HISTORY OF HISTORY OF PLASTIC SURGERYPLASTIC SURGERY

Souvik AdhikariSouvik AdhikariPost-Doctoral TraineePost-Doctoral Trainee

FIRST DESCRIPTIONSFIRST DESCRIPTIONS

Description of replantation in Vedic times.Description of replantation in Vedic times. Sushruta Samhita, compiled in 600 BC Sushruta Samhita, compiled in 600 BC

describes Indian rhinoplasty. Also a describes Indian rhinoplasty. Also a tilemaker method.tilemaker method.

Indian rhinoplasty brought to attention in Indian rhinoplasty brought to attention in 1794, B.L., Letter to Editor, Gentleman’s 1794, B.L., Letter to Editor, Gentleman’s Magazine.Magazine.

Nicolo Manuzzi probably described Indian Nicolo Manuzzi probably described Indian rhinoplasty in early 18rhinoplasty in early 18thth century but it was century but it was not published until 1907.not published until 1907.

FATHER OF INDIAN FATHER OF INDIAN PLASTIC SURGERYPLASTIC SURGERY

SUSHRUTA’S CONTRIBUTIONS SUSHRUTA’S CONTRIBUTIONS TO PLASTIC SURGERYTO PLASTIC SURGERY

RhinoplastyRhinoplasty Classification of mutilated ear lobe defects Classification of mutilated ear lobe defects

and techniques for repair of torn ear lobes and techniques for repair of torn ear lobes (15 different types of otoplasties)(15 different types of otoplasties)

Cheek flap for reconstruction of absent Cheek flap for reconstruction of absent ear lobe.ear lobe.

Repair of accidental lip injuries and Repair of accidental lip injuries and congenital cleft lip.congenital cleft lip.

Skin grafting.Skin grafting.

SUSHRUTA’S CONTRIBUTIONS SUSHRUTA’S CONTRIBUTIONS TO PLASTIC SURGERYTO PLASTIC SURGERY

Piercing children’s ear lobe with a needle or Piercing children’s ear lobe with a needle or awl.awl.

Classification of burns into four degrees and Classification of burns into four degrees and explaining the effect of heat stroke, frostbite, explaining the effect of heat stroke, frostbite, and lightning injuries.and lightning injuries.

Fourteen types of bandaging capable of Fourteen types of bandaging capable of covering almost all the regions of the body covering almost all the regions of the body and different methods of dressings with and different methods of dressings with various medicaments.various medicaments.

Use of leeches to keep wounds free of blood Use of leeches to keep wounds free of blood clotsclots..

PERIOD OF CELSUSPERIOD OF CELSUS

First century AD.First century AD. Compiled The Eight Books of Medicine, Compiled The Eight Books of Medicine,

or De medicina octo libri.or De medicina octo libri. Plastic surgery for repair of nose, lips Plastic surgery for repair of nose, lips

and ears.and ears. Double pedicled advancement flap and a Double pedicled advancement flap and a

form of subcutaneous island flap.form of subcutaneous island flap. Washing wounds with vinegar, removal Washing wounds with vinegar, removal

of part of skull.of part of skull.

PAUL OF AEGINAPAUL OF AEGINA

77thth century Byzantine Greek century Byzantine Greek physician.physician.

Author of Medical Compendium in Author of Medical Compendium in Seven Books.Seven Books.

Treatments for jaw and nasal Treatments for jaw and nasal fractures as well as hypospadias.fractures as well as hypospadias.

1414thth – 15 – 15thth CENTURIES CENTURIES

1414thth century Flemish surgeon Jehan century Flemish surgeon Jehan Yperman: repair of harelips.Yperman: repair of harelips.

Serafeddin Sabuncuoglu: first Serafeddin Sabuncuoglu: first illustrated surgical textbook in illustrated surgical textbook in Turkish-Islamic literature – eyelid Turkish-Islamic literature – eyelid problems, facial fractures, reduction problems, facial fractures, reduction mammoplasty (gynecomastia).mammoplasty (gynecomastia).

Branca: cheek flaps for nasal Branca: cheek flaps for nasal reconstruction.reconstruction.

1616thth CENTURY CENTURY

Tagliacozzi of Bologna: author of De Tagliacozzi of Bologna: author of De Curtorum Chirurgia per Insitionem – Curtorum Chirurgia per Insitionem – delayed arm flap for nasal, ear and delayed arm flap for nasal, ear and lip reconstruction.lip reconstruction.

Antonio, son of Branca: upper arm Antonio, son of Branca: upper arm flaps for nose, ear and lips.flaps for nose, ear and lips.

Vianeo family from Calabria: Vianeo family from Calabria: reconstruction of facial fractures.reconstruction of facial fractures.

