A medieval physician: Amirdovlat Amasiatsi (1420-1495).

We aimed to acquaint the reader with a medieval physician, Amirdovlat Amasiatsi, who lived and practiced in the 15th century Anatolia. Amirdovlat wrote several books on medicine mainly focusing on phytotherapy and pharmacology using medicinal plants, animal-derived products and minerals. All his works were written in Middle Armenian, spoken Armenian language of the time. In his writings, Amirdovlat described unique recipes that represent a portrayal of medical knowledge and practice at the time in Anatolia where he lived and worked. He discussed the physical and therapeutic properties as well as geographic distributions of various plants and minerals, using different languages, mainly Turkish, Greek, Arabic, French and Persian. Amirdovlat's works not only enhanced our understanding of Armenian medical practices but also provided great deal of information on those of Ancient Greco-Roman as well as Islamic world, demonstrating close relationship of Armenian medicine with Greco-Roman and Islamic medicine. Amirdovlat accomplished this by amalgamating the past and contemporary practices of his time. In this regard, Amirdovlat's works, in particular "Useless for the Ignorant", are very unique playing a significant role in preserving traditions and heritage of different cultures.

Great teachers of Gaspare Tagliacozzi (1546-1599).

Gaspare Tagliacozzi successfully practised the art of plastic surgery in the sixteenth century and conducted a long series of precise observations on the basis of which he formulated detailed principles for rhinoplastic. He wrote the first complete description of nasal reconstruction using skin from the arm. Tagliacozzi's teachers at the University of Bologna during his student days remain largely unfamiliar, Giulio Cesare Aranzio, Ulisse Aldrovandi and Girolamo Cardano. Aldrovandi taught the 'ordinary', that is the principal course in natural philosophy. Aranzio taught the chief course in surgery and anatomy. Cardano taught a course in the theory of medicine. Their activity contributed to the slow move from Galenic teaching in medicine and the static acceptance of tradition in all science.

Current trends in breast reconstruction: survey of American Society of Plastic Surgeons 2010.

BACKGROUND: We conducted a retrospective survey of American Society of Plastic Surgeons to ascertain the current trends in breast reconstruction (BR). METHODS: Surveys were sent to 2250 active American Society of Plastic Surgeons members by e-mail with a cover letter including the link using Survey Monkey for the year 2010. In all, 489 surveys (a response rate of 21.7%) were returned. Three hundred fifty-eight surveys from respondents performing BR in their practices were included in the study. The survey included questions on surgeon demographics, practice characteristics, BR after mastectomy, number of BR per year, type and timing of BR, use of acellular dermal matrix, reconstructive choices in the setting of previous irradiation and in patients requiring postmastectomy radiation therapy, timing of contralateral breast surgery, fat grafting, techniques used for nipple-areola reconstruction, the complications, and physician satisfaction and physician reported patient satisfaction. Returned responses were tabulated and assessed. RESULTS: After prophylactic mastectomy, 16% of BRs were performed. In all, 81.2% of plastic surgeons predominantly performed immediate BR. In patients requiring postmastectomy radiation therapy, 81% did not perform immediate BR. Regardless of practice setting and laterality of reconstruction, 82.7% of respondents predominantly performed implant-based BR. Half of the plastic surgeons performing prosthetic BR used acellular dermal matrix. Only 14% of plastic surgeons predominantly performed autologous BR. Surgeons in solo, plastic surgery group practices, and multispecialty group practices preferred implant-based BR for both unilateral and bilateral cases more frequently than those in academic practices (P < 0.05). Overall, plastic surgeons in academic settings preferred autologous BR more frequently than those in other practice locations (P < 0.05). Of total respondents, 64.8% did not perform microsurgical BR at all; 28% reported performing deep inferior epigastric perforator flap BR. Pedicled transverse rectus abdominis myocutaneous flap was the most often used option for unilateral autologous reconstruction, whereas deep inferior epigastric perforator flap was the most commonly used technique for bilateral BR. The overall complication rate reported by respondents was 11%. CONCLUSION: The survey provides an insight to the current trends in BR practice with respect to surgeon and practice setting characteristics. Although not necessarily the correct best practices, the survey does demonstrate a likely portrayal of what is being practiced in the United States in the area of BR.

