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JOURNEY OF PLASTIC SURGERY.pptx
- 1. BY – DR. MEDHUN KUMAR M, MBBS, DNB, M.Ch. PLASTIC SURGERY ASSISTANT SURGEON, ESI AYNAVARAM, CHENNAI
- 2. PLASTIC SURGERY • WHAT? • WHEN? • HOW? • WHO? • WHY? • NEXT?
- 3. WHAT? • PLASTIC – WE ALSO SAY NO! • DERIVED FROM GREEK • ‘PLASTIKOS’ – TO MOULD OR TO RECONSTRUCT
- 4. GENERAL TERMS • AESTHETIC & RECONSTRUCTIVE SURGERY • TRAUMA & RECONSTRUCTIVE SURGERY
- 6. WHEN?(HISTORY) • IT IS A RECENT DISCIPLINE WITH OLD ROOTS • ANCIENT ROOTS – EGYPTIAN • In 1213 BC – Ramses II (After life) – INDIAN • In 600 BC – Sushruta - First known Plastic surgery – ROMANS • 100 BC – 5TH CENTURY AD • Aulus Cornelius Celsus
- 7. FATHER OF PLASTIC SURGEON • MAHARISHI SUSHRUTA • Author of Sushruta Samhita • Rhinoplasty, Ear lobe reconstruction, amputations, skin grafting, genital reconstruction • Indian Rhinoplasty – Published in Gentleman’s Magazine Of London 1794
- 8. • Middle Age & Renaissance Period – Showed decline in Plastic Surgery works – Tagliocozzi – Brotherhood of Death – Joseph Peter Mettauer- Cleft palate – Vincenz Czerny - Breast Augmentation
- 9. FATHER OF MODERN PLASTIC SURGERY • The seeds of Modern Plastic surgery were sown in the 1920s out of the need for reconstruction of devastating injuries during World War I • HAROLD GILLES - • Born in New Zealand in 17th June 1882 • STUDIED IN CAMBRIDGE • OTOLARYNGOLOGIST • OBSERVER UNDER DENTAL SURGEON • JOINED ROYAL ARMY & WORKED IN WORLD WAR I & II • VISITED INDIA IN 1957
- 10. • EXTENSIVE WORKS IN WAR VETERANS • TUBED FLAPS • SKIN GRAFTING • SEX REASSIGNMENT SURGERIES • PRINCIPLES OF PLASTIC SURGERY
- 11. • Reconstructive microsurgery arrived in the 1960s when free flaps and replantations started off. – Julius Jacobson & Ernesto Suarez – 1960 – Vascular anastomosis – Malt & Mc Khann – 1962 – First successful forearm replant – Yoshio Nakayama – 1964 – First free flap – Cobbett – 1976 – First toe to hand transfer – Koshimo – 1989 – Free Perforator flaps
- 12. • Modern Aesthetic / Cosmetic surgery started taking shape in the 1960s and 1970s when newly created silicone was growing in popularity. • Cronin & Gerow – Silicon implant - 1972 • Botswick – LD flap for breast reconstruction • Illouz – LIPOSUCTION – 1982
- 13. INDIAN HISTORY • 1950 – DR. CBK – Started Plastic Surgery Department in Nagpur • 1957 – Plastic Surgery Section in ASI – By Harold Gillies • 1961 – KEM Hospital , Dr. Pinto – Cleft lip & Palate • 1966 – First microvascular surgery Dr. Antia and Dr. Buch • 1971 – Exclusive Hand Surgery Department in Stanley Medical College
- 14. • 1971 – Burns Association of India • 1974 – Indian Society for Surgery of Hand – by Dr. RV • 1992- Indian Society for Reconstructive Microsurgery
- 15. HOW? (PRINCIPLES OF PLASTIC SURGERY) 1)Observation is the basis of surgical diagnosis 2) Diagnose before you treat 3) Make a plan and a pattern for this plan 4) Make a record 5) Have a lifeboat 6) A good style will get you through 7) Replace what is normal in a normal position and retain it there 8) Treat the primary defect first 9) Losses must be replaced in kind 10) Do something positive 11) Never throw anything away 12) Never let routine methods become your Master 13) Consult other specialists 14) Speed in surgery consists of not doing the same thing twice 15) The after care is as important as the planning of the surgery itself 16) Never do today what can be honourably be put off till tomorrow
- 16. MYTHS & FACTS MYTHS • COSTLY • CAN BE DONE ONLY IN CORPORATE HOSPITALS • ONE MAN SHOW • RESTRICTED TO COSMETIC & SKIN GRAFTING • UNREALISTIC EXPECTATIONS FACTS • AFFORDABLE • DEFINITELY CAN BE DONE IN MOST HOSPITAL SET UP • MULTIDISCIPLINARY • NUMEROUS PROCEDURES • SCIENTIFICALLY POSSIBLE RESULTS
- 17. WHO? TEAM • Together Everyone Achieves More
- 18. PLASTIC SURGERY ANAESTHETIST GENERAL SURGEON ORTHOPAEDICIAN GENERAL PHYSICIAN RADIOLOGIST PHYSICAL MEDICINE& REHABILITATION OBSTETRICS & GYNAECOLOGY ENT OPHTHALMOLOGY DENTAL SURGEON PAEDIATRICS DERMATOLOGIST PSYCHIATRY CARDIOLOGY
- 19. WHY? • MULTIDISCIPLINARY APPROACH – IT IS NOT A LUXURY, IT’S A NECESSITY • TWO HEADS ARE BETTER THAN ONE – C.S. LEWIS
- 20. HAND SURGERY
- 21. RV FLAP – HOMODIGITAL ISLAND FLAP
- 22. TENDON INJURY
- 23. GROIN FLAP
- 24. BURNS
- 25. TRAUMA SURGERY
- 30. NEXT? • REGENERATIVE WOUND TEMPLATES – INTEGRA – MATRIDERM
- 31. SUPER MICRO VASCULAR SURGERY • Vessels < 0.8mm – Perforators , Lymphatics • FINGER TIP REPLANTATION • FREE VASCULARISED LYMPH NODE TRANSFER • LYMPHATIC ANASTOMOSIS
- 32. PRESERVATION OF AMPUTATED PART • WARM ISCHEMIA TIME: – UPPER LIMB AMPUTATIONS – 3 – 4 hours – PROXIMAL FORE ARM AMPUTATIONS – 4 – 6 hours – DISTAL FOREARM & HAND – 6- 8 hours – DIGITS – 8- 10 hours
- 33. TRANSPLANTATION • HAND TRANSPLANTATION – > 100 CASES SUCCESSFULLY DONE WORLD WIDE – AROUND 8 CASES DONE IN INDIA – 1ST HAND TRANSPLANT IN TAMIL NADU – STANLEY MEDICAL COLLEGE – FEB 2018
- 34. FACE TRANSPLANT • First partial face transplant in 2005 • Around 50 cases performed in world • Yet to be started in India