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Why plastic??
A (Very) Brief History
Tagliacozzi, an
Italian surgeon,
describes
reconstruction of
the nose with a
flap from the arm
in his book
published 1597
In 1804, Baronio, an Italian
physiologist performed and
described successful skin
grafting in sheep
In 1817, the Royal College
of Surgeons of England first
record a successful graft in
humans on an amputated
thumb
Sir Harold Gillies (1882-1960)
Father of modern
plastic surgery-
established plastic A burned soldier being
surgery unit to treat reconstructed with tubed
pedicle flaps
war injuries in WWI
Here he uses the Indian forehead flap-
which we still use today
Gillies Principles
Observation is the basis of surgical diagnosis
Diagnose before you treat
Make a plan and a pattern for this plan
Make a record
The lifeboat
A good style will get you through
Replace what is normal in normal position and
retain it there
Gillies Principles
Treat the primary defect first
Losses must be replaced in kind
Do something positive
Never throw anything away
Never let routine methods become your master
Consult other specialists
Speed in surgery consists of not doing the same thing
twice
The after-care is as important as the planning
Never do today what can honourably be put off till
tomorrow
Joseph Murray
Treated victims of WWII and
became interested in rejection of
skin grafts- it was known that the
only successful allografts were
between identical twins
Tissue engineering
Adipose derived stem cells, Growth factors, Neuron
regeneration, Bionic interfaces
The Present
What do plastic surgeons do?
a c hea
pleura t r
In
no
m
ina otid Pectoralis flap
te m on car
ve C om
in
Cover vital structures
Patient with exposed vascular anastomosis after
removal of infected graft
Rectus femoris
muscle flap
Pt with lymphoma
involving spine, s/p
radiation.
Infected, non-healing
wound for months
following decompressive
laminectomy for cord
compression.
Partial Hadbased
latissimus flap to on
live in perforator
lumbar nursing home for
Fills dead space with vascularized tissue
wound care
Wound Healing
Peroneal nerve
Supply deficient tissue