History of Plastic Surgery ~ Part IV (09-2004)
Albeit that developments in plastic surgery continued to focus on nasal reconstruction, there were also many other advances, upon which other areas of modern plastic surgery had their foundation. To name a few . . . skin grafting, maxillofacial surgery and burn treatment were areas in which there was significant development over the last several centuries.
Developments in Cleft Lip Repair
Cleft lip repair traces it roots as far back as the fourth century and saw significant development over the last four centuries. Initially the procedure involved trimming the edges of the defect and stitching them together. In the 16th century, the procedure was practiced in two stages. The first step made use of a sharp instrument or cautery to "neaten" the edges. In the second step the surgeon performed a delayed approximation with a "harelip needle." It was during this period as well that the use of full-thickness sutures came into use a replacement to "simple pinning."
In a surgery textbook written by James Cooke in 1693, he affirms the then current belief that cleft lip was "usually caused by some Frights and strong Fancies." He also describes his procedures for surgical repair of unilateral and bilateral cleft lip. He strongly warned that cleft lip repair was more dangerous to perform on adults than on children and emphasized the need for rest after the surgery was concluded. The latter half of the19th century saw additional contributions in honing the procedures involved in cleft palate repair which increased the aesthetic results that surgeons were able to achieve.
In contrast, developments in cleft palate repair were limited to the repair of the soft palate. This was due to the fact that general anesthesia was not yet in use. Not until 1816 was the first successful soft palate repair accomplished. In the 20th century, two-stage repairs came into use and bone grafting, first performed in 1908, remains in use today.
Skin Grafting
The practice of skin grafting also originated with ancient civilizations. There are records of more than 2500 years ago that detail ancient Hindus use of free skin grafts as a tissue source in nasal and facial reconstruction. Although some scientific historians question whether such grafting was possible in ancient times, they agree with the report that details a 1570 description of a successful skin auto graft did take place.
At the latter part of the 18th century, scientist/physicians began experimenting with skin grafting in sheep and successfully performed large free autogenous skin transplants to varying sites on the sheep. As a result of these experiments, the first successful human skin graft took place in 1817. There are, however, records of many unsuccessful attempts at free skin grafting, during the 19th century and the clinical importance of grafting did not come to center stage until1869, when reports detail the use of small, split-thickness grafts to increase the rate of healing of granulating wounds. It was shortly thereafter (1872) that the name "skin" graft became part of the vernacular.
Advancements continued with the recognition that immediate grafting was possible over a fresh surgical wound and full-thickness grafts came into clinical use, followed by improved techniques of split-thickness skin grafting. The calibrated knife, a primitive mechanical skin harvesting device developed in 1920, was replaced by a more advanced skin grafting knife whose use was combined with a suction apparatus for removing the graft.
The dermatome came into use in 1939. It was a tool that allowed the surgeon to quickly, accurately and uniformly create splitthickness skin grafts. It revolutionized the treatment of open wounds and burns, and remains one of the most important tools of the plastic surgeon.
Developments in Cleft Lip Repair
Cleft lip repair traces it roots as far back as the fourth century and saw significant development over the last four centuries. Initially the procedure involved trimming the edges of the defect and stitching them together. In the 16th century, the procedure was practiced in two stages. The first step made use of a sharp instrument or cautery to "neaten" the edges. In the second step the surgeon performed a delayed approximation with a "harelip needle." It was during this period as well that the use of full-thickness sutures came into use a replacement to "simple pinning."
In a surgery textbook written by James Cooke in 1693, he affirms the then current belief that cleft lip was "usually caused by some Frights and strong Fancies." He also describes his procedures for surgical repair of unilateral and bilateral cleft lip. He strongly warned that cleft lip repair was more dangerous to perform on adults than on children and emphasized the need for rest after the surgery was concluded. The latter half of the19th century saw additional contributions in honing the procedures involved in cleft palate repair which increased the aesthetic results that surgeons were able to achieve.
In contrast, developments in cleft palate repair were limited to the repair of the soft palate. This was due to the fact that general anesthesia was not yet in use. Not until 1816 was the first successful soft palate repair accomplished. In the 20th century, two-stage repairs came into use and bone grafting, first performed in 1908, remains in use today.
Skin Grafting
The practice of skin grafting also originated with ancient civilizations. There are records of more than 2500 years ago that detail ancient Hindus use of free skin grafts as a tissue source in nasal and facial reconstruction. Although some scientific historians question whether such grafting was possible in ancient times, they agree with the report that details a 1570 description of a successful skin auto graft did take place.
At the latter part of the 18th century, scientist/physicians began experimenting with skin grafting in sheep and successfully performed large free autogenous skin transplants to varying sites on the sheep. As a result of these experiments, the first successful human skin graft took place in 1817. There are, however, records of many unsuccessful attempts at free skin grafting, during the 19th century and the clinical importance of grafting did not come to center stage until1869, when reports detail the use of small, split-thickness grafts to increase the rate of healing of granulating wounds. It was shortly thereafter (1872) that the name "skin" graft became part of the vernacular.
Advancements continued with the recognition that immediate grafting was possible over a fresh surgical wound and full-thickness grafts came into clinical use, followed by improved techniques of split-thickness skin grafting. The calibrated knife, a primitive mechanical skin harvesting device developed in 1920, was replaced by a more advanced skin grafting knife whose use was combined with a suction apparatus for removing the graft.
The dermatome came into use in 1939. It was a tool that allowed the surgeon to quickly, accurately and uniformly create splitthickness skin grafts. It revolutionized the treatment of open wounds and burns, and remains one of the most important tools of the plastic surgeon.
