Trascendencia de la cirugía plástica y la rinoplastia en la historia y la filosofía de la medicina / Transcendence of plastic surgery and rhinoplasty in the history and philosophy of medicine

Se explica el origen de los términos cirugía plástica y rinoplastia, así como los inicios de la especialidad y de esta cirugía nasal. Se exponen cuáles fueron las necesidades que atendieron y qué lugar ocuparon la reparación y la reconstrucción en la historia y la filosofía de la medicina. La cirugía plástica se instaló como la disciplina quirúrgica encargada de buscar la recuperación de la identidad perdida. (AU)

The origin of the terms of "plastic surgery" and "Rhinoplasty" is explained, as well as the beginning of the specialty and this nasal surgery. It explains what his need was and how he filled that gap, the repair and reconstruction in the history and philosophy of medicine. It was installed as the surgical discipline in charge of seeking the recovery of the lost identity. (AU)

The Untold Story of the First Hand Transplant: Dedicated to the Memory of one of the Great Minds of the Ecuadorian Medical Community and the World.

BACKGROUND: In 1964, faced with the challenge of traumatic amputation, a team of surgeons at Clinica Guayaquil was convinced that the transplantation of a hand could significantly improve function and quality of life for the recipient. With a current but basic understanding of immunosuppression, the surgeons identified a recipient and waited for the correct donor. A human hand transplant had never been performed to date. METHODS: The surgeons' criteria for the recipient included a young healthy individual who had sustained a traumatic amputation at the distal forearm level with full motion of the proximal joints. Communication with receiving hospitals and military facilities identified what they perceived to be a feasible donor for an allograft transplantation. Consent was obtained from the family in conjunction with the local military medical authorities and the clergy. Iced saline solution and Heparin irrigation were to be used to prepare the donor extremity. The immunosuppression regimen, limited at the time, consisted only of intravenous cortisone, Imuran, and a single dose of radiation. RESULTS: A member of the Ecuadorian marine sustained a limited blast injury that amputated his dominant hand but spared the forearm. He was transferred to the emergency department of Clinica Guayaquil. A donor who had recently died in a nearby hospital was identified not long after. A successful technical surgical transplantation was achieved. Consultants from major hospitals around the world (including Peter Bent Brigham Hospital) convened at the patient's bedside to observe the results. Despite all efforts, the patient suffered an irreversible rejection at 21 days post-transplant. CONCLUSION: This was the first allograft transplantation of a hand. The surgeons embarked on an intervention never tried before, firmly believing that better function and quality of life would result. The bravery of this surgical team was commendable. This early surgical endeavor opened the way for future successes in transplant surgery today.

The Paramedian Forehead Flap for Nasal Reconstruction: From Antiquity to Present.

Nasal reconstruction is considered the historic foundation of facial plastic surgery, and the forehead flap remains the workhorse of repair. To recreate both the aesthetic contour and function of the nose, all anatomic layers must be addressed-covering, lining, and structural support. This article reviews the noteworthy history underlying the development of the paramedian forehead flap as the primary tool in reconstruction of large nasal defects while highlighting its implications on modern nasal repair. Current developments in the use of 2-staged paramedian forehead flap reconstruction are examined and a modern technique is presented.

História da Cirurgia Plástica: Sir Harold Gillies, pioneiro da cirurgia plástica reconstrutiva / History of plastic surgery: Sir Harold Gillies, a pioneer of reconstructive plastic surgery

Historicamente, as guerras foram um dos maiores catalisadores para o avanço da Medicina, e especialmente da cirurgia. Sem dúvida, a maior autoridade da Cirurgia Plástica nas primeiras décadas do século XX foi o neozelandês radicado na Inglaterra Sir Harold Delf Gillies, que se destacou pelo tratamento de pacientes com lesões faciais no contexto da I Guerra Mundial. Nosso artigo faz uma análise da vida pessoal e do legado que Gillies deixou para a cirurgia plástica e reconstrutiva moderna; muitos de seus ensinamentos são atemporais e servem de reflexão para cirurgiões da atualidade.

Historically, wars have been among the greatest catalysts for advances in medicine in general, and surgery in particular. Without doubt, the greatest practitioner of plastic surgery in the early decades of the twentieth century was Sir Harold Delf Gillies, a New Zealander living in England, who advocated the treatment of patients with facial injuries in the context of the First World War. This article examines Gillies' personal life and the legacy he left for modern plastic and reconstructive surgery; many of his teachings are timeless and serve as an inspiration for the surgeons of today.

The Chimera Flap: A Quarter Century Odyssey.

Incredibly complicated multidimensional defects have always strained the ingenuity of the reconstructive surgeon. Secondary perhaps to vascularized composite allotransplantation as a solution to this dilemma, the compound flap has been developed to be a more useful and available alternative. Their greatest versatility has been proven by its subtype, the chimera flap. The chimera flap itself consists of multiple flaps, the latter possibly composed of bone, skin, muscle, and so on, where each part has an independent vascular supply, and each part is independent of any physical interconnection whatsoever with the other components, except where joined ultimately only to a common vascular pedicle. An appellation for this concept was first introduced a quarter century ago in this very journal, a time frame now the impetus for a recapitulation of its origin and subsequent history that proves that it has eventually withstood the test of time and has been successfully assimilated into the reconstructive repertoire.

