Francis C. Usher, herniologist of the twentieth century

Summary

1999 is a fit time to belatedly recognize Francis Usher, who epitomizes the best of 20th Century herniology. This pioneer, in the '50s, had fabricated and developed Marlex mesh, an infection-proof prosthesis which today is the most widely used worldwide. Despite academic disdain, he made a number of technical advances, many of which were later credited to others. Thus, he replaced overlay reinforcement of sutured repairs with inlay tension-free bridging of hernial defects. In the groin, he introduced anterior preperitoneal prosthetic replacement of the transversalis fascial floor of the inguinal canal. His unsplit groin prostheses provided lateral, sutured, preperitoneal parietalization of the spermatic cord, thereby maintaining obliquity of the internal ring. Selvage techniques may, in the future, be used to prevent “buttonholing” after closure of laparotomies in those known to be at risk for incisional herniation. More than any other he, at long last, should receive the credit he deserved for his primary role in the greatest advance in herniology this century — control of recurrence after herniorrhaphy.