The history and illustration of anatomy in the Middle Ages.

This article reviews the influence of key figures on the pictorial representation of anatomy and the evolution of anatomical illustration during the Middle Ages until the time of the Renaissance, based on medical history books, journals and ancient medical books. During the early period in the Middle Ages, most illustrations were traditional drawings of emblematic nature, oftentimes unrealistic, not only because the precise knowledge of anatomy was lacking but also because the objective was to elucidate certain principles for teaching purposes. Five figure-series that came down to us through ancient manuscripts and textbooks represent the best examples of such traditional illustrations. With the advent of human dissection in the 13th and 14th centuries, a significant transformation in the depiction of anatomy began to project the practice of human dissection, as we see in the works of Mondino de Luzzi, Henri de Mondeville and Guido de Vigevano. After the invention of book printing in the second half of the 15th century, the reproduction of books was commonly practised and the woodcut made multiplication of pictures easier. Peter of Abano, Hieronymous Brunschwig, Johannes de Ketham, Johannes Peyligk, Gregory Reisch, Magnus Hundt, Laurentius Phryesen and many more included several anatomical illustrations in their treatises that demonstrated the development of anatomical illustration during the later Middle Ages.

Umbilical transposition in functional panniculectomy of the massive weight loss patient: is it aesthetic or medically necessary?

BACKGROUND: We review the procedures used in panniculectomy and explore the necessity of umbilical transposition when adequately treating the medical and functional problems associated with panniculus in the massive weight loss patient. METHODS: Thirty-five consecutive patients with symptomatic panniculus after massive weight loss undergoing panniculectomy during the time period from November 2008 to October 2010 at Denver Health Medical Center were retrospectively analyzed. Inclusion criteria consisted of insurance approval for the panniculectomy. All patients had persistent skin problems in the lower abdomen. Seven patients had additional skin problems in the skin around navel and/or mid-abdomen. Eleven patients complained of difficulty in performing activities of daily living. Nine patients had a concomitant ventral hernia repair. RESULTS: An infraumbilical panniculectomy was adequate in treating the medical and functional symptoms of the abdominal region in 3 patients with no need for umbilical transposition. The remaining 32 patients required a different procedure instead of only an infraumbilical panniculectomy. Among these 32 patients, 3 patients underwent panniculectomy with sacrifice of the umbilicus. Umbilical transposition following abdominal undermining was needed in the remaining 29 patients undergoing panniculectomy. CONCLUSIONS: Functional umbilical transposition was required to avoid unnatural displacement of the navel while treating chronic skin problems in the lower abdomen, or additional persistent skin problems around the navel or in the mid-abdomen, and to access the supraumbilical region, particularly for large ventral hernia repair during panniculectomy. Therefore, umbilical transposition in these cases was not aesthetic in nature but an integral part of achieving a functional surgical treatment.

Functional reconstruction of total lower lip defects using innervated gracilis flap in the setting of high-energy ballistic injury to the lower face: preliminary report.

BACKGROUND: Reconstruction of total full-thickness lower lip defects combined with extensive composite mandibular defects particularly in the setting of close-range high-energy ballistic injury presents a formidable challenge for the reconstructive plastic surgeon. While the fibular flap has been widely accepted for its usefulness in the reconstruction of composite mandibular defects, to date, there is no definitive widely established method of total lower lip reconstruction. The article presents authors' approach using innervated gracilis muscle flap for total lower lip reconstruction in the setting of high-energy gunshot injuries to the face. METHODS: Three patients underwent composite mandibular defect reconstruction using fibular osteocutaneous flap and functional lower lip reconstruction using innervated gracilis muscle flap. Lip lining was reconstructed using the skin paddle of the fibular flap. The external surface of the gracilis muscle was skin-grafted. Facial artery myomucosal flap provided vermilion reconstruction in two patients. RESULTS: All fibular (n=3) and gracilis flap transfers (n=3) were viable. An electromyographic study at 1 year postoperatively demonstrated successful re-innervation of the gracilis muscle. Starting at about 10 weeks postoperatively, patients exhibited voluntary lip movements and oral competence. In addition, all patients achieved near-normal speech, evidence of recovered protective sensitivity and satisfactory appearance. The mean follow-up was 16.1 months. CONCLUSIONS: Our preliminary report in three patients demonstrated that innervated gracilis muscle transfer combined with fibular flap provides a successful reconstruction of extensive composite mandibular and total lower lip defects resulting from gunshot injuries to the face. Oral continence was achieved by combination of regained tonicity and voluntary movement of the gracilis muscle following re-innervation and assistance of the cheek muscles on the gracilis muscle. The described technique was reliable and the results were promising.

