Plastic surgery

Plastic surgery is "an extremely diverse surgical specialty whose chief purpose is to restore form and function". The field of plastic surgery is unique among modern surgical specialties because the entire body, with the exception of the Central Nervous System, is potentially within the province of the General Plastic Surgeon. Besides general plastics, there are regional specialties such as facial plastic surgery and ophthalmologic (eye) plastic surgery. The training of the surgeon may differ depending on whether the specialty is general or facial plastic surgery. Whether general or regional, plastic surgery includes two broad types of surgery. These types are divided on the basis of the purpose of the surgery.

• Reconstructive surgery, including microsurgery, focuses on undoing or masking deformities from trauma, surgery or disease.
• Cosmetic (or aesthetic) surgery is performed in order to change features the patient finds unflattering.

History

The history of Plastic Surgery reaches back to the ancient world. Understanding the development of the field helps clarify what procedures and techniques fall into the realm of modern plastic surgery. Before the 20th Century, there was little ability for any surgeon to offer effective pain relief during an operation or to combat infection after one. All surgery was painful and fraught with a relatively high risk of complications and death. It is not surprising then, that the first operations in plastic surgery were reconstructive.

Reconstruction of facial features deformed by trama

The Romans were able to perform simple techniques such as repairing damaged ears from around the 1st century BC.

Physicians in ancient India including the great Indian surgeon Susrutha were utilizing skin grafts for reconstructive work as early as the 8th century BC. His work Sushruta Samhita describes rhinoplasty and otoplasty. This knowledge of plastic surgery existed in India up to the late 18th century as can be seen from the reports published in Gentleman's Magazine (October 1794). [1] [2]

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, it was not until the 19th and 20th centuries that such surgeries became commonplace, even for reconstructive purposes.

Repair of birth defects

The U.S.'s first plastic surgeon was Dr. John Peter Mettauer. He performed the first cleft palate operation in 1827 with instruments that he designed himself. The New Zealander Sir Harold Gillies developed many of the techniques of modern plastic surgery in caring for those who suffered facial injuries in World War I, he is considered to be the father of modern plastic surgery. 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.

Common reconstructive surgeries are: breast reconstruction for women who have had a mastectomy, cleft lip and palate surgery, contracture surgery for burn survivors, and closing skin and mucosa defects after removal of tumors in the head and neck region. Sex reassignment surgery for transsexual people is another example of reconstructive surgery.

Care of wounds: plastic skin closure and repair of tissue defects

Although wound closure is a part of every type of surgery that requires a substantial incision, plastic surgery has had a strong focus on optimal techniques of skin closure and the repair of open wounds. Plastic surgeons have developed the use of microsurgery to transfer tissue for coverage of a defect when no local tissue is available. Tissue "flaps" comprised of skin, muscle, bone, fat or a combination, may be removed from the body, moved to another site on the body and reconnected to a blood supply by suturing arteries and veins as small as 1-2 mm in diameter.

Besides such specialized operations for restroring the integrity of the body, plastic surgery utilizes a set of principles for skin and wound closure that are aimed to minimize scarring and to camouflage the presence of scars.

Cosmetic surgery

Until advancements in medicine allowed some surgical procedures to be low risk, cosmetic surgery was not a reasonable undertaking by either surgeon or patient. In the 20th century, such surgery became practical and, with improvements in techniques that allowed greater chances of a good results, and improvements in medicine that continued to reduce the risk, cosmetic surgical procedures have become more common than reconstrucive procedures.