TAGLIACOZZI OF TAGLIACOZZI OF BOLOGNABOLOGNA

1717thth – 18 – 18thth CENTURIES CENTURIES

Art of facial restoration was in much Art of facial restoration was in much disrepute following false ideas and disrepute following false ideas and perceptions.perceptions.

Reemergence from India: article Reemergence from India: article published in Gentleman’s Magazine published in Gentleman’s Magazine in October 1794 in London.in October 1794 in London.

1919thth CENTURY CENTURY

Joseph Carpue: reconstructed 2 noses Joseph Carpue: reconstructed 2 noses using the Indian technique.using the Indian technique.

von Graefe: “Rhinoplastik” – von Graefe: “Rhinoplastik” – reconstructed noses using 3 different reconstructed noses using 3 different methods; lower eyelid reconstruction, methods; lower eyelid reconstruction, cleft soft palate repair.cleft soft palate repair.

Dieffenbach: leeches in nose Dieffenbach: leeches in nose reconstruction, bone flaps for cleft hard reconstruction, bone flaps for cleft hard palate, “nose” creation in patient’s arm palate, “nose” creation in patient’s arm & transfer – & transfer – Die Operative ChirurgieDie Operative Chirurgie..

1919thth CENTURY CENTURY

von Langenbeck: principles of von Langenbeck: principles of modern cleft lip & palate surgeries.modern cleft lip & palate surgeries.

Serre: advancement flap – French Serre: advancement flap – French method of nasal reconstruction.method of nasal reconstruction.

Dupuytren: palmar fibromatosis, Dupuytren: palmar fibromatosis, burn classification (6 degrees burn classification (6 degrees according to depth), removal of according to depth), removal of lower jaw, wry neck treatment.lower jaw, wry neck treatment.

1919thth CENTURY CENTURY

Z plasty: Denonvilliers – lower lid Z plasty: Denonvilliers – lower lid ectropion.ectropion.

Sir Astley Cooper: first human skin Sir Astley Cooper: first human skin graft.graft.

Jacques Reverdin: detached pinch Jacques Reverdin: detached pinch grafts (STSG).grafts (STSG).

Wolfe, Krause: full thickness grafts.Wolfe, Krause: full thickness grafts.

2020thth CENTURY CENTURY Morestin: French army surgeon-Morestin: French army surgeon-

reconstruction, ear protrusion.reconstruction, ear protrusion. Harold Gillies: NZ ENT surgeon-Father of Harold Gillies: NZ ENT surgeon-Father of

Modern Plastic Surgery; tubed pedicle Modern Plastic Surgery; tubed pedicle flaps for facial reconstruction (done earlier flaps for facial reconstruction (done earlier by Filatov), epithelial outlay technique, by Filatov), epithelial outlay technique, intranasal skin graft, replantation, cosmetic intranasal skin graft, replantation, cosmetic surgery, sex reassignment.surgery, sex reassignment.

Kazanjian: IMF, facial clefts, bone grafting Kazanjian: IMF, facial clefts, bone grafting for facial bone loss, prosthetic devices.for facial bone loss, prosthetic devices.

SIR HAROLD GILLIESSIR HAROLD GILLIES

SEPARATE SPECIALTY (USA)

Education not standardized.Education not standardized. Resistance from traditional surgeons.Resistance from traditional surgeons. 1921: American Association of Oral 1921: American Association of Oral

& Plastic Surgeons.& Plastic Surgeons. 1931: American Society of Plastic & 1931: American Society of Plastic &

Reconstructive Surgeons.Reconstructive Surgeons. 1937: American Board of Plastic 1937: American Board of Plastic

Surgery-efforts of Blair.Surgery-efforts of Blair.

DEVELOPMENTS IN DEVELOPMENTS IN EUROPEEUROPE

Dufourmentel: rhomboid flap, lower Dufourmentel: rhomboid flap, lower maxillary condylar resection.maxillary condylar resection.

1931: First journal – 1931: First journal – Revue de Revue de Chirurgie PlastiqueChirurgie Plastique..

1936: European Society of Structive 1936: European Society of Structive Surgery.Surgery.

Esser: island flaps.Esser: island flaps.

WORLD WAR IIWORLD WAR II

Refinement in plastic surgery.Refinement in plastic surgery. McIndoe: early skin grafting for McIndoe: early skin grafting for

burns.burns. Sterling Bunnell: reconstructive Sterling Bunnell: reconstructive

hand surgery.hand surgery. Converse: scalping flap.Converse: scalping flap.

DEVELOPMENTSDEVELOPMENTS

Earl Padgett & George Hood: Earl Padgett & George Hood: development of dermatome.development of dermatome.

Work on transplantation: Joseph Work on transplantation: Joseph Murray received Noble Prize - work Murray received Noble Prize - work on kidney transplants.on kidney transplants.

Millard & Marks: better approach to Millard & Marks: better approach to cleft lip and cleft palate repairs.cleft lip and cleft palate repairs.