Giulio Cesare Aranzio (Arantius) (1530-89) in the pageant of anatomy and surgery.

Giulio Cesare Aranzio in Italian (Julius Caesar Arantius in Latin) has not received full acclaim for his achievements in the field of anatomy and surgery that remain unknown to most physicians. His anatomical books Observationes Anatomicas, and De Humano Foetu Opusculum and surgical books De Tumoribus Secundum Locos Affectos and Hippocratis librum de vulneribus capitis commentarius brevis printed in Latin and additional existing literature on Aranzio from medical history books and journals were analysed extensively. Aranzio became Professor of Anatomy and Surgery at the University of Bologna in 1556. He established anatomy as a distinguished branch of medicine for the first time in medical history. Aranzio combined anatomy with a description of pathological processes. He discovered the 'Nodules of Aranzio' in the semilunar valves of the heart. He gave the first description of the superior levator palpebral and the coracobrachialis muscles. Aranzio wrote on surgical techniques for a wide spectrum of conditions that range from hydrocephalus, nasal polyp, goitre and tumours to phimosis, ascites, haemorrhoids, anal abscess and fistulae, and much more. Aranzio had an extensive knowledge in surgery and anatomy based in part on the ancient Greek and his contemporaries in the 16th century but essentially on his personal experience and practice.

Do plastic surgeons have cosmetic surgery?

BACKGROUND: Thoughts and attitudes of plastic surgeons about having cosmetic surgery on themselves remain obscure for the most part and pose an attractive subject to study. MATERIALS AND METHODS: A survey was distributed to a random sample of 2635 American Society of Plastic Surgeons member and candidate member surgeons to determine plastic surgeons' interest in both minimally invasive cosmetic procedures and cosmetic surgical procedures, selection of facility type, selection of surgeon, and their satisfaction level. RESULTS: There were 276 responses. Sixty-two percent of the plastic surgeons had undergone at least one type of minimally invasive cosmetic procedure. Female plastic surgeons had significantly more minimally invasive cosmetic procedures compared with male plastic surgeons (84.9 versus 57 percent; p < 0.05). The most common procedure was botulinum toxin type A injection (31.5 percent). Approximately one-third of plastic surgeons had at least one type of cosmetic surgery. The most common cosmetic surgical procedure was liposuction of the trunk and/or extremity (18.6 percent). Male plastic surgeons were more likely to have a procedure than men in the general population, and female plastic surgeons were less likely to have breast augmentation than the general population. The percentage of operations conducted by a plastic surgeon was 88.2 percent. The percentage performed by a nationally known surgeon was 45.3 percent; 75.9 percent of plastic surgeons selected a surgeon who was certified by the American Board of Plastic Surgery. The satisfaction rate was 90 percent. CONCLUSIONS: The survey provides insight on the stance of American Society of Plastic Surgeons member and candidate member surgeons on the subject. To the authors' knowledge, this is the first survey designed for this purpose.

Carl Nicoladoni and his contributions to scoliosis.

