued to escalate. Art historian Alison Matthews David reports that in 1860, the British medical journal The Lancet “recorded more than 3,000 deaths annually from fire, many of them because of clothing ignition.” In addition to the popular fabrics of the 1800s, wearing numerous layers of clothing was typical at the time. Layers were frequently secured in place with ties, which severely restricted movement and made them difficult and time-consuming to remove. These delicate materials and constrictive layers, combined with the proximity to open flames, created a deadly risk.
Fire was a part of daily life in the 19th century. Buildings were lit by candles and gaslight, heated by fireplaces, and cooking was done over an open hearth. Doctors in the early 1800s warned that “a young woman, whose style of clothing puts her at greater exposure to this accident, without thinking of the dangers that surround her, negligently approaches a fireplace, and in one instant finds herself in a general conflagration.” These clothing fires grew quickly and were very difficult to extinguish. Women could easily become trapped in flames, unable to remove their many layers of clothing. Often, their necks and faces would become severely burned, leaving those who survived with scar tissue and contractures. This scarring could permanently pull open burn survivors’ mouths and eyes as well as prevent them from turning their heads. In her biography of Dr. Mütter, Dr. Mütter’s Marvels, Cristin O’Keefe Aptowicz writes, “It was said the lucky ones died. The ones who did survive were cursed to live half a life, as monsters.” Beyond the physical pain, many faced societal stigma and isolation due to their scarring.
Driven by compassion for people shunned by society, Mütter became a pioneer of surgery to help people impacted by these types of tragic accidents. Having studied plastic surgery or “les opérations plastiques” in Paris, he became familiar with the techniques needed to perform successful skin grafts, which at the time were likely to end in infection and rejection. Mütter utilized a new method where he cut, twisted, and moved a patient's tissue to cover their wound while prioritizing maintaining the tissue's attachment to its blood supply. This method significantly improved the chances of success because the skin grafted over the wound maintained an uninterrupted blood supply. Mütter’s first patient was a 28-year-old woman who was severely burned when she was five years old. She had thickened scar tissue that pulled her chin almost completely down to her chest. Despite this scarring on her neck, Mütter observed that her back was completely unburned, ideal for his planned surgery. Encouraged by this, he went forward with his experimental surgery. He successfully cut through the scar tissue at her neck, being careful to avoid critical blood vessels. Next, he cut a piece of skin from her back slightly larger than the open wound on her neck, making sure to keep this skin attached to her back with a thin piece of tissue while moving the rest of this flap to her front. He sutured the flap into place on her neck and bandaged her up. Beyond the revolutionary nature of the surgery, Mütter was also committed to the importance of hygienic post-operative care. Rather than immediately sending her back home to recover, as was the usual practice in 1841, Mütter had his patients stay in hygienic recovery suites where he would monitor their post-operative progress to ensure the wound was clean and healing properly.
The surgery was ultimately a success. The wound healed properly, and the woman regained the ability to close her mouth 23 years after her injury. This was life-changing for her as she stated, “You have set my head at liberty, so that I can turn it any way, at pleasure, and without pain; you have relieved the drawing of my eyes; and I am also enabled to close my mouth with comfort, a blessing that cannot be described!” Mütter carefully documented his results and performed the same groundbreaking surgery on other patients, including a twelve-year-old girl and a nine-year-old boy.
Despite a lack of anesthesia during these early surgeries, Mütter would go on to become the first surgeon in Philadelphia to successfully administer anesthesia in 1846. Not only did Mütter transform the lives of patients who experienced pain, disfigurement, and social isolation for years following severe burns, but he also transformed the practice of medicine.
For more examples of Dr. Mütter’s surgical advancements, please visit our .
Bibliography
- Appel, Cristin O'Keefe. Dr. Mütter's Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine. New York: Gotham Books, 2014.
- David, Alison Matthews. Fashion Victims: The Dangers of Dress Past and Present. London: Bloomsbury Visual Arts, 2015.
- Fashioning the Victorians : A Critical Sourcebook. London: Bloomsbury Publishing USA, 2018. Accessed February 15, 2025. ProQuest Ebook Central.
- Schwartz, Alan Jay, Melissa L. Coleman, and Jane S. Moon. "Thomas Dent Mütter, M.D. (1811 to 1859): Exemplar of Expertise." Anesthesiology 137, no. 6 (December 2022): 666–72.