While many women desire round, lifted, and proportionate breasts, pregnancy, weight loss or gain, heredity, and age, can affect these goals. Breast augmentation, also known as breast enhancement or breast enlargement, allows a woman to increase the size of her breasts. Implants filled with silicone or saline can provide balance to their figure, while feeling surprisingly natural.
While many women desire round, lifted, and proportionate breasts, pregnancy, weight loss or gain, heredity, and age, can affect these goals. Breast augmentation, also known as breast enhancement or breast enlargement, allows a woman to increase the size of her breasts. Implants filled with silicone or saline can provide balance to their figure, while feeling surprisingly natural.
Liposuction is the commonly performed surgical procedure. Lasting removal of fat cells using a suction device can be performed through this procedure. The procedure is safe and can be done in a minimum time. The surgical procedure has been subjected to some controversies. This has been due to performance of the surgery by untrained personnel.
Liposuction is the commonly performed surgical procedure. Lasting removal of fat cells using a suction device can be performed through this procedure. The procedure is safe and can be done in a minimum time. The surgical procedure has been subjected to some controversies. This has been due to performance of the surgery by untrained personnel.
We know that the past is our foundation for future developments. We must build upon it so that we too can act as a stable foundation for future generations. One must be aware of the way surgeons in the past have contributed to Orthopaedics.
This presentation is a brief historical review Mankind's cumulative experience in fracture management which was Started by the Ancient very primitive trials and ended by the presence of Robotic and Telesurgery the so called Remote surgery.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
2. Definition
• The word “plastic” comes form “plasticus”, which is a
Latinization of the ancient Greek adjective “plastikos”
(“πλαστικός”, “fit for moulding”).
3. Historical definition
• 1597, the Bolognese Gaspare
Tagliacozzi (1545–1597), gave the
following definition of our
discipline:
to “restore what Nature has given
and chance has taken away. The
main purpose of this procedure is
not the restoration of the original
beauty of the face, but rather the
rehabilitation of the part in
question”.
4. The distant past and the wound as a problem
• The ancient origin of plastic surgery relates to the healing of
wounds.
• Transform a defect that heals slowly by 2° intention into one
healing quicker by 1° intention.
• Used, fibers or strips of tendon for sewing, or pinned
together using insect mandibles.
• Bronze pins.
5. In Ancient Egypt
• 3000 to 2500 BCE – Edwin Smith Papyrus
• Contains descriptions of broken noses and their repair.
• Fresh wounds – grease and honey, linen and swabs, strips of
cloth, a clamp and stitches
6. In Mesopotamia
• 2000 BCE to 600 BCE
• Congenital anomalies
• “If a man is sick with a blow on the cheek, pound together
turpentine, tamarisk, daisy, flour of Inninnu strain mix in milk
and beer in a small copper pan; spread on skin and he shall
recover.”
• Use of a dressing with oil for an open wound.
7. In India
• 600 BC – Sushruta, Indian physician
• Samhita (a Sanskrit text on surgery attributed to Sushruta) -
reconstructive procedures of face
• Entropion, trichiasis, and repair of the nose is reported.
