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PLASTIC SURGERY
• WHAT?
• WHEN?
• HOW?
• WHO?
• WHY?
• NEXT?
WHAT?
• PLASTIC – WE ALSO SAY NO!
• DERIVED FROM GREEK
• ‘PLASTIKOS’ – TO MOULD OR TO RECONSTRUCT
GENERAL TERMS
• AESTHETIC & RECONSTRUCTIVE SURGERY
• TRAUMA & RECONSTRUCTIVE SURGERY
PLASTIC
SURGERY
AESTHETIC
HAND SX
ONCO
PLASTIC
MICRO
VASCULAR
TRAUMA
SX
BURNS
CRANIO
FACIAL SX
DIABETIC
FOOT SX
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
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
• Middle Age &
Renaissance Period
– Showed decline in Plastic
Surgery works
– Tagliocozzi –
Brotherhood of Death
– Joseph Peter Mettauer-
Cleft palate
– Vincenz Czerny - Breast
Augmentation
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
• EXTENSIVE WORKS IN
WAR VETERANS
• TUBED FLAPS
• SKIN GRAFTING
• SEX REASSIGNMENT
SURGERIES
• PRINCIPLES OF PLASTIC
SURGERY
• 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
• 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
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
• 1971 – Burns
Association of India
• 1974 – Indian Society
for Surgery of Hand – by
Dr. RV
• 1992- Indian Society for
Reconstructive
Microsurgery
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
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
WHO?
TEAM
• Together Everyone Achieves More
PLASTIC
SURGERY
ANAESTHETIST
GENERAL SURGEON
ORTHOPAEDICIAN
GENERAL
PHYSICIAN
RADIOLOGIST
PHYSICAL
MEDICINE&
REHABILITATION
OBSTETRICS &
GYNAECOLOGY
ENT
OPHTHALMOLOGY
DENTAL SURGEON
PAEDIATRICS
DERMATOLOGIST
PSYCHIATRY
CARDIOLOGY
WHY?
• MULTIDISCIPLINARY APPROACH
– IT IS NOT A LUXURY, IT’S A NECESSITY
• TWO HEADS ARE BETTER THAN ONE – C.S.
LEWIS
HAND SURGERY
RV FLAP – HOMODIGITAL ISLAND FLAP
TENDON INJURY
GROIN FLAP
BURNS
TRAUMA SURGERY
CRANIO FACIAL SURGERY
DIABETIC FOOT SURGERY
AESTHETIC SURGERY
AESTHETIC
SURGERY
HAND
SURGERY
TRAUMA
SURGERY
BURNS
CRANIO
FACIAL
SURGERY
DIABETIC
FOOT
SURGERY
NEXT?
• REGENERATIVE WOUND TEMPLATES
– INTEGRA
– MATRIDERM
SUPER MICRO VASCULAR SURGERY
• Vessels < 0.8mm
– Perforators , Lymphatics
• FINGER TIP
REPLANTATION
• FREE VASCULARISED
LYMPH NODE
TRANSFER
• LYMPHATIC
ANASTOMOSIS
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
FACE TRANSPLANT
• First partial face transplant in 2005
• Around 50 cases performed in world
• Yet to be started in India
Journey continue….
JOURNEY OF PLASTIC SURGERY.pptx

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JOURNEY OF PLASTIC SURGERY.pptx

  • 1. PLASTIC SURGERY • WHAT? • WHEN? • HOW? • WHO? • WHY? • NEXT?
  • 2. WHAT? • PLASTIC – WE ALSO SAY NO! • DERIVED FROM GREEK • ‘PLASTIKOS’ – TO MOULD OR TO RECONSTRUCT
  • 3. GENERAL TERMS • AESTHETIC & RECONSTRUCTIVE SURGERY • TRAUMA & RECONSTRUCTIVE SURGERY
  • 5. 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
  • 6. 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
  • 7. • Middle Age & Renaissance Period – Showed decline in Plastic Surgery works – Tagliocozzi – Brotherhood of Death – Joseph Peter Mettauer- Cleft palate – Vincenz Czerny - Breast Augmentation
  • 8. 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
  • 9. • EXTENSIVE WORKS IN WAR VETERANS • TUBED FLAPS • SKIN GRAFTING • SEX REASSIGNMENT SURGERIES • PRINCIPLES OF PLASTIC SURGERY
  • 10. • 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
  • 11. • 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
  • 12. 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
  • 13. • 1971 – Burns Association of India • 1974 – Indian Society for Surgery of Hand – by Dr. RV • 1992- Indian Society for Reconstructive Microsurgery
  • 14. 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
  • 15. 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
  • 18. WHY? • MULTIDISCIPLINARY APPROACH – IT IS NOT A LUXURY, IT’S A NECESSITY • TWO HEADS ARE BETTER THAN ONE – C.S. LEWIS
  • 20. RV FLAP – HOMODIGITAL ISLAND FLAP
  • 23. BURNS
  • 29. NEXT? • REGENERATIVE WOUND TEMPLATES – INTEGRA – MATRIDERM
  • 30. SUPER MICRO VASCULAR SURGERY • Vessels < 0.8mm – Perforators , Lymphatics • FINGER TIP REPLANTATION • FREE VASCULARISED LYMPH NODE TRANSFER • LYMPHATIC ANASTOMOSIS
  • 31. 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
  • 32. FACE TRANSPLANT • First partial face transplant in 2005 • Around 50 cases performed in world • Yet to be started in India