Anyway here is the interesting article:
Article link: http://www.emedicine.com/plastic/topic433.htm
QUOTE
Egyptian and Indian reconstructive efforts
Egyptian physicians may be credited broadly as the earliest contributors to the modern specialty of reconstructive plastic surgery. The “Edwin Smith Papyrus,” the origins of which are dated at approximately 3000 BC, contains the first descriptions of the surgical management of facial trauma, including the treatment of mandibular and nasal fractures. Such descriptions are impressive for their age, for their basis on scientific principles, and for their departure from the superstitious attitudes of the time.
Many hundreds of years would pass before the true birth of reconstructive surgery occurred. Although the precise date is disputed by historians, the first recorded description of actual reconstructive plastic surgery may be traced back over 2600 years to the Sanskrit texts of ancient India. During this period such surgery was needed greatly, as acts of facial mutilation, especially of the nose, were perpetrated commonly in India and its surrounding territories by vicious bands of marauders as a method of visible and lasting humiliation.
The Hindu justice system also contributed to the need for reconstructive surgery by levying harsh penalties upon its subjects for various crimes, including amputation of the genitalia or nose of an unfaithful spouse. It appears reasonable that the nose, a symbol of dignity and respect in many societies throughout antiquity, should be among the first as well as a recurring subject in the history of plastic and reconstructive surgery.
In his Samhita, or encyclopedia, the Hindu author Sushruta first described both a reconstruction of the earlobe using skin from the cheek and a traditional method of reconstructing the nose, commonly referred to since as the “Indian” or “Hindu” method. This involved the use of a pedicle flap either from the forehead or the adjacent cheek as the tissue source for reconstruction. Whether this original “Indian” method used a pedicle cheek flap rather than a forehead flap, as commonly is reported by historians, remains unclear. However, translations of the Samhita from its original Sanskrit indicate that the cheek was probably the preferred source for the nasal reconstruction flap.
I now narrate the proper method of constructing a nose of one whose nose is mutilated. A careful physician having taken a plant leaf of the size of the nose of that person, and having cut adjoining cheek according to that measurement, and having scarified the nose tip should attach it to the nose tip and quickly join it with perfect sutures…When the healing is complete and the parts united, remove the excess skin. If the nose is smaller than required, try to increase it; if it is in excess, trim it.
While early research originally dated Sushruta's work at approximately 600 BC, modern historians dispute this, placing its first writing anywhere from 400 BC to the first century AD. Whatever the true date, Sushruta unquestionably was an important early contributor of actual reconstructive technique to the specialty of plastic surgery.
The use of full-thickness free skin grafts also has been cited as an interesting and alternate method of nasal reconstruction used by Indian surgeons. This technique, along with the pedicle flap nasal reconstruction, was performed by the Koomas caste of tile and brick makers. It reportedly entailed the use of a free autogenous full-thickness skin graft harvested from the gluteal region and applied to the nasal defect. If accurate, such a technique predates the first “officially” successful autogenous skin graft, cited by Reverdin in 1869, by more than 2 millennia.
Whether full-thickness free skin grafting truly was practiced or even feasible in ancient India always has been in doubt. If this technique did exist, why is there no evidence that it was practiced throughout the ages and into recent history, as with the traditional Indian method using the cheek or forehead flap? As reported by Haube and Koch in 1941, “if it was actually carried out, it remains an achievement that the surgeons of today have not been able to equal.”
Buenger reportedly performed a successful reproduction of this technique in 1821. No matter what the original technique, these early methods of nasal soft tissue reconstruction appear even more incredible when considering that Indian surgeons likely had practiced them for many years, perhaps many generations, prior to their being described in the literature.
Hellenistic, Roman, and Byzantine reconstructive efforts
Whether these Hindu methods of facial reconstruction spread immediately throughout the ancient world or largely remained the secret of their creators until later centuries, when more certain connections between Western and Indian civilization can be documented, is unclear. While the sharing of medical knowledge between Greek and Indian civilizations reportedly existed even earlier than Alexander the Great's expedition to India in the fourth century BC, the transfer of such reconstructive technique prior to the seventh century BC, although likely, has never been confirmed.
