1. PLASTIC AND RECONTRUCTIVE SURGERY
Dr Sumer Yadav
Mch plastic and reconstructive surgeon

2. What Is Plastic Surgery?


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The name is taken from the Greek word
“plastikos”, which means to form or mold!
Plastic surgery is a special type of surgery that
involves both a person's appearance and his or
her ability to function.
It intends to improve patients' appearance, selfimage, and confidence through both
reconstructive and cosmetic procedures.

3. 3
PLASTIC SURGERY
cont’d

Broad classification:
Plastic Surgery

4. There are two main kinds of plastic
surgery: employed for medical
1. Reconstructive surgery - is usually
purposes, and some common examples include:
* cleft lip surgery
* breast reconstruction surgery for those who have had
mastectomy
* contracture surgery for burn survivors
2. Cosmetic surgery - is done mostly for aesthetic
enhancement and includes:
- Different types of cosmetic surgery include:
Tummy tuck (abdominoplasty)
* Liposuction
* Breast lift
* Cheek augmentation
* Breast reduction/enlargement (augmentation
mammaplasty)
*

5. Why do people get Plastic
Surgery?
1.
2.
3.
4.
To improve the appearance.
Some people ore addicted to cosmetic
surgery
To correct a physical defect or to alter a
part of the body that makes them feel
uncomfortable
To feel better about the way they look

6. 6
PLASTIC SURGERY
cont’d
• To correct functional impairments caused by:
•
•
•
•
•
•
Burns
Traumatic Injuries (Facial bone fractures & breaks)
Congenital Abnormalities
Infection
Cancer
Tumors
• Most common reconstructive procedures
• Microsurgery to transfer tissue
Plastic Surgery

7. 7
Plastic Surgery

8. 8
TECHNIQUES AND PROCEDURES
Plastic Surgery

9. HISTORY OF
PLASTIC SURGERY

10. FIRST DESCRIPTIONS
 Description of replantation in Vedic times.
 Sushruta Samhita, compiled in 600 BC describes
Indian rhinoplasty. Also a tilemaker method.
 Indian rhinoplasty brought to attention in 1794,
B.L., Letter to Editor, Gentleman’s Magazine.
 Nicolo Manuzzi probably described Indian
rhinoplasty in early 18th century but it was not
published until 1907.

11. FATHER OF INDIAN PLASTIC
SURGERY

13. SUSHRUTA’S CONTRIBUTIONS TO
PLASTIC SURGERY
 Rhinoplasty
 Classification of mutilated ear lobe defects and
techniques for repair of torn ear lobes (15
different types of otoplasties)
 Cheek flap for reconstruction of absent ear lobe.
 Repair of accidental lip injuries and congenital
cleft lip.
 Skin grafting.

14. SUSHRUTA’S CONTRIBUTIONS TO
PLASTIC SURGERY
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Piercing children’s ear lobe with a needle or awl.
Classification of burns into four degrees and explaining
the effect of heat stroke, frostbite, and lightning
injuries.
Fourteen types of bandaging capable of covering
almost all the regions of the body and different
methods of dressings with various medicaments.
Use of leeches to keep wounds free of blood clots.

15. PERIOD OF CELSUS
 First century AD.
 Compiled The Eight Books of Medicine, or De
medicina octo libri.
 Plastic surgery for repair of nose, lips and ears.
 Double pedicled advancement flap and a form
of subcutaneous island flap.
 Washing wounds with vinegar, removal of part
of skull.

16. 14 – 15 CENTURIES
th
th
 14th century Flemish surgeon Jehan Yperman:
repair of harelips.
 Serafeddin Sabuncuoglu: first illustrated surgical
textbook in Turkish-Islamic literature – eyelid
problems, facial fractures, reduction
mammoplasty (gynecomastia).
 Branca: cheek flaps for nasal reconstruction.

17. 16 CENTURY
th
 Tagliacozzi of Bologna: author of De Curtorum
Chirurgia per Insitionem – delayed arm flap for
nasal, ear and lip reconstruction.
 Antonio, son of Branca: upper arm flaps for
nose, ear and lips.
 Vianeo family from Calabria: reconstruction of
facial fractures.

