Plastic and reconstructive surgery is a very important medical specialty that uses a number of surgical and nonsurgical techniques to change the appearance and function of a person's body.Plastic surgery procedures include both cosmetic enhancements as well as functionally reconstructive operations. In the former case, where aesthetics are considered more of the concern than changing the functionality, plastic surgery is also sometimes incorrectly referred to as "cosmetic surgery". However, most procedures involve both aesthetic and functional elements.
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. Plastic surgeons typically mold and reshape the following tissues of the body: bone, cartilage, muscle, fat, and skin.
HistoryPlastic surgery reaches back to the 700s BCE. Physicians in ancient India including Sushruta were utilizing skin grafts for reconstructive work as early as the 8th century BC. In 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) .
The Romans were able to perform simple techniques such as repairing damaged ears from around the 1st century BC. 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 ambigius 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 1791, Chopart performed operative procedure of a lip using a flap from the neck. In 1814, Joseph Carpue successfully performed operative procedure in 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.
Techniques and proceduresCommon techniques used in plastic surgery are:
- laser surgery
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.
Plastic surgery sub-specialities
Plastic surgery is a broad field, and may be subdivided further. Plastic surgery training and approval by the American Board of Plastic Surgery includes mastery of the following as well:
* Craniofacial surgery mostly revolves around the treatment of pediatric congenital anomalies, such as cleft lip and palate, craniosynostosis, and other disturbances in facial growth and development. This field is also practiced by oral and maxillofacial surgeons. Because these children have multiple issues, the best approach to providing care to them is an interdisciplinary approach which also includes otolaryngologists, speech therapists, occupational therapists and geneticists.
* Hand surgery is a field that is also practiced by general surgeons and orthopedic surgeons (see Hand surgeon). Plastic surgeons receive training in hand surgery, with some trainees deciding even to do an additional full-year hand fellowship afterwards (this fellowship can also be pursued by general surgeons and orthopedic surgeons). In particular, plastic surgeons receive training in microvascular surgery, which is needed to replant an amputated hand or digit. Many hand operations (such as reconstruction of injuries, replantations, rheumatoid surgery and surgery of congenital defects) are performed by plastic surgeons.
* Burn surgery
* Aesthetic or cosmetic surgery is a growing component of general plastic surgeons. However, a select few promising graduates are chosen for an extra year of advanced fellowship training in aesthetic surgery.
* Pediatric plastic surgery. Children often face medical issues unique from the experiences of an adult patient. Many birth defects or syndromes present at birth are best treated in childhood, and pediatric plastic surgeons specialize in treating these conditions in children. Many have additional training in Pediatric care, including doing residencies in some of the nation's top pediatric plastic surgery programs. Conditions commonly treated by pediatric plastic surgeons include craniofacial anomalies, cleft lip and palate, and congenital hand deformities. Some of the nation's top pediatric hospitals have well established departments of Pediatric Plastic Surgery.
The field of hand surgery deals with both surgical and non-surgical treatment of conditions and problems that may take place in the hand or upper extremity (commonly from the tip of the hand to the shoulder). Hand surgery may be practiced by graduates of general surgery, orthopaedic surgery and plastic surgery. Plastic surgeons and orthopaedic surgeons receive significant training in hand surgery during their residency training, with some graduates continuing on to do an additional one year hand fellowship. These fellowships are sometimes also pursued by general surgeons. Plastic surgeons are particularly well suited to handle traumatic hand and digit amputations that require a "replant" operation. Plastic surgeons are trained to reconstruct all aspects to salvage the appendage: blood vessels, nerves, tendons, muscle, bone. Orthopaedic surgeons are particularly well suited to handle complex fractures of the hand and injuries to the carpal bones that alter the mechanics of the wrist. Hand surgeons perform a wide variety of operations such as fracture repairs, nerve decompressions, releases, transfeer and repairs of tendons and reconstruction of injuries, rheumatoid deformities and congenital defects.