This remains an interesting question, considering that several Hellenistic and Roman physicians described the care and surgical correction of various facial defects in a manner similar to that of their Indian counterparts. Aulus Cornelius Celsus, considered by many to be the greatest Roman medical writer, included similar techniques to repair mutilated lips, ears, and noses in his classic medical text of the first century, Demedicina. Therefore, despite the inability to demonstrate a direct transfer of reconstructive methods, the influence of Indian medicine in this age cannot be discounted.
The royal Byzantine physician Oribasius, whose contributions to plastic surgery are found in his comprehensive medical encyclopedia entitled Synagogue Medicae, followed Celsus in the fourth century. Within this 70-volume text, which encompassed the broad sum of existing Roman and Hellenistic medical knowledge, Oribasius devoted two chapters to the reconstruction of facial defects. He demonstrated his understanding of basic reconstructive principles, including the importance of tensionless suture lines, the debridement of exposed bone to aid in the healing of overlying skin, and the use of flaps to avoid the distortion of facial features associated with primary closure.
Oribasius described in detail the use of bipedicle advancement flaps for skin defects around the area of the eyebrow, ala, cheek, nasal dorsum and tip, columella, and ear. To create a square defect around the original wound in the design of this closure, he instructed the removal of healthy surrounding tissue, a rather bold suggestion for his time. Also of great significance was his technique of undermining the tissues prior to wound closure. He warned of skin necrosis if the skin alone was undermined, and instead advocated the inclusion of subcutaneous tissue when undermining to maintain blood supply and avoid necrosis.
Oribasius's techniques of alar and ear repair further demonstrated his thorough grasp of reconstructive knowledge. He understood the importance of cartilage on the underlying structure of the ear and nose and advocated removing a small amount of it when repairing defects to avoid buckling in the final result. His method of alar reconstruction used what may be the first superiorly based nasolabial flap, as described in this free English translation of the original Greek text, provided by Lascaratos and Cohen.
Egyptian physicians may be credited broadly as the earliest contributors to the modern specialty of reconstructive plastic surgery. The “Edwin Smith Papyrus,” the origins of which are dated at approximately 3000 BC, contains the first descriptions of the surgical management of facial trauma, including the treatment of mandibular and nasal fractures. Such descriptions are impressive for their age, for their basis on scientific principles, and for their departure from the superstitious attitudes of the time.
Many hundreds of years would pass before the true birth of reconstructive surgery occurred. Although the precise date is disputed by historians, the first recorded description of actual reconstructive plastic surgery may be traced back over 2600 years to the Sanskrit texts of ancient India. During this period such surgery was needed greatly, as acts of facial mutilation, especially of the nose, were perpetrated commonly in India and its surrounding territories by vicious bands of marauders as a method of visible and lasting humiliation.
The Hindu justice system also contributed to the need for reconstructive surgery by levying harsh penalties upon its subjects for various crimes, including amputation of the genitalia or nose of an unfaithful spouse. It appears reasonable that the nose, a symbol of dignity and respect in many societies throughout antiquity, should be among the first as well as a recurring subject in the history of plastic and reconstructive surgery.
In his Samhita, or encyclopedia, the Hindu author Sushruta first described both a reconstruction of the earlobe using skin from the cheek and a traditional method of reconstructing the nose, commonly referred to since as the “Indian” or “Hindu” method. This involved the use of a pedicle flap either from the forehead or the adjacent cheek as the tissue source for reconstruction. Whether this original “Indian” method used a pedicle cheek flap rather than a forehead flap, as commonly is reported by historians, remains unclear. However, translations of the Samhita from its original Sanskrit indicate that the cheek was probably the preferred source for the nasal reconstruction flap.
