History of Surgery: Bernhard von Langenbeck (1810–1887)

Military surgeon, teacher of subsequent surgical greats, and surgical technique innovator

The Langenbeck name is familiar to all surgeons, even more so to the most junior BTS trainees perhaps. This first article in the BTS Surgical History Series will highlight a few of his innovations that remain relevant today. In overview, he was a well-regarded German military surgeon who served as a field surgeon in four major wars, pioneered a rumoured 21 novel surgical techniques, at least two of which are widely used today, and developed a legacy through his writings and journal contributions, and through his pupils, surgical greats in their own rights whose names you may also recognise.

Career 

Born in 1810 at Padingbüttel on the German coast, he was the son of a clergyman, and nephew of the Göttingen anatomist Konrad Johann Martin Langenbeck¹ (who is himself somewhat famous in anatomy circles I hear). He undertook his PhD thesis on the structure of the retina, spent a year visiting surgical schools in France and England, and returned as Privatdozent (equivalent to maybe a Senior Lecturer in the UK). In 1842 he was appointed Professor of Surgery and Director of the Friedrichs Hospital at Kiel, then in 1848 Director of the Clinical Institute for Surgery and Ophthalmology at the Charité in Berlin. He then served in a number of conflicts and returned to his post in Charité, Berlin afterwards, until his retirement in 1882.¹

Military service

Like many other surgical titans (Mattox for example) Langenbeck was a prominent military field surgeon. He served in four conflicts: the First Schleswig War of 1848, the Second Schleswig War of 1864, the Austro-Prussian War of 1866, and the Franco-Prussian War of 1870–71.¹,² For his service in the Schleswig wars he was ennobled in 1864, acquiring the von prefix to his surname. The campaigns also cost him his only son.²

He published his observations from the Franco-Prussian War in 1874 as Chirurgische Beobachtungen aus dem Kriege, in which he set out the technical philosophy that ran through all his operative work: “the choice of method is less important than careful performance of the procedure. The surgeon who performs a subperiosteal resection must avoid the misuse of the periosteal elevator, and thereby prevent tears and bruises which delay healing.”³

Despite his sustained service, his position on the treatment of enemy combatants was notably recorded “a wounded enemy is no longer an enemy but a comrade who needs help,” a sentiment in line with the impartiality principles later codified in the Geneva Conventions.²

Surgical Innovations

Subperiosteal bone resection

This was perhaps his single most influential contribution to trauma surgery. Faced with gunshot injuries that would otherwise have mandated amputation, Langenbeck developed a technique of resecting the affected segment of bone while preserving the periosteum and the subperiosteal layer of medullary cells, allowing new bone to regenerate and the limb to be retained as functional.²,³ The experimental basis had been established by others. Langenbeck himself credited Bernhard Heine of Würzburg with performing the first subperiosteal resections on dogs in 1830–40, the specimens of which were preserved in the Museum of the University of Würzburg.⁴ The physiological principle was developed in France by Léopold Ollier, whose experimental work on periosteal transplantation and bone regeneration was contemporaneous with Langenbeck’s clinical application and explicitly acknowledged by him.⁵ Langenbeck’s contribution was to apply the technique systematically on the battlefield. A contemporary American observer reporting from his Berlin clinic in 1872 described a Prussian officer aged 22 who had been wounded by a Chassepot ball at the Battle of Mars-la-Tour on 16 August 1870, shattering the head and neck of the right humerus. Resection of the head and upper half of the humerus was performed via anterior and posterior straight incisions fourteen days after the battle. The periosteum deposited new osseous tissue and every movement of the limb and joint could be restored.⁶ An English surgeon who accompanied the German army during the campaign of 1870 recorded that Langenbeck performed a large number of such resections during the Franco-Prussian War and noted the markedly decreased mortality where resection could be substituted for amputation.⁴

The Kocher-Langenbeck posterior approach to the hip

Langenbeck also produced what would become one of the standard approaches in modern trauma orthopaedics. This is a workhorse approach still used in almost half of acetabular fractures in modern practice^8,13. Working on infected gunshot wounds of the hip among soldiers during the Schleswig and Franco-Prussian wars, Langenbeck described in 1868 a longitudinal posterior incision for resection of the femoral head, intended as a limb-salvage alternative to disarticulation.⁷,⁸ The technique was refined by his pupil Kocher at Bern in the late nineteenth century and the Kocher-Langenbeck approach to the acetabulum was born.

Von Langenbeck Cleft Palate repair

Drawing on his classic subperiosteal principle, Langenbeck developed a bipedicled mucoperiosteal flap repair of cleft palate (the Uranoplastik), in which the mucoperiosteum was elevated from each side of the hard palate and brought together in the midline.⁹,¹⁰ The technique was published in the early 1860s and remains in current use for isolated cleft palate repair, particularly where the cleft is incomplete.¹¹

Immediate fixation of fractures

Langenbeck was among the earliest advocates of immediate rigid fixation of fractures with immovable plaster dressings, in opposition to the prevailing practice of delayed fixation after the resolution of soft-tissue swelling.⁴ Combined with subperiosteal resection, this approach provided early stability for the regenerating bone and is the conceptual ancestor of the modern damage-control orthopaedic principle of early definitive immobilisation in limb-threatening trauma.