• Indian Koomas - Repair of the nose
Local flaps,
Blunt (yantra) and sharp (sastra) instruments used
8. Indian forehead flap nasal reconstruction. (Gentleman’s Magazine. 1794;64:891–892.)
9. In Rome
• 30 AD Aulus Cornelius Celsus (25BCE - 50AD) – De
Medicina (On Medicine)
• Vessel ligature, lip closure (cleft lip or lip tumor) by
use of flaps
• Advancement flap
• Cardinal signs of acute inflammation, “redness and
swelling with heat and pain” (rubor et tumor, cum
calore et dolore)
10. In Rome
• (c. 129–201 AD) Claudius Galen
• Asklepieion,
• Physician, surgeon & philosopher in Roman Empire
• Wounds - sutures and cautery
11. Plastic surgery after the decline of the Roman Empire
• 325 – 403 AD Oribasius
• Synagogae Medicae - cheek, nose, ears, and eyebrow defects
• 625 – 690 AD Paulus of Aegina
• Medical encyclopedia (Epitome)
• Book 6 - ectropion, upper eyelid retraction and lip repair
12. The Middle Ages - Arabian surgery
• 936 – 1013 AD Abū-l- Qāsim or Albucasis
• Al Tasrif (On Surgery – 1500 AD) - > 200 illustrations of
surgical instruments e.g. cauteries
• Cauteries – use in wounds and cleft lips.
13. The Renaissance
• 1510 – 1590 Ambroise Paré, a barber-surgeon
• Wounds - dressings and ointment of egg yolk, oil of roses
& turpentine
• Cleft lip suture in medical literature.
• Adhesive and wound margin fastening
14. Service of the Eyes
• 1583 - Blepharoplasty
• Georg Bartisch (1535–1607) -
Ophthalmodouleia, or the Service of
the Eyes
• Blepharochalasis, a guillotine.
15. On the Surgery of Injuries by Grafting
• 1597 AD
• De Curtorum Chirurgia per Insitionem (On the Surgery of Injuries by
Grafting), published in Venice in 1597, by Gaspare Tagliacozzi
(1544–1599), Professor of Surgery at Bologna University.
• Nasal reconstruction procedure is shown step by step and skillfully
illustrated.
16. Nasal reconstruction with the arm flap.
(A) Preoperative view of the patient. The missing nose and flap are outlined.
(B) The flap sutured into position.
(C) Final result. (Tagliacozzi G., De Curtorum Chirurgia per Insitionem)
17. Rhinoplasty
• 15th C
• Branca family from Catania (Sicily); Gustavo – cheek
Antonio – arm flap
• In Calabria (Southern Italy)
• Vincenzo Vianeo – arm flap rhinoplasty
Pietro (about 1510–1571) and
Paolo (about 1505–1560) - Rhinoplasty clinic in
Tropea (Calabria).
• Captured in Leonardo Fioravanti (1517–1588) Tesoro della Vita
Humana (Treasure of Human Life) issued in Venice in 1570.
18. The decline of plastic surgery
• 17th and 18th C
• Fallopio (1523–1562), Heister (1683–1758), Camper (1722–
1789)
• Epithesis – wood, silver.
19. Rebirth of plastic surgery - “my God, there is a nose!”
• 1814 Joseph Constantine Carpue - Forehead flap rhinoplasty
Nasal reconstruction with the forehead flap. (A) Preoperative view. (B) The flap transposed into position.
(Carpue JC. Restoring a Lost Nose from the Integuments of the Forehead, in the Case of Two Officers of his
Majesty’s Army. London)
20. The 19th century - The golden age of plastic surgery
• Carl Ferdinand von Gräfe, compared the Italian and Indian
procedures in Rhinoplasty: or the Art of Reconstructing the
Nose
• Carpue’s and von Gräfe’s publications - European interest
• Johann F. Dieffenbach, Germany - rhinoplasty, facial
restorations, cleft lip & palate repairs.
• Jacques Mathieu Delpech, France –Rhinoplasty
• Pancoast, US, Balassa, Hungary and Sabattini in Italy
• With Anesthesia (1846), donor site 1°closure, forehead
rhinoplasty preferred due to simplicity, color match and
excellent results
21. Autologus Skin Graft
• 1804 Giuseppe Baronio - autologous skin graft in a ram in 1804
• 1869 Jacques Reverdin - first successful epidermic graft on a human
• Louis Ollier - split-thickness skin graft
• Carl Thiersch (STSG) & John R Wolfe - advances in the procedure.
