Friday, July 6, 2007

Praise for John Hopkins Facial Plastic Surgeons

Rebuilding--restoring--repairing. That is what drew me to Plastic Surgery. Recently John Hopkins Facial Plastic Surgeons rebuilt a young soldier's nose. You need to check out this article. Photo credit-reference #1.
In the history of plastic surgery, facial injuries have done much to move us forward. The first surgical attempts at nasal reconstruction were recorded in India (1500 b.c.), where nasal mutilation was prevalent. Nasal reconstruction was at that time performed by brickmakers or potters. It is known that forehead flap reconstructions were being carried out in Kangra (near Delhi) from 1000 a.d. onward by the Kanghiara family. The operative technique was a family secret, such that a daughter-in-law would be allowed to watch and assist but not a daughter, who might subsequently marry and take the secret outside the family. The surgical technique practiced in India arrived in England via a circuitous route in the eighteenth century. From 1769 to 1799, wars were fought between Tipu Sultan and the British. A bullock cart driver named Kawasjee and four Indian soldiers of the British army fell into the hands of the Sultan. Their noses and right arms were cut off as punishment, and the men were sent back to their English command. When faced with the amputees, an English officer recalled the case of a merchant’s nose that had been cut off and subsequently reconstructed by a potter named Maratha Vaidya. The commanding officer sent for Vaidya and asked him to reconstruct the nose of Kawasjee. The operation was performed in the presence of two English doctors, Thomas Cruso and James Findlay. Subsequently, the article was reproduced in the Gentleman’s Magazine of London in October of 1794 and signed with the initials “B. L.,” the English author being a surgeon named Cully Lyon Lucas. Thereafter, the forehead flap method became known as the “Indian method.”
Alessandro Benedetti (about 1445-1525) was Professor of Anatomy and Surgery at Padua University. He published articles on many subjects, first of all on anatomy. His work Anatomice, sive Historia Corporis Humani (Anatomy, or the History of the Human Body), first printed in Venice in 1502, was very popular and influential at that time. Of the many topics treated in the book, one is of special interest to plastic surgeons, i.e., the description of nasal reconstruction by means of a skin flap taken from the arm. The procedure is the same as the one the Branca family practiced in Sicily in the middle of fifteenth century. It is well known that the Brancas kept secret the operation and never published it. Hence, Alessandro Benedetti played an important role in the history of plastic surgery because he first reported in the Western surgical literature the procedure of nasal repair, later called the "Italian" method, almost 100 years before Tagliacozzi's publication in 1597.
Dr. Tagliacozzi’s procedure was not, however, for the faint-hearted. First, a flap of skin was partially cut from the upper arm. When enough healing had taken place to ensure that the tissue remained living, a second operation was performed, in which the flap was shaped into a rudimentary nose and attached to the face. After about two weeks (and presumably a lot of arm ache) the new nose was finally severed from the arm. Then the doctor operated yet again, this time to refine the contours and general appearance. The entire procedure took from 3 to 5 months. Presumably it was accompanied by considerable pain, as anesthetics were virtually unknown in those days.
The John Hopkins surgeons have built on all this history and more. Their results are wonderful!
References:
  1. ORIGINS OF THE "INDIAN METHOD" OF NASAL RECONSTRUCTION; Plastic & Reconstructive Surgery; Vol 116(4):1177-1179, September 15, 2005. Singh, Gurminder B.Sc., M.B.B.S.; Kelly, Martin F.R.C.S.(Plast.)
  2. Nasal Reconstruction: Forehead Flap; Plastic & Reconstructive Surgery; Vol 113(6):100e-111e, May 2004; Menick, Frederick J. M.D.
  3. Alessandro Benedetti, a Fifteenth Century Anatomist and Surgeon: His Role in the History of Nasal Reconstruction; Plastic & Reconstructive Surgery; Vol 96(3):739-743, September 1995; Furlan, Silvano; Mazzola, Riccardo F.
  4. Nasal reconstruction: the state of the art; Jin Soon Chang, Samuel S. Becker and Stephen S. Park

1 comment:

kmcallister911 said...

What an amazing story - and the history of nasal reconstruction is fascinating!