The document provides a history of plastic surgery from ancient times to modern developments. It describes early contributions from Sushruta in India in the 6th century BC and later developments in Europe from the 15th century onwards. It then discusses the establishment and growth of plastic surgery as a specialty in the 20th century, including developments during World Wars and more recent subspecializations and techniques.

1. HISTORY OF PLASTIC SURGERY Souvik Adhikari Post-Doctoral Trainee

3. 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 18 th century but it was not published until 1907.

4. FATHER OF INDIAN PLASTIC SURGERY

6. 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.

7. SUSHRUTA’S CONTRIBUTIONS TO PLASTIC SURGERY 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 .

8. 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.

9. PAUL OF AEGINA 7 th century Byzantine Greek physician. Author of Medical Compendium in Seven Books. Treatments for jaw and nasal fractures as well as hypospadias.

10. 14 th – 15 th CENTURIES 14 th 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.

11. 16 th CENTURY 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.

12. TAGLIACOZZI OF BOLOGNA

13. 17 th – 18 th CENTURIES 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.

14. 19 th CENTURY 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 .

15. 19 th CENTURY 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.

16. 19 th CENTURY Z plasty: Denonvilliers – lower lid ectropion. Sir Astley Cooper: first human skin graft. Jacques Reverdin: detached pinch grafts (STSG). Wolfe, Krause: full thickness grafts.

17. 20 th CENTURY 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.

18. SIR HAROLD GILLIES

19. 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.

20. DEVELOPMENTS IN EUROPE Dufourmentel: rhomboid flap, lower maxillary condylar resection. 1931: First journal – Revue de Chirurgie Plastique . 1936: European Society of Structive Surgery. Esser: island flaps.

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

22. 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.

23. 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.

24. 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.

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

26. 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.

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

28. PROBLEM AROUSAL Development of subspecialties has led to fragmentation & decreased cohesiveness. Worsening of professional liability. New models of reimbursement: restriction of reconstructive procedures to a sizeable population.

29. FUTURE More people, especially minorities would lean towards plastic surgery. Development of minimally invasive techniques: lunch-hour facelift, fat melting without surgery. Male cosmetic surgery, stem cells. Will the specialty disintegrate??

30. “ 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

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