CLASHES, WARS AND PLASTIC SURGERY

The modern identity of plastic surgery came through a long and storied history. Many turning moments in the history of plastic surgery have occurred during the time of struggles and wars and several major breakthroughs were born out of horrors of war.

THE ANCIENT TIMES

Lord Shiva, the great Hindu God attached an elephant's head on his son, Ganesh's body. Hindu mythological text mentions it as an example of a kind of plastic surgery, a great feat that no human being has been able to achieve until now. In addition to this myth, in India, Sushruta (known as the father of Indian surgery) in 600 BC., is belived to be the first individual to describe plastic surgery in his Samhita' or encyclopedia'. He described both a reconstruction of an ear lobe and the a method of reconstructing the nose, commonly referred to as the "Indian" or "Hindu" method. During that period nose,a symbol of respect and reputation since antiquity,was the common organ to be amputated to punish criminals and the inhabitants of conquered cities. So, Indian surgeons of that period had many opportunities to hone their nose repair skills. Sushruta Indian surgeons used the cheek flap for their reconstructions and thus pioneered modern rhinoplasty.

The Hindu methods of facial reconstruction had great influence in the ancient world and were often adopted by other nations. The great Roman medical writer Aulus Cornelius Celsus, in his classic medical text of the first century, Demedicina described similar techniques as those used by Sushruta.

MIDDLE AGES

The Middle Ages yielded very few significant surgical developments, however, the practice of established methods such as facial reconstruction continued. Even Emperor Justinian II of the 8th century benefited from a nasal reconstruction procedure. Known as Rhinometis' or the one with the amputated nose', the Emperor was overthrown and his nose mutilated so that his disfigured appearance would him from regaining power. Justinian received a nasal reconstruction and reigned for an additional three years (until another revolt lead to his execution).

The great Islamic conquest of India in the 10th century and invasion and occupation of Sicily during the 9th to 12th centuries played a very important role in the development of plastic surgery. It is during this period that the reconstructive techniques of earlier periods were introduced to Arabic culture and subsequently all over Europe. A few centuries later, the need for reconstructive operations grew in Europe due to frequent clashes between armed men resulting in disfigurements. Compared with earlier periods, the 15th and 16th centuries were distinguished by unparalleled bloodshed in Europe. At that time, the famous Branca family performed reconstructive surgeries in Sicily, though they kept their techniques close guarded secrets. Leonardo Fioravanti and Gasparo Tagliacozzi, two doctors from the University of Bologna disseminated the principles of reconstructive surgeries performed by Branca family in academic circles.

THE REBIRTH

The practice of plastic surgery declined in the 17th and 18th centuries due to rampant superstition surrounding surgery. However, the rebirth of plastic surgery occurred in the late 18th century and is attributed to a historical event that took place in British India. In October 1794, Gentleman's Magazine' published a simple letter by a British surgeon named Lucas. In this famous account, Lucas described an operative procedure that was used to reconstruct the nose of a British bullock driver, Cowasjee, whose nose was mutilated by an enemy to punish him for transporting supplies to the British East India forces. A man of brick maker caste performed the procedure in India while two British surgeons observed. Impressed by this story, Joseph Carpue, a British surgeon, reportedly performed nasal reconstructive surgeries more quickly and published the account of these successful operations in Restoration of lost nose' in 1816. Reconstructive surgeries were again vitalized in Europe.

WORLD WARS: THE PERIOD OF GREAT LEAPS FOR PLASTIC SURGERY

Plastic surgery as a specialty was born out of horrors of World War I and its tremendous toll on mankind. The thousands of soldiers were killed many millions more were crippled or hideously deformed, often requiring ingenious and specialized surgical treatments. Surgeons of that time dealt with shattered jaws, blown off noses and lips, and gaping skull wounds. A group of American, British, French, German, Russian, and Austro-Hungarians began to form associations for the purpose of coordinating and disseminating knowledge. Giants of plastic surgery, like Sir Harold Delf Gillies, Vilray Papin Blair and Morestin, devoted themselves to restoring the faces of war victims. Sir Harold Delf Gillies, a British trained otolaryngologist from New Zealand, played a monumental role in advancing plastic surgery by developing a separate specialized treatment centre for war victims with facial injuries in Cambridge Hospital in Aldershot, England. At the hands of such reconstructive surgeons, many lives were saved and hopes restored. No longer were crude facial masks the only option for individuals wishing to conceal broad facial injuries, which gave many soldiers the confidence to return to society as productive citizens. While World War I acted as a catalyst to raise plastic surgery to unimagined heights, World War II brought further growth and refinement of the specialty. It provided a platform for collaborative and communicative efforts among plastic surgeons. In addition, the creation of an organizational framework for plastic surgery, emergence of hand surgery as subspecialty and establishment of many treatment centres also advanced the specialty immeasurably.

The work of the reconstructive surgeons during the war captured the eye of the general public as well as attention of major academic institutions. Then, public demand and pressure mounted for aesthetic surgical procedures capable of improving quality of life.

Most of the turning points in the history of plastic surgery evolved from the struggles and advances made during the times of crises or battlefield settings. The post world war era saw tremendous proliferation of new surgical techniques. The modern medical landscape of plastic surgery now abounds with new procedures and techniques.

References

1 Rana RE, Arora BS. History of plastic surgery in India. Journal of postgraduate Medicine 2002;48:76-8

2Chari PS. Sushruta and our heritage. Indian Journal of plastic surgery 2003;36:4-13

3Ciaschini M, Bernard SL.History of plastic surgery. Available at http://www.emedicine.com/plastic/topic433.htm.

4McCarthy JG:Introduction.In:McCarthy JG, ed. Plastic surgery.Philadelphia:WB Saunders Co;1990

5 Paolo SR, Riccardo M. Leonardo Fioravanti(1517-1588): A Barber-surgeon who influenced the development of Reconstructive surgery. Plastic and Reconstructive surgery 1997;99(2):570-575.

6Backstein R, Hinek A. War and Medicine: The origins of plastic surgery. University of Toronto Medical Journal 2005;82(3):217-218

JYI publishes undergraduate research from the natural sciences, mathematics, engineering, and from some of the social sciences, such as psychology and the history of science.
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