Creativity in plastic surgery as a major contribution to medicine, surgery, and patient care.

All human beings are provided by nature with the ability not only to survive but also to improve the quality of life. A sort of brain plasticity allows us to adapt to new information and circumstances. This also accounts for what is called creativity. Due to its etymological roots in Latin, the word suggests that by means of imagination either a new idea of significant value may be ``created'' or an already existing and valid one may be improved, transformed, and applied so as to serve more purposes. As the German poet Goethe aptly observed, the ``birth'' of something new often requires the ``death,'' or the letting go, of old ideas. In the course of history, creativity has brought about changes, innovations and advances in all aspects of human life. Creativity, accompanied by talent, motivation and interest, patience and perseverance, self-confidence and courage, as well as the determination to overcome obstacles, is highly significant also in the field of medicine, in surgery, and, of course, in Plastic Surgery. Specific techniques and methods, invented by creative individuals and/or the research community, have contributed to a history of great innovations in Plastic Surgery and have also proved useful in other surgical institutions. Cooperation beyond the scope of 1 discipline has always been highly important, as it is the patient who is meant to profit from the products of creative minds in these fields. Two examples from my own experience shall serve to illustrate the vast scope of possibilities in the field of Plastic Surgery: cross-face nerve grafting and total reconstruction of a trachea.

Safe and sustainable: the extracranial approach toward frontoethmoidal meningoencephalocele repair.

OBJECTIVE Although rare, frontoethmoidal meningoencephaloceles continue to pose a challenge to neurosurgeons and plastic reconstructive surgeons. Especially when faced with limited infrastructure and resources, establishing reliable and safe surgical techniques is of paramount importance. The authors present a case series in order to evaluate a previously proposed concise approach for meningoencephalocele repair, with a focus on sustainability of internationally driven surgical efforts. METHODS Between 2001 and 2016, a total of 246 patients with frontoethmoidal meningoencephaloceles were treated using a 1-stage extracranial approach by a single surgeon in the Department of Neurosurgery of the Yangon General Hospital in Yangon, Myanmar, initially assisted by European surgeons. Outcomes and complications were evaluated. RESULTS A total of 246 patients (138 male and 108 female) were treated. Their ages ranged from 75 days to 32 years (median 8 years). The duration of follow-up ranged between 4 weeks and 16 years (median 4 months). Eighteen patients (7.3%) showed signs of increased intracranial pressure postoperatively, and early CSF rhinorrhea was observed in 27 patients (11%), with 5 (2%) of them requiring operative dural repair. In 8 patients, a decompressive lumbar puncture was performed. There were 8 postoperative deaths (3.3%) due to meningitis. In 15 patients (6.1%), recurrent herniation of brain tissue was observed; this herniation led to blindness in 1 case. The remaining patients all showed good to very good aesthetic and functional results. CONCLUSIONS A minimally invasive, purely extracranial approach to frontoethmoidal meningoencephalocele repair may serve well, especially in middle- and low-income countries. This case series points out how the frequently critiqued lack of sustainability in the field of humanitarian surgical missions, as well as the often-cited missing aftercare and dependence on foreign supporters, can be circumvented by meticulous training of local surgeons.

Primary simultaneous lip and nose repair in the unilateral cleft lip and palate.

BACKGROUND: "Do not touch the nose in primary repair of the unilateral cleft lip and palate!" In the past, this dogmatic attitude caused functional and aesthetic (psychological) problems for the child until secondary corrections during adolescence were performed. In the 1950s, surgeons started to correct at least a few features of the nasal deformity and to develop radically corrective measures. Since 1970, a new and very comprehensive concept of correction has been used at the authors' department of plastic and reconstructive surgery. METHODS: Methods of primary nasal repair by various surgeons are presented chronologically. The main features of the authors' strategy are special incision lines, extensive mobilization of all dislocated structures, straightening of the deviated septum, correction of the deformed ala and nasal tip, induction of bone growth in hypoplastic areas under the alar base and along the piriform aperture, and a special suture technique of the orbicularis muscle to form a better philtrum. RESULTS: Improvement of the aesthetic and functional results can be achieved with this type of nasal repair. Since 1970, approximately 500 patients have been operated on with this method at the authors' hospital and elsewhere, with 80 percent showing satisfactory results and 20 percent revealing deficiencies. Severe nasal deformities, which were common when no primary repair was applied, were not observed. This observation period provides evidence that no growth retardation occurs. CONCLUSIONS: Because of the good results of this method and the lack of growth retardation, this approach is to be recommended. It also benefits children in underdeveloped countries, where frequent surgery is not possible.