History Of Plastic Surgery


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  • Too much stress is laid on the article in The Gentleman’s Magazine by Ayurvedic proponents to establish the authenticity of Sushruta’s rhinoplasty. But the fact of the matter is that there is no reference at all to Sushruta in the Gentleman’s Magazine. It is a clear evidence that Sushruta was not known in 1794 and this fictitious figure was created only several decades after 1794. The Gentleman’s magazine of October 1794 edition gives a bizarre account of a curious operation of making a nose from a forehead flap of one Cowsajee. It is quite weird to note that the so-called operation was performed not by an Ayurvedic physician but by an illiterate man belonging to ‘brick-maker’ caste. The condition of the patient mentioned in the Magazine causes further doubt. It is alleged that Cowsajee, the patient, was caught by Tipu sultan’s men and they cut off his nose and one hand. It is also stated that he lived “for about 12 months without a nose.” On the face of it everything appears uncanny, inscrutable and strange. How could Cowsajee escape infection when his one hand and nose were amputated? This account is sent in the form of a letter addressed to the Gentleman’s Magazine by a person who had not divulged his name and address, but only the initials “B.L.” To give credence to this story, he has also given the names of two surgeons, Thomas Cruso and James Trindlay, who were alleged to have witnessed the operation. The surgeons’ identity has not been proved and they have not given any statement. They have not also published such a feat in any medical journal. Even the details of the grafting procedure and the figure of the patient shown in the Magazine were all diagrams and painting, and were published at third hand in London in 1794. In those days scholars belonging to Asiatic Society invented stories to become famous. In the absence of printed texts, and with no manuscript library, it was easy for them to get spurious manuscripts and claim inventions. Edward Pococke had hundreds of such fabricated manuscripts and he attempted to prove that Pythagoras got his ideas from India. William Jones, for instance, gave several arguments to prove that a group of Egyptian priests had in some remote age settled down in India. Reuben Burrow tried to prove that the Binomial Theorem was known to ancient Indians. Francis Wilford was cheated by Brahmin pundits employed by him when they interpolated into the old Sanskrit texts material cleverly forged so that the Sanskrit texts specifically mentioned Adam, Abraham and other Biblical personages. The forgery was detected by Wilford himself, but only after he had contributed quite a lot of material on the subject in The Asiatic Researches --- which he sorely regretted. (Kejariwal,O.P., The Asiatic Society of Bengal, p.43)It is against this backdrop that we have to view the letter sent to The Gentleman’s Magazine describing skin grafting by one ‘B.L.’ was fabricated in view of the fact that without sterile technique, anesthesia and antibiotics an illiterate ‘brick maker’ could not have performed plastic surgery.
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History Of Plastic Surgery

  1. 1. HISTORY OF PLASTIC SURGERY Souvik Adhikari Post-Doctoral Trainee
  2. 3. FIRST DESCRIPTIONS <ul><li>Description of replantation in Vedic times. </li></ul><ul><li>Sushruta Samhita, compiled in 600 BC describes Indian rhinoplasty. Also a tilemaker method. </li></ul><ul><li>Indian rhinoplasty brought to attention in 1794, B.L., Letter to Editor, Gentleman’s Magazine. </li></ul><ul><li>Nicolo Manuzzi probably described Indian rhinoplasty in early 18 th century but it was not published until 1907. </li></ul>