• In the late 1800s - skin grafting, preferred solution for chronic wounds
and granulating wounds
• Humby 1936 – Modified Graft cutting razor
• Otto Lanz 1907 – Mesh graft
• Ioannis Yannas & Dr. John F. Burke 1970’s – Artificial skin ‘Integra’
22. Modified graft cutting razor” described by Humby in 1936
Integra Dermal Regeneration Template™ (Integra DRT)
23. The 20th century & Origin of modern plastic surgery
• WW1 soldiers, major maxillofacial mutilations,
• Development of a new discipline, reconstructive surgery.
• Hippolyte Morestin (1868–1919), dentist Charles Auguste Valadier
(1873–1931) Hôpital Valde-Grâce (Paris) - MDT approach.
• 1915, Harold Gillies - Queen’s Hospital, Sidcup. Face and jaw
injuries.
• Gilles MDT team - William Fry and and Henry Pickerill (dental
surgeons) and anesthesiologists.
24. Harold Gillies – Gillies forceps
• Gillies - tubed flap, skin flaps, bone,
cartilage, and skin grafts.
25. The interior of the plastics theatre, at the Queen’s hospital with Gillies seated on the right.
27. Sequelae of facial burn from World War I. Repair using the tubed flap.
(A) Preoperative view of the patient. (B) Outlining of the tubed flap. (C) The flap in position. (D) Final result.
(B) (Reproduced from Gillies H. Plastic Surgery of the Face. London: Frowde, Hodder and Stoughton; 1920.)
28. Lieutenant William Spreckley after surgery. Gillies, implanted a shaped piece of cartilage to
give him a cartilage graft to create a nasal bridge.
29. Private Arthur Mears is captured during treatment (left) and afterwards (right) following
the repair of his jaw using his rib.
30. The training programs
• UK - Queen’s Hospital at Sidcup, Sir Harold Gillies, famous for
facial injuries
• Other training programs in the UK, by Sir Archibald McIndoe,
Rainsford Mowlem, and Pomfret Kilner.
• Paris, France - Fernand Lemaître (1880–1958) - Residency at
the International Clinic of Oto-Rhino-Laryngology and Facio-
Maxillary Surgery,
• Milan, Italy - The Pavilion for Facial Cripples, headed by G.
Sanvenero Rosselli
• US - by Vilray Blair at Washington University in St. Louis.
31. The scientific journals
• Revue de Chirurgie Plastique - Gillies, Maliniak, and Rethi,
• Lasted until the end of 1938 (8 years) due to WW II.
• 1946, Plastic and Reconstructive Surgery Journal – Warren B. Davis
32. Postwar plastic surgery
• 1960s - arterialized flaps, culminating with their microvascular
transfer.
• Musculocutaneous flaps - Italian Iginio Tansini (1855–1943)
• 1960s - Craniofacial techniques, developed by Paul Tessier
(1917– 2008)
• Systematization of breast reconstruction
• Fat grafting for numerous aesthetic and reconstructive
indications,
• Most recently, face transplantation, constitute further
achievements of our specialty.
33. Aesthetic surgery - The origin
• 1845, Johann F. Dieffenbach – Nasal hump rhinoplasty
• A few years later - Julius von Szymanowsk. Handbook of Operative
Surgery
• 1881, Edward Ely in NewYork - Correction of prominent ears and
modifications of nasal appearance
• 1887, John Orlando Roe - reduction of a bulbous or “pug nose,”
under LA.
• 1891, John Orlando Roe - hump removal using scissors
• 1892, Robert Weir, New York - alar base excision, “Weir operation”,
to lower an over projected nose
• ?1931 Jacques Joseph, Berlin – Codified Aesthetic rhinoplasty
steps
34. Aesthetic surgery - The origin
• Aesthetic surgery boom - in Europe & US between the two world
wars.
• Problem of quacks - crude rubber mixed with gutta-percha and
ground in a mill for fillers
• Plastic surgical societies - establish a barrier against quacks
• 1920’s Suzanne Noël ,Paris, successful solo practice, facial
rejuvenation, abdominoplasty or mammoplasty.