Reconstrucción mamaria post-mastectomía: contribución de cirujanos plásticos argentinos / Post- mastectomy breast reconstruction: contribution of argentine plastic surgeons

Se describen los inicios -a finales del siglo XIX- de las técnicas de reconstrucción mamaria post-mastectomía. Se enumeran las técnicas más importantes que las continuaron y quiénes las crearon en el mundo. Se destacan los aportes de dos cirujanos plásticos argentinos, Julián Fernández (1965) y Enrique Gandolfo (1982), que utilizaron tejidos autólogos del abdomen, colgajos dermograso con abordaje vertical y musculo-cutáneo con abordaje horizontal, respectivamente.

Early (late nineteenth century) techniques post-mastectomy breast reconstructions are described. Techniques that continued and its creators in the world are listed. The contributions of two plastic surgeons from Argentina, Julian Fernandez (1965) and Enrique Gandolfo (1982), who used autologous tissue from the abdomen, dermofat flaps vertically approach and musculocutaneous flaps with horizontal approach, respectively stand.

[From Tansini to Angrigiani: improvement and refinement of the thoracodorsal flap]. / De Tansini à Angrigiani : amélioration et raffinements du lambeau thoracodorsal.

Flap surgery is the art of transposing an autonomous vascularised tissue, from a donor site to a distant recipient site. It was born 2000 years ago in India, evolving from random flaps to microsurgical flaps with a skeletonised vascular pedicle. This evolution was possible through the knowledge of cutaneous vascularisation and allows today the spreading field of perforator flaps. Writing the story of any particular flap is, in fact, looking back to understand the global concept and evolution of flaps surgery. Therefore the authors detail every step of the development and technical improvement of the thoracodorsal flap from the classical musculocutaneous latissimus dorsi flap to one of its latest achievement, the thoracodorsal perforator flap. This story helps us to appreciate the armamentarium of thin and low donor site morbidity flap that perforator flaps offer to us.

Plastic surgery: personal recollections, contributions, and some thoughts: the Ohmori lecture: 18th I.S.A.P.S. Congress, Rio De Janeiro--2006.

Professor Ivo Pitanguy is Head Professor of the Plastic Surgery Departments of the Pontifical Catholic University of Rio de Janeiro and the Carlos Chagas Institute of Postgraduate Medical Studies. He also is a member of the Brazilian Society of Plastic Surgery, the National Academy of Medicine, and the Brazilian Academy of Letters, as well as Visiting Professor of the International Society of Aesthetic Plastic Surgery (ISAPS). He is a Fellow of the American and the International College of Surgeons (FICS, FACS). He also is the Honorary President of the Alumni Association of Professor Ivo Pitanguy, and has recently been declared the Patron of Plastic Surgery in Brazil through a unanimous vote by the Brazilian Society of Plastic Surgery.

The dawn of plastic surgery in Mexico: XVIth century.

An aspect of early Mexican surgery in the sixteenth century is presented. The treatment of facial wounds by Alonso Lopez de Hinojosos and Agustin Farfán is reviewed. Farfán proposed total nose reconstruction, with a cutaneous arm flap, 18 years before its description in De Curtorum Chirurgia, by Tagliacozzi, in 1597 in Venice, Italy. The chapter on facial wounds by Lopez de Hinojosos and Farfán shows their concern for the final aesthetic results and should be considered the first Mexican publication in the field of plastic surgery.

History of surgery in the rehabilitation of the tetraplegic upper limb.

Surgery in the tetraplegic upper limb made tremendous strides during the last half of the 20th century, inspiring the motivation and creativity of hand surgeons to restore upper limb functions in one of the most unfortunate complications of trauma. Undoubtedly, the future will provide new tools to improve the surgeons' challenge. Meanwhile, they must proceed with meticulous clinical examinations, determine the level of the spinal cord lesion and the muscles available for transfer, and select the most appropriate and proven surgical procedures for each patient.

Cirugía reconstructiva dorsal ancho / Reconstructive surgery wide dorsal

La reconstrucción mamaria post-mastectomía ha sido universalmente aceptada y tiene ya su lugar en el arsenal terapéutico del cáncer de mama. Los cirujanos han perdido el temor al enmascaramiento de recidivas tempranas y se han concientizado del beneficio psicológico que se brinda a la paciente con este tipo de operaciones. Es evidente que los actuales métodos de diagnóstico con que disponemos nos permiten detectar carcinomas de mama en estadios más tempranos, lo que posibilita obtener sobrevidas similares con operaciones menos mutilantes. No obstante, la mastectomía no ha perdido vigencia en el correcto tratamiento de cáncer mamario y es así que la seguimos practicando en el 43 por ciento de nuestras pacientes y es a ellas a quienes tenemos la obligación de informar acerca de estos procedimientos reconstructivos