Plastic surgery
Plastic surgery is a surgical specialty involving restoration, reconstruction, or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery covers a wide range of specialties, including craniofacial surgery, oral and maxillofacial surgery, hand surgery, microsurgery, and the treatment of burns. This kind of surgery focuses on restoring a body part or improving its function. In contrast, cosmetic surgery focuses solely on improving the physical appearance of the body. A comprehensive definition of plastic surgery has never been established, because it has no distinct anatomical object and thus overlaps with practically all other surgical specialties. An essential feature of plastic surgery is that it involves the treatment of conditions that require or may require tissue relocation skills.
Etymology
The word plastic in plastic surgery refers to the concept of "reshaping" and comes from the Greek πλαστική, plastikē, "the art of modelling" of malleable flesh. This meaning in English is seen as early as 1598. In the surgical context, the word "plastic" first appeared in 1816 and was established in 1838 by Eduard Zeis, preceding the modern technical usage of the word for the synthetic polymer material by 70 years.History
Treatments for the plastic repair of a broken nose are first mentioned in the Egyptian medical text called the Edwin Smith papyrus. The early trauma surgery textbook was named after the American Egyptologist, Edwin Smith. Reconstructive surgery techniques were being carried out in India by 800 BC. Sushruta was a physician who made contributions to the field of plastic and cataract surgery in the 6th century BC.The Romans also performed plastic cosmetic surgery, using simple techniques, such as repairing damaged ears, from around the 1st century BC. For religious reasons, they did not dissect either human beings or animals, thus, their knowledge was based in its entirety on the texts of their Greek predecessors. Notwithstanding, Aulus Cornelius Celsus left some accurate anatomical descriptions, some of which—for instance, his studies on the genitalia and the skeleton—are of special interest to plastic surgery.
Arabs practiced the plastic surgery, during the Abbasid Caliphate in 750 AD. The Arabic translations made their way into Europe via intermediaries. In Italy, the Branca family of Sicily and Gaspare Tagliacozzi became familiar with the techniques of Sushruta.
In all fields of surgery, the Arab physician, surgeon, and chemist Al-Zahrawi talks of the use of silk thread sutures to achieve good cosmesis. He describes what is thought to be the first attempt at reduction mammaplasty for the management of gynaecomastia. He gives detailed descriptions of other basic surgical techniques such as cautery and wound management.
British physicians travelled to India to see rhinoplasties being performed by Indian methods. Reports on Indian rhinoplasty performed by a Kumhar vaidya were published in the Gentleman's Magazine by 1794. Joseph Constantine Carpue spent 20 years in India studying local plastic surgery methods. Carpue was able to perform the first major surgery in the Western world in the year 1815. Instruments described in the Sushruta Samhita were further modified in the Western world.
In 1465, Sabuncu's book, description, and classification of hypospadias were more informative and up to date. Localization of the urethral meatus was described in detail. Sabuncuoglu also detailed the description and classification of ambiguous genitalia. In mid-15th-century Europe, Heinrich von Pfolspeundt described a process "to make a new nose for one who lacks it entirely, and the dogs have devoured it" by removing skin from the back of the arm and suturing it in place. However, because of the dangers associated with surgery in any form, especially that involving the head or face, it was not until the 19th and 20th centuries that such surgery became common.
In 1814, Joseph Carpue successfully performed an operative procedure on a British military officer who had lost his nose to the toxic effects of mercury treatments. In 1818, German surgeon Carl Ferdinand von Graefe published his major work entitled Rhinoplastik. Von Graefe modified the Italian method using a free skin graft from the arm instead of the original delayed pedicle flap.
The first American plastic surgeon was John Peter Mettauer, who, in 1827, performed the first cleft palate operation with instruments that he designed himself.
File:Johann Friedrich Dieffenbach.jpg|thumb|170px|left|Johann Friedrich Dieffenbach established many modern techniques of reconstructive surgery.
Johann Friedrich Dieffenbach specialized in skin transplantation and early plastic surgery. His work in rhinoplastic and maxillofacial surgery established many modern techniques of reconstructive surgery. In 1845, Dieffenbach wrote a comprehensive text on rhinoplasty, titled Operative Chirurgie, and introduced the concept of reoperation to improve the cosmetic appearance of the reconstructed nose. Dieffenbach has been called the "father of plastic surgery".
Another case of plastic surgery for nose reconstruction from 1884 at Bellevue Hospital was described in Scientific American.
In 1891, American otorhinolaryngologist John Roe presented an example of his work: a young woman on whom he reduced a dorsal nasal hump for cosmetic indications. In 1892, Robert Weir experimented unsuccessfully with xenografts in the reconstruction of sunken noses. In 1896, James Israel, a urological surgeon from Germany, and in 1889 George Monks of the United States each described the successful use of heterogeneous free-bone grafting to reconstruct saddle nose defects. In 1898, Jacques Joseph, the German orthopaedic-trained surgeon, published his first account of reduction rhinoplasty. In 1910, Alexander Ostroumov, the Russian pharmacist, and perfume and cosmetics manufacturer, founded a unique plastic surgery department in his Moscow Institute of Medical Cosmetics. In 1928, Jacques Joseph published Nasenplastik und Sonstige Gesichtsplastik.