• 1926, she published La Chirurgie Esthétique. Son Rôle Sociale, one
of the first textbooks on this topic and the first written by a woman.
• 1929, Julien Bourguet - transconjunctival blepharoplasty
• 1901, Eugen Holländer - reported on a facelifting
35. Postwar aesthetic surgery
• Increase in number of plastic surgeons
• Improved techniques for noses, faces, necks, eyelids, ears, chins,
• breasts, and abdomens
• 1960’s New solutions – e.g. hypoplastic breast – silicone mammary
prosthesis in mid-1960s
• 1980’s – Liposuction
• Faceliftings, fillers, botulinum toxin, and fat injection favorably
improved the demand for facial rejuvenation.
36. THE HISTORY OF PLASTIC SURGERY IN KENYA.
• 60 years ago
• Tremendous growth
37. HISTORY OF PLASTIC SURGERY IN KENYA
• 1956, Ol Orien Farm, Mt Kilimanjaro slopes –
3 men, Sir Archibald “Archie” McIndoe,
Sir Michael Wood
Dr. Tom Rees, all reconstructive surgeons, conceived
the idea of AMREF
• Sir Michael Wood and Dr. Thomas Rees - first plastic
surgeons to work in Kenya.
• Former pupils of Mc-Indoe
Sir Miachel Wood
Dr. Thomas Rees
38. Professor Michael Mwasia Mbalu
• The Late Professor - first indigenous Kenyan to study plastic
surgery.
• 1966 – Bachelor’s degree in medicine and surgery - Makerere
University
• 1972, Prof. Mbalu went to Glasgow on a Commonwealth
scholarship for post-graduate training in surgery leading to
FRCS.
• He was then awarded an 18 month scholarship to study plastic
surgery at the University of California.
• Licensed from UCLA to practice plastic surgery.
• 1975 he returned to Kenya and was in charge of plastic surgery at the Kenyatta National
Hospital and the whole of Kenya.
• 1984 he started the Burns Unit. At the time, he was the deputy director of AMREF. The
first Operation Smile Mission to Kenya was conducted under him in the 1990s
39. • Dr. Bernard Githae was the second indigenous
Kenyan to study plastic surgery
• He trained in the USA under Dr. Bill Magee
• He is among the pioneers of the microvascular
surgery in Kenya
• He is the former Ag. Deputy Director of Clinical
Services at the Kenyatta National Hospital
40. Professor Ominde, Stanley Khainga
• 3rd indigenous Kenyan to venture into the specialty
• 1987, MBChB, UoN
• 1994, Mmed Surgery, UoN
• 1996, Lecturer, Surgery, UoN, worked closely with Professor Mbalu for 3 years
• 2004 to 2005 - W.H.O fellowship in plastic surgery at the Medical University of
Southern Africa(MEDUNSA), Pretoria
• 2004 - Certificate of micro-vascular surgery in plastic and reconstructive
surgery
• Positions held - Chairman of the Prof Pratt Foundation Kenyan Chapter,
Chairman of IPRAS, Coordinator Healing the Children Plastic and
Reconstructive Project Kenya, Chairman of the Multidisciplinary Committee
for Head and Neck Reconstructive Surgery at KNH and Chairman Kenya Society
of Micro-vascular Surgeons
41. Involved in
• Development of master’s program in Plastic and Reconstructive Surgery
• Annual training in micro-vascular surgery under Prof Pratt Foundation
• Setting up of pedicle and micro-vascular flaps labs at the human anatomy
department University of Nairobi.
• Involved in writing a practical teaching manual for micro-vascular surgery
• A teaching manual in plastic and reconstructive surgery for undergraduates at
the University of Nairobi.
• Coordinating MOU’s in training of plastic surgeons between the University of
Nairobi and other universities such as University of Cincinnati-USA, National
University of Rwanda, University of Limpopo and University of Pretoria.