  4. 6. SUSHRUTA’S CONTRIBUTIONS TO PLASTIC SURGERY <ul><li>Rhinoplasty </li></ul><ul><li>Classification of mutilated ear lobe defects and techniques for repair of torn ear lobes (15 different types of otoplasties) </li></ul><ul><li>Cheek flap for reconstruction of absent ear lobe. </li></ul><ul><li>Repair of accidental lip injuries and congenital cleft lip. </li></ul><ul><li>Skin grafting. </li></ul>
  5. 7. SUSHRUTA’S CONTRIBUTIONS TO PLASTIC SURGERY <ul><li>Piercing children’s ear lobe with a needle or awl. </li></ul><ul><li>Classification of burns into four degrees and explaining the effect of heat stroke, frostbite, and lightning injuries. </li></ul><ul><li>Fourteen types of bandaging capable of covering almost all the regions of the body and different methods of dressings with various medicaments. </li></ul><ul><li>Use of leeches to keep wounds free of blood clots . </li></ul>
  6. 8. PERIOD OF CELSUS <ul><li>First century AD. </li></ul><ul><li>Compiled The Eight Books of Medicine, or De medicina octo libri. </li></ul><ul><li>Plastic surgery for repair of nose, lips and ears. </li></ul><ul><li>Double pedicled advancement flap and a form of subcutaneous island flap. </li></ul><ul><li>Washing wounds with vinegar, removal of part of skull. </li></ul>
  7. 9. PAUL OF AEGINA <ul><li>7 th century Byzantine Greek physician. </li></ul><ul><li>Author of Medical Compendium in Seven Books. </li></ul><ul><li>Treatments for jaw and nasal fractures as well as hypospadias. </li></ul>
  8. 10. 14 th – 15 th CENTURIES <ul><li>14 th century Flemish surgeon Jehan Yperman: repair of harelips. </li></ul><ul><li>Serafeddin Sabuncuoglu: first illustrated surgical textbook in Turkish-Islamic literature – eyelid problems, facial fractures, reduction mammoplasty (gynecomastia). </li></ul><ul><li>Branca: cheek flaps for nasal reconstruction. </li></ul>
  9. 11. 16 th CENTURY <ul><li>Tagliacozzi of Bologna: author of De Curtorum Chirurgia per Insitionem – delayed arm flap for nasal, ear and lip reconstruction. </li></ul><ul><li>Antonio, son of Branca: upper arm flaps for nose, ear and lips. </li></ul><ul><li>Vianeo family from Calabria: reconstruction of facial fractures. </li></ul>
  11. 13. 17 th – 18 th CENTURIES <ul><li>Art of facial restoration was in much disrepute following false ideas and perceptions. </li></ul><ul><li>Reemergence from India: article published in Gentleman’s Magazine in October 1794 in London. </li></ul>
  12. 14. 19 th CENTURY <ul><li>Joseph Carpue: reconstructed 2 noses using the Indian technique. </li></ul><ul><li>von Graefe: “Rhinoplastik” – reconstructed noses using 3 different methods; lower eyelid reconstruction, cleft soft palate repair. </li></ul><ul><li>Dieffenbach: leeches in nose reconstruction, bone flaps for cleft hard palate, “nose” creation in patient’s arm & transfer – Die Operative Chirurgie . </li></ul>
  13. 15. 19 th CENTURY <ul><li>von Langenbeck: principles of modern cleft lip & palate surgeries. </li></ul><ul><li>Serre: advancement flap – French method of nasal reconstruction. </li></ul><ul><li>Dupuytren: palmar fibromatosis, burn classification (6 degrees according to depth), removal of lower jaw, wry neck treatment. </li></ul>
  14. 16. 19 th CENTURY <ul><li>Z plasty: Denonvilliers – lower lid ectropion. </li></ul><ul><li>Sir Astley Cooper: first human skin graft. </li></ul><ul><li>Jacques Reverdin: detached pinch grafts (STSG). </li></ul><ul><li>Wolfe, Krause: full thickness grafts. </li></ul>
  15. 17. 20 th CENTURY <ul><li>Morestin: French army surgeon-reconstruction, ear protrusion. </li></ul><ul><li>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. </li></ul><ul><li>Kazanjian: IMF, facial clefts, bone grafting for facial bone loss, prosthetic devices. </li></ul>
