Plastic Surgery

Plastic surgery is a medical and cosmeticspecialty interested in the correction of form and function. While famous for aesthetic surgery, plastic surgery also includes a variety of fields: craniofacial surgery, hand surgery, burn surgery, microsurgery, and pediatric surgery. The word "plastic" derives from the Greek plastikos meaning to mold or to shape; its use here is not connected with the synthetic polymer material known as plastic.

History

Plastic surgery was being carried out in India by 2000 BC.Sushruta (6th century BC) made important contributions to the field of Plastic and Cataract surgery.The medical works of both Sushruta and Charak were translated into Arabic language during the Abbasid Caliphate (750 AD).These Arabic works made their way into Europe via intermediaries.In Italy the Branca family of Sicily and Gaspare Tagliacozzi (Bologna) became familiar with the techniques of Sushruta.

British physicians traveled to India to see Rhinoplasty being performed by native methods.Reports on Indian Rhinoplasty 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 by 1815.Instruments described in the Sushruta Samhita were further modified in the Western world.

The Romans were able to perform simple techniques such as repairing damaged ears from around the 1st century BC. Due to religious reasons they didn't approve of the dissection of both human beings and animals, thus their knowledge was based in its entirety on the texts of their Greek predecessors. Notwithstanding this Aulus Cornelius Celsus has left some surprisingly accurate anatomical descriptions, some of which —for instance, his studies on the genitalia and the skeleton— are of special interest to plastic surgery.

The Egyptians were also one of the first people to perform plastic cosmetic surgery.

In 1465, Sabuncuoglu's book, description, and classification of hypospadias was more informative and up to date. Localization of urethral meatus was described in detail. Sabuncuoglu also detailed the description and classification of ambiguous genitalia (Kitabul Cerrahiye-i Ilhaniye -Cerrahname-Tip Tarihi Enstitüsü, Istanbul)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 commonplace.

Up until the techniques of anesthesia became established, all surgery on healthy tissues involved great pain. Infection from surgery was reduced once sterile technique and disinfectants were introduced. The invention and use of antibiotics beginning with sulfa drugs and penicillin was another step in making elective surgery possible.

In 1792, Chopart performed operative procedure on a lip using a flap from the neck. In 1814, Joseph Carpue successfully performed 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. In 1845, Johann Friedrich Dieffenbach wrote a comprehensive text on rhinoplasty, entitled Operative Chirurgie, and introduced the concept of reoperation to improve the cosmetic appearance of the reconstructed nose. 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 (duck sternum) 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 1928, Jacques Joseph published Nasenplastik und Sonstige Gesichtsplastik.

The U.S.'s first plastic surgeon was Dr. John Peter Mettauer. In 1827, he performed the first cleft palate operation with instruments that he designed himself. The New Zealander Sir Harold Gillies, an otolaryngologist, developed many of the techniques of modern plastic surgery in caring for those who suffered facial injuries in World War I. His work was expanded upon during World War II by one of his former students and cousin, Archibald McIndoe, who pioneered treatments for RAF aircrew suffering from severe burns. McIndoe's radical, experimental treatments, lead to the formation of the Guinea Pig Club. Plastic surgery as a specialty evolved tremendously during the 20th century in the United States. One of the founders of the specialty, Dr. Vilray Blair, was the first chief of the Division of Plastic and Reconstructive Surgery at Washington University in St. Louis, Missouri. In one of his many areas of clinical expertise, Blair treated World War I soldiers with complex maxillofacial injuries, and his paper on "Reconstructive Surgery of the Face" set the standard for craniofacial reconstruction. He was also one of the first surgeons without a dental background to be elected to the American Association of Oral and Plastic Surgery (later the organizations split to be renamed the American Association of Plastic Surgeons and the American Association of Oral and Maxillofacial Surgeons) and taught many surgeons who became leaders in the field of plastic surgery.

Techniques and procedures

Common techniques used in plastic surgery are: Liposuction, Breast Augmention, Eyelid surgery, Face lift, Tummy tuck, Collagen injections, Chemical peel, Laser skin Resurfacing Rhinoplasty, Forehead lifts.

In plastic surgery the transfer of skin tissue (skin grafting) is one of the most common procedures. (In traditional surgery a "graft" is a piece of living tissue, organ, etc., that is transplanted.

  • Autografts: Skin grafts taken from the recipient. If absent or deficient of natural tissue, alternatives can be:
    • Cultured Sheets of epithelial cells in vitro.
    • Synthetic compounds (e.g., Integra—a 2 layered dermal substitute consisting superficially of silicone and deeply of bovine tendon collagen with glycosaminoglycans).
  • Allografts: Skin grafts taken from a donor of the same species.
  • Xenografts: Skin grafts taken from a donor of a different species.

Usually, good results are expected from plastic surgery that emphasizes:

  • Careful planning of incisions so that they fall in the line of natural skin folds or lines.
  • Appropriate choice of wound closure.
  • Use of best available suture materials.
  • Early removal of exposed sutures so that the wound is held closed by buried sutures.