• 2006, introduced NPWT in Kenya
• Currently the thematic head of PRAS at UoN.
• Indeed, ‘the father of plastic surgery in Kenya’
42. Expatriate contributions
• 1980 - Dr. Ismail Aref, an Egyptian expatriate.
• Worked at KNH, taught undergraduates and postgraduates at
UoN.
• In the late 1990s he started the surgical procedure reduction
mammoplasty.
• Currently retired into private practice and remains a great
teacher and mentor to many.
• Others,
• Dr. Mohamed Abdul Haq
• Dr. Makram Ghali
• Dr. Banjara.
43. The role of the University of Nairobi and Kenyatta
National Hospital
• The University of Nairobi (UON) and Kenyatta National Hospital
(KNH) have played a crucial role in the growth of plastic surgery in
Kenya.
• The UoN Medical school, based at KNH, started the plastic surgery
postgraduate training program in 2013 and recruited students, some
of whom were in their third year of study in surgery.
• It is a regional training program currently with residents from
Tanzania (1), Uganda (1 graduated), Zimbabwe (3), Cameroon (1)
and Zambia(1 recently graduated).
44. The role of the University of Nairobi and Kenyatta
National Hospital
• World class training
• Plastic surgeons from around the world visit to give lectures
• Mutual exchange of knowledge and skills local surgeons
• Collaborations with Hedelberg University - craniofacial surgery
training for residents.
• Lecturers from Toure University also visit the department and
train more on aesthetic surgeries by giving lectures and
performing surgeries.
45. The role of the University of Nairobi and Kenyatta
National Hospital
• The pioneer students are Dr. Peter Biribwa who graduated in 2016
and Dr. Faith Karanja 2017.
• 2018 – 1
• 2019 - 4
• 2020 – 2
• 2020, 25 plastic surgeons in the country serving a population of
53,771,296 (2020 midyear projections)
46. Evolution of the surgeries performed in Kenya
• At par with the rest of the world in terms of reconstructive surgery, aesthetic
surgery and research
• Reconstructive surgery including breast reconstruction,
trauma,
cleft lip and palate repair,
lower limb and ear reconstruction,
craniofacial and hand surgeries.
• Late 1990’s, Dr. Aref – Started reduction mammoplasty.
• Initially the popular technique - inferior pedicle technique using the inverted T
incision
• Later, the superomedial pedicle with the vertical scar technique got popular
• Inferior pedicle technique is still being used for the large breasts. It’s reliable for
both its viability and retention of sensation.
47. Evolution of the surgeries performed in Kenya
• 2005, at KNH, Dr. Githae, Prof. Khainga assisted by an American
surgeon - The first free flap was for the radial forearm.
• 2006, Dr. Githae, Prof. Khainga, Dr. Tanga and Dr. Kahoro – The
second free flap, on Ca Larynx patient.
• The success rate is now at 90% - compares fairly well with the
world
48. Milestones
• 2016 November - Separation of conjoined twins (sacropagus) –
MDT team plastic surgeons, neurosurgeons and pediatric
surgeons among others
• 2018 January - Hand re-implantation in a 17 yo M: MDT
consisting of 15 specialists led by Professor Stanley Khainga
and Dr. Ferdinand Nangole
• 2018 March - Foot re-implantation in a 31 yo M, by a
multidisciplinary team led by Professor Stanley Khainga and Dr.
Ferdinand Nangole
• 2019 January - Penile reimplantation of a 16 yo M at KNH by a
MDT lead by Professor Khainga and Dr Nangole
49. On November 2, 2016, Favour and Blessing, who were born conjoined, were separated at Kenyatta National
Hospital (KNH) in a surgical procedure that took more than 50 medical experts and 23 hours to complete.
50. First foot replant surgery at Nairobi Coptic Hospital in Kenya as well as in East Africa.
51.
