Background: In the early Byzantine era, bridging late antiquity and the Middle Ages, physician-authors like Paul of Aegina significantly advanced surgical knowledge. Paul stood out in the seventh century, overshadowing contemporaries such as Oribasius and Alexander of Tralles with his contributions to surgical practices. Methods: Paul's "Epitome of Medicine" (Pragmateia), a seven-volume medical encyclopaedia, expanded on Galen and Hippocrates, filling gaps left by Oribasius. It detailed various diseases and their surgical treatments. Results: The Pragmateia's sixth book focused on surgery, presenting methods for treating nasal fractures, gynaecomastia, ectropion, and mandible dislocations, and examining intersex anatomy. Johan Heiberg's 1919 survey of the lost manuscript led to its first printing in 1528, but translation efforts were challenging until Francis Adams' English version in 1844. Conclusions: Paul's enduring success in the Middle Ages was boosted by his integration into Islamic Golden Age medical texts. Albucasis in Ummayad Spain notably utilized Paul's work in his "Kitab al-Tasrif," a comprehensive 30-volume surgical guide. This work incorporated Paul's techniques, making it the premier surgical text in Europe, Africa, and the Middle East, thereby cementing Paul's influence on medical practices across these regions. (1) Pormann PE (2004) The oriental tradition of Paul of Aegina’s Pragmateia. Studies in ancient medicine 29:1–337