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The Revolution in Reconstructive Surgery | Esma Coskan

Plastic surgery – it has become an extremely common and accessible form of anatomical reconstruction or modification, with 15.6 million cosmetic procedures and 6.8 million reconstructive surgeries undergone in 2020 alone. We see it everywhere: social media platforms, magazines, and even celebrities showing off their new waistlines and features to their masses of followers. However, even though cosmetic surgery is now in regular practice, it was first recorded around 600 years ago during the 15th century.

Sicilian surgeon Antonio Branca performed the first nose reconstructive surgery on one of his patients– although the method was extremely different to a modern-day rhinoplasty (where he would use the skin from the arm and use it as a ‘flap’, where the new nose would be shaped from, with the arm and nose being sewn together during the healing process), it was still highly effective and the technique earned widespread fame amongst European surgeons, as it was the first demonstration of skin grafting and surgery that could rebuild and reshape an individual’s features – a very promising start!

Despite this, there were no breakthroughs in ‘plastic’ surgery until 300 years later where, in the late 18th century, the skin graft was rediscovered following an ancient Indian book called the ‘Sushruta Samhita’ – which dates to the 8th century – where a leaf-shaped section or flap of the forehead would be cut and used to reconstruct the nose. This method was deemed more effective than Branca’s method, as it did not require the patient to have their arm sewn to their face for 8-10 highly uncomfortable days. As a result of this impressive new procedure, Felix Jean Casimir Guyon of Paris and Jacques Reverdin of Geneva began to develop more advanced skin grafts in their practice in 1869 which are still similar to the techniques used today.

As you can see, there is still a large gap in the surgeries performed 130 years ago than the advanced surgeries performed in the 21st century. Just a few decades later, the greatest advancements in prosthetics, reconstructive and cosmetic surgery arose out of desperate necessity and as a result of the first world war (1914-1918). Pioneering skin grafting techniques such as the ‘tubed pedicled graft’ – a type of graft where the skin graft remains attached by one corner and is used as a flap over the amended area – were developed and refined by leading plastic surgeons Archibald McIndoe and Harold Gilles, who used this methodology to treat severe facial burns and horrific injuries sustained by soldiers. This new and revolutionized version of plastic surgery differed from the previous centuries’ as it relied on the dispersal of the recipients’ blood supply into the grafted area making it a permanent and touch-sensitive part of the body rather than a new layer of skin. Just two decades later, in 1924, as science, medicine and knowledge of bacteria and microorganisms developed, Gillies and McIndoe performed their facial burn surgeries on British Airmen with the media in attendance, pushing plastic surgery into the public eye and introducing it into the mainstream, allowing for its huge strides and importance that it has in the 21st century.

The gradual, yet hugely significant journey of plastic surgery, means that now, around the globe, individuals can undergo even the most complex of reconstructive surgeries with comfort and security, knowing that after centuries of experience, they will hopefully be able to achieve the results they desire.

Edited by Ayla Samson

References

Royalfree.nhs.uk. 2021. History of plastic surgery | Facial reconstruction and face transplants | Plastic surgery | Services A-Z | Services | The Royal Free. [online] Available at: <https://www.royalfree.nhs.uk/services/services-a-z/plastic-surgery/facial-reconstruction-and-face-transplants/history-of-plastic-surgery/&gt; [Accessed 13 November 2021].

2021. ASPS National Clearinghouse of Plastic Surgery Procedural Statistics. 1st ed. [eBook] American Society of Plastic Surgeons, pp.3-5. Available at: <https://www.plasticsurgery.org/documents/News/Statistics/2020/plastic-surgery-statistics-full-report-2020.pdf&gt; [Accessed 13 November 2021].

G, K., 2021. [The history of plastic surgery (author’s trans)]. [online] PubMed. Available at: <https://pubmed.ncbi.nlm.nih.gov/355747/&gt; [Accessed 14 November 2021].

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