52. Aesthetic surgeries
• Face lifts
• Neck lift
• Rhinoplasty
• Cheek augmentation
• Breast reduction and augmentation
• Breast lift
• Abdominoplasty
• Liposuction
• Hip and buttock enhancement
• Hair transplants
• Botox injections and filler injections
57. Future of Plastic surgery in Kenya
• Very promising
• Stem cell based therapies - The Plastic Surgery department,
Obs&Gyn department and KAVI.
• Advances in stem cell research, breakthrough in transitional stem
cell therapy and regenerative medicine.
• Plan? Stem cell harvest and Stem cell bank in the country.
• Professor Khainga and Dr. Biribwa pioneered a study on chronic
wound management using fat stem cells.
• Make Kenya a center for excellence in plastic and aesthetic surgery.
• To have world class, up to date aesthetic surgery performed in
Kenya.
58. New Frontiers?
• Aesthetic Surgery – room for exploration
• 3D Printing – tissues e.g. Skin,
• Robotic Surgery
• Supermicrosurgery
59.
60. Professional Societies in Kenya
• The Kenya Society of Plastic, Reconstructive and Aesthetic Surgeons (KSPRAS).
Registered on 10th November, 2006.
1st Chairman - Dr. B. Githae 1st patron Dr AP Landra
2nd Chairman - Professor Khainga
Mission - to uplift the standard of practice in the field of plastic surgery in Kenya and
Sub Saharan Africa at large.
National Burns Centre
Sub-Saharan institute of plastic surgery
Collaborative Master in Plastic Surgery training venture with Egypt, the University of
Nairobi and the Aga Khan University Teaching Hospital, Nairobi.
2015 - International scientific conferences
2010 - Hosted the 1st Pan African plastic, reconstructive and Aesthetic conference
Member of IPRAS
61.
62. Professional Societies in Kenya
• Wound Care Society of Kenya
Founded in 2012,
Multi-disciplinary, non-profit association
Chair – Dr Nangole
• Burns Society of Kenya (BSK)
64. The mural; Plastic and Reconstructive Surgery: History and Philosophy
Dr. Jose Guerrerosantos and Mexican-muralist Guillermo Chavez Vega, On the alley’s main
entrance of the Jalisco Reconstructive Surgery Institute, Mexico.
65. References
1. Valdas Macionis, History of plastic surgery: art, philosophy, and
rhinoplasty, Journal of Plastic, Reconstructive & Aesthetic Surgery
(2018), https://doi.org/10.1016/j.bjps.2018.03.001.
2. Geoffrey Gurtner, Peter Neligan, Plastic surgery. Volume 1,
Principles, 4th Edition, Chapter 2.
3. Bullivant, E., 2007. A brief history of plastic surgery. BMJ 335.
https://doi.org/10.1136/sbmj.0712462
4. Isabella C. Mazzola, Riccardo F. Mazzola, History of Reconstructive
Rhinoplasty
5. Ménard S. An Unknown Renaissance Portrait of Tagliacozzi (1545-
1599), the Founder of Plastic Surgery. Plast Reconstr Surg Glob
Open. 2019 Jan 4;7(1):e2006. doi: 10.1097
66. 6. https://medicalboard.co.ke/online-services/online-retention-registers/
7. Waithaka A.W, Khainga S.O, Aref. I, Wanjeri K, Muoki A; THE HISTORY OF
PLASTIC SURGERY IN KENYA.
8. Our History AMREF Available: http://amref.org/about-us/our-history
[June 14th 2016]
9. Kenya Society of Plastic Reconstructive and Aesthetic surgery Overview
http://kspras.com/#overview [June 5th 2016
10. David Tolhurst, Pioneers in Plastic Surgery
11. Mckoy Rolling, Faces From the Front: World War I Soldiers’ Horrific
Facial Injuries
12. East African Orthopaedic Journal, History of Orthopedics in Kenya
13. Da Vinci Medical Group
14. KAVI