  17. 19. SEPARATE SPECIALTY (USA) <ul><li>Education not standardized. </li></ul><ul><li>Resistance from traditional surgeons. </li></ul><ul><li>1921: American Association of Oral & Plastic Surgeons. </li></ul><ul><li>1931: American Society of Plastic & Reconstructive Surgeons. </li></ul><ul><li>1937: American Board of Plastic Surgery-efforts of Blair. </li></ul>
  18. 20. DEVELOPMENTS IN EUROPE <ul><li>Dufourmentel: rhomboid flap, lower maxillary condylar resection. </li></ul><ul><li>1931: First journal – Revue de Chirurgie Plastique . </li></ul><ul><li>1936: European Society of Structive Surgery. </li></ul><ul><li>Esser: island flaps. </li></ul>
  19. 21. WORLD WAR II <ul><li>Refinement in plastic surgery. </li></ul><ul><li>McIndoe: early skin grafting for burns. </li></ul><ul><li>Sterling Bunnell: reconstructive hand surgery. </li></ul><ul><li>Converse: scalping flap. </li></ul>
  20. 22. DEVELOPMENTS <ul><li>Earl Padgett & George Hood: development of dermatome. </li></ul><ul><li>Work on transplantation: Joseph Murray received Noble Prize - work on kidney transplants. </li></ul><ul><li>Millard & Marks: better approach to cleft lip and cleft palate repairs. </li></ul><ul><li>Paul Tessier et al: development of craniofacial surgery. </li></ul>
  21. 23. CONTINUED DEVELOPMENTS <ul><li>McGregor’s groin flap, Bakamjian’s deltopectoral flap. </li></ul><ul><li>Ralph Ger: muscle flaps. </li></ul><ul><li>Malt (1962): reattached an amputated arm. </li></ul><ul><li>Komatsu & Tamai (1968): digital replantation. </li></ul><ul><li>McClean & Buncke (1972): microvascular omental transfer. </li></ul>
  22. 24. DEVELOPMENTS IN AESTHETIC SURGERY <ul><li>Sheen: improvements in rhinoplasty. </li></ul><ul><li>Cronin & Gerow: silicone gel. </li></ul><ul><li>Botswick: LD for breast reconstruction. </li></ul><ul><li>Hartrampf: RA for breast reconstruction. </li></ul><ul><li>Illouz: fat aspiration through hollow cannulas. </li></ul>
  23. 25. PLASTIC SURGERY IN INDIA <ul><li>Sushruta Samhita & tilemaker method. </li></ul><ul><li>Maharishi Atreya & modification to classical forehead flap. </li></ul><ul><li>Description of rhinoplasty by Tribhovan & Keegan in late 19 th century. </li></ul><ul><li>!945: maxillofacial surgical units at Kirkee & Secunderabad. </li></ul><ul><li>1950: Plastic surgery dept at Patna & Nagpur. </li></ul>
  24. 26. PLASTIC SURGERY IN INDIA <ul><li>1957: Plastic Surgery section of ASI: Sir Gillies. </li></ul><ul><li>1960: MS degree in plastic surgery at Nagpur. “Nagpur classification” of cleft lip & palate by Dr. Balakrishnan. </li></ul><ul><li>1966: first microvascular surgery in humans in the world done by Dr. Antia & Dr. Buch. </li></ul><ul><li>1961: KEM Hospital, Dr. Pinto; “Hole-in-one” procedure for cleft lip & palate. </li></ul>
  25. 27. FORMATION OF ASSOCIATIONS <ul><li>1971: Burns Association of India. </li></ul><ul><li>1974: Indian Society for Surgery of the Hand. </li></ul><ul><li>1992: Indian Society for Reconstructive Microsurgery. </li></ul>
  26. 28. PROBLEM AROUSAL <ul><li>Development of subspecialties has led to fragmentation & decreased cohesiveness. </li></ul><ul><li>Worsening of professional liability. </li></ul><ul><li>New models of reimbursement: restriction of reconstructive procedures to a sizeable population. </li></ul>
  27. 29. FUTURE <ul><li>More people, especially minorities would lean towards plastic surgery. </li></ul><ul><li>Development of minimally invasive techniques: lunch-hour facelift, fat melting without surgery. </li></ul><ul><li>Male cosmetic surgery, stem cells. </li></ul><ul><li>Will the specialty disintegrate?? </li></ul>
  28. 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
  29. 31. i