I now narrate the proper method of constructing a nose of one whose nose is mutilated. A careful physician having taken a plant leaf of the size of the nose of that person, and having cut adjoining cheek according to that measurement, and having scarified the nose tip should attach it to the nose tip and quickly join it with perfect sutures…When the healing is complete and the parts united, remove the excess skin. If the nose is smaller than required, try to increase it; if it is in excess, trim it.
While early research originally dated Sushruta's work at approximately 600 BC, modern historians dispute this, placing its first writing anywhere from 400 BC to the first century AD. Whatever the true date, Sushruta unquestionably was an important early contributor of actual reconstructive technique to the specialty of plastic surgery.
The use of full-thickness free skin grafts also has been cited as an interesting and alternate method of nasal reconstruction used by Indian surgeons. This technique, along with the pedicle flap nasal reconstruction, was performed by the Koomas caste of tile and brick makers. It reportedly entailed the use of a free autogenous full-thickness skin graft harvested from the gluteal region and applied to the nasal defect. If accurate, such a technique predates the first “officially” successful autogenous skin graft, cited by Reverdin in 1869, by more than 2 millennia.
Whether full-thickness free skin grafting truly was practiced or even feasible in ancient India always has been in doubt. If this technique did exist, why is there no evidence that it was practiced throughout the ages and into recent history, as with the traditional Indian method using the cheek or forehead flap? As reported by Haube and Koch in 1941, “if it was actually carried out, it remains an achievement that the surgeons of today have not been able to equal.”
Buenger reportedly performed a successful reproduction of this technique in 1821. No matter what the original technique, these early methods of nasal soft tissue reconstruction appear even more incredible when considering that Indian surgeons likely had practiced them for many years, perhaps many generations, prior to their being described in the literature.
Hellenistic, Roman, and Byzantine reconstructive efforts
Whether these Hindu methods of facial reconstruction spread immediately throughout the ancient world or largely remained the secret of their creators until later centuries, when more certain connections between Western and Indian civilization can be documented, is unclear. While the sharing of medical knowledge between Greek and Indian civilizations reportedly existed even earlier than Alexander the Great's expedition to India in the fourth century BC, the transfer of such reconstructive technique prior to the seventh century BC, although likely, has never been confirmed.
This remains an interesting question, considering that several Hellenistic and Roman physicians described the care and surgical correction of various facial defects in a manner similar to that of their Indian counterparts. Aulus Cornelius Celsus, considered by many to be the greatest Roman medical writer, included similar techniques to repair mutilated lips, ears, and noses in his classic medical text of the first century, Demedicina. Therefore, despite the inability to demonstrate a direct transfer of reconstructive methods, the influence of Indian medicine in this age cannot be discounted.
The royal Byzantine physician Oribasius, whose contributions to plastic surgery are found in his comprehensive medical encyclopedia entitled Synagogue Medicae, followed Celsus in the fourth century. Within this 70-volume text, which encompassed the broad sum of existing Roman and Hellenistic medical knowledge, Oribasius devoted two chapters to the reconstruction of facial defects. He demonstrated his understanding of basic reconstructive principles, including the importance of tensionless suture lines, the debridement of exposed bone to aid in the healing of overlying skin, and the use of flaps to avoid the distortion of facial features associated with primary closure.
Oribasius described in detail the use of bipedicle advancement flaps for skin defects around the area of the eyebrow, ala, cheek, nasal dorsum and tip, columella, and ear. To create a square defect around the original wound in the design of this closure, he instructed the removal of healthy surrounding tissue, a rather bold suggestion for his time. Also of great significance was his technique of undermining the tissues prior to wound closure. He warned of skin necrosis if the skin alone was undermined, and instead advocated the inclusion of subcutaneous tissue when undermining to maintain blood supply and avoid necrosis.
Oribasius's techniques of alar and ear repair further demonstrated his thorough grasp of reconstructive knowledge. He understood the importance of cartilage on the underlying structure of the ear and nose and advocated removing a small amount of it when repairing defects to avoid buckling in the final result. His method of alar reconstruction used what may be the first superiorly based nasolabial flap, as described in this free English translation of the original Greek text, provided by Lascaratos and Cohen.
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