Paul Tessier et al: development of Paul Tessier et al: development of craniofacial surgery.craniofacial surgery.

CONTINUED CONTINUED DEVELOPMENTSDEVELOPMENTS

McGregor’s groin flap, Bakamjian’s McGregor’s groin flap, Bakamjian’s deltopectoral flap.deltopectoral flap.

Ralph Ger: muscle flaps.Ralph Ger: muscle flaps. Malt (1962): reattached an amputated Malt (1962): reattached an amputated

arm.arm. Komatsu & Tamai (1968): digital Komatsu & Tamai (1968): digital

replantation.replantation. McClean & Buncke (1972): McClean & Buncke (1972):

microvascular omental transfer.microvascular omental transfer.

DEVELOPMENTS IN DEVELOPMENTS IN AESTHETIC SURGERYAESTHETIC SURGERY

Sheen: improvements in rhinoplasty.Sheen: improvements in rhinoplasty. Cronin & Gerow: silicone gel.Cronin & Gerow: silicone gel. Botswick: LD for breast Botswick: LD for breast

reconstruction.reconstruction. Hartrampf: RA for breast Hartrampf: RA for breast

reconstruction.reconstruction. Illouz: fat aspiration through hollow Illouz: fat aspiration through hollow

cannulas.cannulas.

PLASTIC SURGERY IN PLASTIC SURGERY IN INDIAINDIA

Sushruta Samhita & tilemaker method.Sushruta Samhita & tilemaker method. Maharishi Atreya & modification to Maharishi Atreya & modification to

classical forehead flap.classical forehead flap. Description of rhinoplasty by Tribhovan Description of rhinoplasty by Tribhovan

& Keegan in late 19& Keegan in late 19thth century. century. !945: maxillofacial surgical units at !945: maxillofacial surgical units at

Kirkee & Secunderabad.Kirkee & Secunderabad. 1950: Plastic surgery dept at Patna & 1950: Plastic surgery dept at Patna &

Nagpur.Nagpur.

PLASTIC SURGERY IN PLASTIC SURGERY IN INDIAINDIA

1957: Plastic Surgery section of ASI: Sir 1957: Plastic Surgery section of ASI: Sir Gillies.Gillies.

1960: MS degree in plastic surgery at 1960: MS degree in plastic surgery at Nagpur. “Nagpur classification” of cleft lip Nagpur. “Nagpur classification” of cleft lip & palate by Dr. Balakrishnan.& palate by Dr. Balakrishnan.

1966: first microvascular surgery in 1966: first microvascular surgery in humans in the world done by Dr. Antia & humans in the world done by Dr. Antia & Dr. Buch.Dr. Buch.

1961: KEM Hospital, Dr. Pinto; “Hole-in-1961: KEM Hospital, Dr. Pinto; “Hole-in-one” procedure for cleft lip & palate.one” procedure for cleft lip & palate.

FORMATION OF FORMATION OF ASSOCIATIONSASSOCIATIONS

1971: Burns Association of India.1971: Burns Association of India. 1974: Indian Society for Surgery of 1974: Indian Society for Surgery of

the Hand.the Hand. 1992: Indian Society for 1992: Indian Society for

Reconstructive Microsurgery.Reconstructive Microsurgery.

PROBLEM AROUSALPROBLEM AROUSAL

Development of subspecialties has Development of subspecialties has led to fragmentation & decreased led to fragmentation & decreased cohesiveness.cohesiveness.

Worsening of professional liability.Worsening of professional liability. New models of reimbursement: New models of reimbursement:

restriction of reconstructive restriction of reconstructive procedures to a sizeable population.procedures to a sizeable population.

FUTUREFUTURE

More people, especially minorities More people, especially minorities would lean towards plastic surgery.would lean towards plastic surgery.

Development of minimally invasive Development of minimally invasive techniques: lunch-hour facelift, fat techniques: lunch-hour facelift, fat melting without surgery.melting without surgery.

Male cosmetic surgery, stem cells.Male cosmetic surgery, stem cells. Will the specialty disintegrate??Will the specialty disintegrate??

““Through all of Sushruta’s flowery Through all of Sushruta’s flowery language, incantations and language, incantations and irrelevancies, there shines the irrelevancies, there shines the unmistakable picture of a great unmistakable picture of a great surgeon. Undaunted by his surgeon. Undaunted by his failures, unimpressed by his failures, unimpressed by his successes, he sought the truth successes, he sought the truth unceasingly and passed it on to unceasingly and passed it on to those who followed. He attacked those who followed. He attacked disease and deformity definitively, disease and deformity definitively, with reasoned and logical with reasoned and logical methods. When the path did not methods. When the path did not exist, he made one.”exist, he made one.”

Frank McDowellFrank McDowell

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