Carl Nicoladoni (1847-1902) studied medicine in Vienna and became Privatdozent in surgery in 1876. He accepted a chair as a Professor of Surgery at the university clinics of Innsbruck (1881) and Graz (1895). Nicoladoni has made significant contributions in the progress of surgery and performed a variety of operations in several surgical disciplines. However, his principal contributions are in the field of orthopedic surgery, in particular his excellent and detailed studies on scoliosis, based on thorough anatomic and kinetic investigation. His commitment to the research of scoliosis resulted in three books and three bigger treatises, all of which were printed in German. His earliest book was printed in 1882 and was on the torsion of the scoliotic spine, Die Torsion der Skoliotischen Wirbelsäule. Three bigger treatises on scoliosis entitled Die Architektur der Sskoliotischen Wirbelsäule (The Architecture of the Scoliotic Spine, 1889), Die Architektur der Kindlichen Skoliose (The Architecture of Juvenile Scoliosis, 1894), and Die Skoliose des Lendensegmentes (The Scoliosis of Lumbar Segments, 1894) were published in an anthology called Denkschriften der Kaiserlichen Akademie der Wissenschaften, a series of publications from the imperial academy of science. Two versions of his epical work, Anatomie und Mechanismus der Skoliose (Anatomy and Mechanism of Scoliosis) were printed. A larger edition printed in 1904 was part of the Bibliotheca Medica, a monumental series of various clinical books published around the beginning of the past century. The second version, a shortened one, with the same title was included in an anthology called Deutsche Chirurgie (German Surgery) and published in 1909. The purpose of this historical article is to discuss Nicoladoni's achievements in the field of scoliosis based on a detailed analysis of his books.

Review of the " Chirurgia" of Giovanni de Vigo: estimate of his position in the history of surgery.

Giovanni de Vigo, who was born in at Rapallo, Italy, lived in the early Renaissance period (1450-1525). In 1503, De Vigo became the personal surgeon to Pope Julius II. He wrote a surgical book, " Practica Copiosa in Arte Chirurgia," which was completed in 1514 and published in Latin. It was translated into English by Richard Traheron and printed by Edward Whytchurch in 1543. Vigo's " Chirurgia" consists of nine books ranging from a consideration of anatomy necessary for a surgeon, to sections on abscesses, wounds, ulcers, benign and malignant tumors, fractures and dislocations, pharmaceuticals, ointments and plasters, as well as sections on dentistry, exercise, diet, syphilis, among others. De Vigo introduces a novel approach for treating mandible dislocations and describes a trephine he invented, as well as a number of new instruments. Examination of his surgical piece demonstrates that he had a broad spectrum of knowledge in surgery based in part on the ancient Greek and Arabic medical literature but mainly on his personal experience. Giovanni de Vigo contributed significantly to the revival of medicine in the sixteenth century, and he can be considered as a bridge between Greek medicine of antiquity, Arabic medicine, and the Renaissance.

Paul of Aegina: landmark in surgical progress.

During the Byzantine period the most prominent medical personalities were Oribasius, Aetius of Amida, Alexander of Tralles, and Paul of Aegina (Paulus Aegineta). The last of the eclectic Greek compilers, Paul of Aegina (625-690 AD) was born on the island of Aegina and practiced medicine in Alexandria. He was the author of the Epitome of Medicine (seven books), which was first printed in Greek by the Aldine Press in Venice in 1528. The Syndenham Society of London published an English translation by Francis Adams of Banchory between 1844 and 1847. The most noteworthy of his Epitome is the sixth book on surgery. Paul was not only a scribe but also a highly capable surgeon. He was the quintessential student of the best medical authorities: Hippocrates and Galen in Greek and Roman medicine, respectively. He also displayed a peculiar genius in the field of surgery. He gave us novel descriptions of tracheotomy, tonsillectomy, catheterization of the bladder, lithotomy, inguinal hernia repair, abdominal paracentesis for ascites, and many other surgical procedures including reduction of breast size. He not only influenced those in his own era but had great influence on physicians such as Rhazes, Haly Abbas, Albucasis, Avicenna, and Fabricius ab Aquapendente, who lived in subsequent eras. This historical article emphasizes the role of Paul of Aegina in the history of surgery and provides a comprehensive review of his surgical treatise with original case examples that represent his contributions to surgical progress.