18. TAGLIACOZZI OF BOLOGNA

19. 17 – 18 CENTURIES
th
th
 Art of facial restoration was in much disrepute
following false ideas and perceptions.
 Reemergence from India: article published in
Gentleman’s Magazine in October 1794 in
London.

20. 19 CENTURY
th
 Joseph Carpue: reconstructed 2 noses using the
Indian technique.
 von Graefe: “Rhinoplastik” – reconstructed
noses using 3 different methods; lower eyelid
reconstruction, cleft soft palate repair.
 Dieffenbach: leeches in nose reconstruction,
bone flaps for cleft hard palate, “nose” creation
in patient’s arm & transfer – Die Operative
Chirurgie.

21. 19 CENTURY
th
 von Langenbeck: principles of modern cleft lip
& palate surgeries.
 Serre: advancement flap – French method of
nasal reconstruction.
 Dupuytren: palmar fibromatosis, burn
classification (6 degrees according to depth),
removal of lower jaw, wry neck treatment.

22. 19 CENTURY
th
 Z plasty: Denonvilliers – lower lid ectropion.
 Sir Astley Cooper: first human skin graft.
 Jacques Reverdin: detached pinch grafts (STSG).
 Wolfe, Krause: full thickness grafts.

23. 20 CENTURY
th
 Morestin: French army surgeon-reconstruction,
ear protrusion.
 Harold Gillies: NZ ENT surgeon-Father of
Modern Plastic Surgery; tubed pedicle flaps for
facial reconstruction (done earlier by Filatov),
epithelial outlay technique, intranasal skin graft,
replantation, cosmetic surgery, sex reassignment.
 Kazanjian: IMF, facial clefts, bone grafting for
facial bone loss, prosthetic devices.

24. SIR HAROLD GILLIES

25. SEPARATE SPECIALTY (USA)
 Education not standardized.
 Resistance from traditional surgeons.
 1921: American Association of Oral & Plastic
Surgeons.
 1931: American Society of Plastic &
Reconstructive Surgeons.
 1937: American Board of Plastic Surgery-efforts
of Blair.

26. WORLD WAR II
 Refinement in plastic surgery.
 McIndoe: early skin grafting for burns.
 Sterling Bunnell: reconstructive hand surgery.
 Converse: scalping flap.

27. DEVELOPMENTS
 Earl Padgett & George Hood: development of
dermatome.
 Work on transplantation: Joseph Murray
received Noble Prize - work on kidney
transplants.
 Millard & Marks: better approach to cleft lip and
cleft palate repairs.
 Paul Tessier et al: development of craniofacial
surgery.

28. CONTINUED
DEVELOPMENTS
 McGregor’s groin flap, Bakamjian’s
deltopectoral flap.
 Ralph Ger: muscle flaps.
 Malt (1962): reattached an amputated arm.
 Komatsu & Tamai (1968): digital replantation.
 McClean & Buncke (1972): microvascular
omental transfer.

29. DEVELOPMENTS IN
AESTHETIC SURGERY
 Sheen: improvements in rhinoplasty.
 Cronin & Gerow: silicone gel.
 Botswick: LD for breast reconstruction.
 Hartrampf: RA for breast reconstruction.
 Illouz: fat aspiration through hollow cannulas.

30. PLASTIC SURGERY IN INDIA
 Sushruta Samhita & tilemaker method.
 Maharishi Atreya & modification to classical
forehead flap.
 Description of rhinoplasty by Tribhovan &
Keegan in late 19th century.
 !945: maxillofacial surgical units at Kirkee &
Secunderabad.
 1950: Plastic surgery dept at Patna & Nagpur.

31. PLASTIC SURGERY IN INDIA
 1957: Plastic Surgery section of ASI: Sir Gillies.
 1960: MS degree in plastic surgery at Nagpur.
“Nagpur classification” of cleft lip & palate by
Dr. Balakrishnan.
 1966: first microvascular surgery in humans in
the world done by Dr. Antia & Dr. Buch.
 1961: KEM Hospital, Dr. Pinto; “Hole-in-one”
procedure for cleft lip & palate.

32. FORMATION OF ASSOCIATIONS
 1971: Burns Association of India.
 1974: Indian Society for Surgery of the Hand.
 1992: Indian Society for Reconstructive
Microsurgery.

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

35. Plastic Surgery

36. Megan Fox O.o

37. THANKS