The Berlin school and the founding of the surgical residency

At the Charité, Langenbeck created and ran what is now recognised as the first surgical residency in the modern sense. Medical graduates lived at the hospital and assumed graduated responsibility for surgical patients under direct supervision. The model was adopted wholesale by William Stewart Halsted at Johns Hopkins in the 1890s and became, in time, the template for postgraduate surgical training in the English-speaking world.¹,²

His house staff at the Charité included Theodor Billroth, Friedrich von Esmarch, Friedrich Trendelenburg, Vincenz Czerny, Carl Hueter, and Bernhard Bardenheuer. Theodor Kocher visited from Bern during his 1865–66 European tour. Through these pupils and their own subsequent pupils, the Berlin school’s philosophy of anatomical, methodical, periosteum-preserving operative technique was transmitted across nineteenth-century European surgery and, through Halsted (we will discuss this interesting surgeon in a future episode), to the United States.

Institutional contributions

In 1860 he founded the Archiv für klinische Chirurgie, universally known as Langenbeck’s Archiv and now published as Langenbeck’s Archives of Surgery.¹ It is among the oldest continuously published surgical journals in the world.

In 1872, together with Gustav Simon (Heidelberg) and Richard von Volkmann (Halle), he founded the Deutsche Gesellschaft für Chirurgie, the German Surgical Society, and served as its first president.¹²

Eponyms

The principal surviving eponyms attached to his name are:

• Langenbeck retractor
• Langenbeck cleft palate repair (Uranoplastik, bipedicled mucoperiosteal flap)
• Kocher-Langenbeck approach to the acetabulum
• Langenbeck amputation (subperiosteal amputation)
• Langenbeck’s Archives of Surgery

Langenbeck published comparatively little for a man of his operative output: his collected papers and pamphlets numbered only 47, set against operations that ran into the thousands.⁴ Nevertheless his legacy is huge in Reconstructive Trauma & Orthopaedics and Maxillofacial surgery, not just in eponymous retractors, but also in the techniques he pioneered and taught to his successors, spreading his experience through Europe. 

References

1. Bernhard von Langenbeck. Encyclopædia Britannica, 11th ed. (1911); reproduced in Wikipedia entry, accessed June 2026.
2. IJpma FFA, et al. The evolution of the posterior approach in hip surgery: Back to Langenbeck. Langenbeck’s Archives of Surgery 2026. DOI: 10.1007/s00423-026-03993-9.
3. Langenbeck B. Chirurgische Beobachtungen aus dem Kriege [Surgical Observations from the War]. Berlin, 1874. Quoted passage as cited in F.-D. Söhn antiquarian record of Grosses Encondrom des Schulterblattes, Dtsch. Klin. 1850;2(7):65–76.
4. Anonymous. Obituary and appreciation of Bernhard von Langenbeck. National Library of Medicine historical collection, NLM UID 101736109. https://collections.nlm.nih.gov/ocr/nlm:nlmuid-101736109-bk
5. Langenbeck B. Osteo-Plastic Operations. Translated and communicated by William F. Holcomb. New York Monthly Review and Buffalo Medical Journal 1860 Apr;15(2). PMC8821272. With editorial commentary on the contemporary experimental work of Léopold Ollier, PMC8821288.
6. Calhoun AW. Reports of Some Interesting Cases from the Surgical Clinics and Hospital of Dr. Van Langenbeck, of Berlin, Prussia. American Journal March 1872. PMC8823964.
7. Langenbeck B. Über die Schussverletzungen des Hüftgelenks. Archiv für klinische Chirurgie 1868;10:305–402.
8. Lavernia CJ, Sierra RJ, Pena S. Hyphenated-History: The Kocher-Langenbeck Surgical Approach. Journal of Orthopaedic Trauma. ResearchGate publication 12683155.
9. Sedillot C, after Langenbeck. Hair-lip and Cleft Palate. Academy of Sciences proceedings, reported November 1863. PMC6887316.
10. Langenbeck B. Die Uranoplastik mittelst Ablösung des mucös-periostalen Gaumenüberzuges. Berlin, 1862.
11. Cleft Palate Repair. StatPearls (NCBI Bookshelf), NBK570586, updated 2025.
12. Wikipedia. Gustav Simon (surgeon); Friedrich von Esmarch; Ernst Julius Gurlt (each accessed June 2026, all cross-confirming the 1872 founding of the Deutsche Gesellschaft für Chirurgie by Langenbeck with Simon and Volkmann).
13. Tosounidis TH, Giannoudis VP, Kanakaris NK, Giannoudis PV. The Kocher-Langenbeck Approach: State of the Art. JBJS Essential Surgical Techniques 2018 Jun 13;8(2):e18. DOI: 10.2106/JBJS.ST.16.00102. PMC6143312. PMID: 30233990.
14. Cesmebasi A, Oelhafen K, Shayota BJ, Klaassen Z, Tubbs RS, Loukas M. A historical perspective: Bernhard von Langenbeck German surgeon (1810-1887). Clinical Anatomy 2014 Oct;27(7):972–5. DOI: 10.1002/ca.22433. PMID: 25044221.
15. Naidu P, Yao CA, Chong DK, Magee WP. Cleft Palate Repair: A History of Techniques and Variations. Plastic and Reconstructive Surgery – Global Open 2022;10(3):e4019. DOI: 10.1097/GOX.0000000000004019.

Written by Dr Lewis Greenan-Barrett