Nascency of maxillofacial surgery
The development of weapons such as machine guns and explosive shells during World War I created trench warfare, which led to a rapid increase in the number of mutilations to the faces and the heads of soldiers because the trenches mainly offered protection to the body. The surgeons, who were not prepared for these injuries, were even less prepared for a large number of injuries and had to react quickly and intelligently to treat the greatest number. Facial injuries were hard to treat on the front line, and because of the sanitary conditions, many infections could occur. Sometimes, some stitches were made on a jagged wound without considering the amount of flesh that had been lost, so the resulting scars were hideous and disfigured soldiers. Some of the wounded had severe injuries, and the stitches were not sufficient, so some became blind or were left with gaping holes instead of their nose. Harold Gillies, scared by the number of new facial injuries and the lack of good surgical techniques, decided to dedicate an entire hospital to the reconstruction of facial injuries as fully as possible. He took into account the psychological dimension. Gillies introduced skin grafts to the treatments of soldiers, so they would be less horrified by looking at themselves in the mirror.It is the multidisciplinary approach to the treatment of facial lesions, bringing together plastic surgeons, dental surgeons, technicians, and specialized nurses, which has made it possible to develop techniques leading to the reconstruction of injured faces. Before the dentist Auguste Charles Valadier and then Gillies identified the need to advance the specialty of maxillofacial surgery, which would be directly dedicated to the management of war wounds at this time. Gillies developed a new technique using rotational and transposition flaps but also bone grafts from the ribs and tibia to reconstruct facial defects caused by the weapons during the war. He experimented with this technique so he knew that he had to start by moving back healthy tissue to its normal position, and then he would be able to fill with tissue from another place on the body of the soldier. One of the most successful techniques in skin grafting had the aim of not completely severing the connection to the body. It was possible by releasing and lifting a flap of skin from the wound. The flap of skin, still connected to the donor site, would then be swung over the site of the wound, allowing the maintenance of physical connection and ensuring that blood is supplied to the skin, increasing the chances of the skin graft being accepted by the body. At this time, we also assisted in improving treating infections also meant that important injuries had become survivable, mostly thanks to the new technique of Gillies. Some soldiers arrived at the hospital of Gillies without noses, chins, cheekbones, or even eyes. But for them, the most important trauma was psychological.
Development of modern techniques
The father of modern plastic surgery is generally considered to have been Sir Harold Gillies. A New Zealand otolaryngologist working in London, he developed many of the techniques of modern facial surgery in caring for soldiers with disfiguring facial injuries during the First World War.During World War I, he worked as a medical minder with the Royal Army Medical Corps. After working with the French oral and maxillofacial surgeon Hippolyte Morestin on skin grafts, he persuaded the army's chief surgeon, Arbuthnot-Lane, to establish a facial injury ward at the Cambridge Military Hospital, Aldershot, later upgraded to a new hospital for facial repairs at Sidcup in 1917. There, Gillies and his colleagues developed many techniques of plastic surgery; more than 11,000 operations were performed on more than 5,000 men. After the war, Gillies developed a private practice with Rainsford Mowlem, including many famous patients, and travelled extensively to promote his advanced techniques worldwide.
In 1930, Gillies' cousin, Archibald McIndoe, joined the practice and became committed to plastic surgery. When World War II broke out, plastic surgery provision was largely divided between the different services of the armed forces, and Gillies and his team were split up. Gillies himself was sent to Rooksdown House near Basingstoke, which became the principal army plastic surgery unit; Tommy Kilner went to Queen Mary's Hospital, Roehampton; and Mowlem went to St Albans. McIndoe, consultant to the RAF, moved to the recently rebuilt Queen Victoria Hospital in East Grinstead, Sussex, and founded a Centre for Plastic and Jaw Surgery. There, he treated very deep burns and serious facial disfigurement, such as loss of eyelids, typical of those caused to aircrew by burning fuel.
McIndoe is often recognized for not only developing new techniques for treating badly burned faces and hands but also for recognising the importance of the rehabilitation of the casualties and particularly of social reintegration back into normal life. He disposed of the "convalescent uniforms" and let the patients use their service uniforms instead. With the help of two friends, Neville and Elaine Blond, he also convinced the locals to support the patients and invite them to their homes. McIndoe kept referring to them as "his boys" and the staff called him "The Boss" or "The Maestro".
His other important work included the development of the walking-stalk skin graft, and the discovery that immersion in saline promoted healing as well as improving survival rates for patients with extensive burns—this was a serendipitous discovery drawn from observation of differential healing rates in pilots who had come down on land and in the sea. His radical, experimental treatments led to the formation of the Guinea Pig Club at Queen Victoria Hospital, Sussex. Among the better-known members of his "club" were Richard Hillary, Bill Foxley and Jimmy Edwards.