this ppt is about the origin of plastic surgery and its journey through the centuries

brief history of plastic surgery

1. HISTORY OF PLASTIC SURGERY Dr satish singh mch resident DKSPGI and Research institute

2. The term plastic was derived from a Greek word ‘ Plastikos ’ which means ‘to mould or to reconstruct.’ Plastic surgery is a recent discipline with old roots .

3. Ramesses II The first plastic surgery wasn't done on living beings, but was considered crucial to the Egyptians who were mummified They believed that facial structure was the only physical feature retained in the afterlife. Ramesses II, third ruler of the Nineteenth Dynasty of ancient Egypy , was known for his elongated nose, so to ensure he would be recognized as a king in the afterlife, bone and seeds were surgically inserted under the skin of his nose after the desiccation of mummification, to restore and exaggerate its original shape

4. Edwin Smith papyrus, the most ancient medical text. The papyrus is a later transcription (about 1650 BC) of an original manuscript dating from the Old Kingdom (between 3000 and 2500 BC). It describes 48 surgical cases, including wounds, fractures, dislocations, sores, and tumors, and suggests their potential management Mesopotamia is the region between the rivers Tigris and Euphrates (now approximately Iraq), cradle of the Sumerian civilization. Medicine was well developed, although strongly influenced by astrology and divination. During excavations of the Nineveh palace, a great library containing more than 30000 clay tablets with cuneiform inscriptions was discovered, 800 of them of a medical nature. They were written about 600 BC, although the text dates from around 2000 BC. A few of them deal with wound healing or congenital anomalies. “If a man is sick with a blow on the cheek, pound together turpentine, tamarisk, daisy, flour of Inninnu […] mix in milk and beer in a small copper pan; spread on skin and he shall recover.”4 Another tablet suggests the use of a dressing with oil for an open wound

5. Greek medicine was influenced by Hippocrates, the greatest physician of his time. Historians consider that Hippocrates was born in the island of Kos around the year 460 BC, and probably trained in medicine at the Asklepieion of Kos. In ancient Greece and Rome, the Asklepieion (Latin: aesculapīum ) was a healing temple, sacred to Asklepios , the Greek god of medicine. About 70 medical treatises, assembled during the Alexandrian era (third century AD), were attributed to Hippocrates. They form the so-called Corpus Hippocraticum

6. Sushrut Samhita is part of Atharva veda Written in 600 BC Sushrut taught surgery in Banaras University Reconstruction of nose by cheek flap , repair of cut earlobe, Piercing of ear lobe, repair of cut lip , skin graft, classification of burn and wound management Father of Plastic Surgery and Hippocrates of 6 th and 7 th BC

7. He described surgery under eight headings: bhedana (incision), chedana (excision), lekhana (scarification), vedhya (puncturing), esana (probing), ahrya (extraction), vsraya (drainage or evacuation), and sivya (suturing). The Sushruta samhita has two parts, first one is known as the Purva-tantra (have five sections) and the second one is known as the Uttara-tantra. These two parts together cover all the other specialties such as the medicine, geriatrics, pediatrics, ear diseases, diseases of the nose, throat, eye, aphrodisiacs, toxicology, and psychiatry.

8. He described rhinoplasty for a cut nose as follows: The leaf of a creeper, long and broad enough to fully cover the whole of the severed or clipped off part, should be gathered, 2) A patch of living flesh, equal in dimension to the preceding leaf should be sliced off from the region of the cheek. 3) After scarifying the severed nose with a knife, the flesh is swiftly adhered to it. 4) Insert two small pipes in the nostrils to facilitate respiration and to prevent flesh from hanging down. 5) The adhesioned part is dusted with the powders of Pattanga , Yashtimadhukam and Rasanjana pulverized together. 6) The nose should be enveloped in Karpasa cotton and several times sprinkled over with the refined oil of pure sesamum. 7) When the healing is complete and parts have united, remove the excess skin.

9. Various instrument used in vedic time

10. There was a second method of rhinoplasty in India as practiced by Tilemakers. This involved using a free graft from the buttock. The skin and the underlying tissue of the shape of the defect on the nose was beaten with wooden slippers and applied on the defect with some “cement ”

11. Sushrutas contribution to plastic surgery Rhinoplasty 15 different types of otoplasty Cheek flap for ear lobe repair Classification of ear lobe defects Congenital cleft lip and lip injuries Skin grafting

12. Sushruta contribution to plastic surgery Piercing children ear lobe with needle or awl Classification of burn into 4 degree, frost bite, heat stroke and lightning injuries Use of leeches to keep wound clot free Different types of bandaging using different type of medicaments

13. He implored surgeons to achieve perfect healing, characterised by the absence of any elevation or induration, swelling or mass, and the return of normal colouring . Sushruta gives an in–depth account and treatment of twelve varieties of fractures and six types of dislocations, which would confound orthopaedic surgeons today. He mentions principles of traction, manipulation, apposition and stabilisation , as well as post–operative physiotherapy. Sushruta described the urinary stones, varieties of stones, signs, symptoms, method of removal, operational complications as well as the anatomy of urinary bladder. Apart from all above, he had described the surgery of intestinal obstruction, perforated intestines, abdomen accidental injuries which involves the protrusion of omentum . His main contribution was towards the field of Plastic and Cataract surgery.

14. Through all of Sushruta’s flowery language, incantations and irrelevancies, there shines the unmistakable picture of a great surgeon. Undaunted by his failures, unimpressed by his successes, he sought the truth unceasingly and passed it on to those who followed. He attacked disease and deformity definitively, with reasoned and logical methods. When the path did not exist, he made one.” FRANK MCDOWELL

15. Period of Celsus First century AD He was a Roman encyclopaedist knows for his medical work. Compiled the eight books of medicine Plastic surgery for repair of nose, lip and ears Double pedicled advancement flap and a form of subcutaneous island flap Washing wounds with vinegar, removal of part of skull

16. Paul of Aegina 7 th century Byzantine Greek physician Author of medical compendium in 7 books Treatments for jaw and nasal fractures as well as hypospadias.

17. 14 th – 15 th century 14 th century Flemish surgeon Jehan Yperman : repair of harelips Serafeddin Sabuncuoglu : first illustrated surgical textbook in Turkish literature- eyelid problems, facial fractures, reduction mammoplasty Branca : cheek flaps for nasal reconstruction

18. 16 th century Tagliacozzi of bologna : author of decurtorum chirugia per institionem - delayed arm flap for nasal, ear and lip reconstruction Antonio, son of Branca : upper arm flaps for nose, ear and lips Vianeo family from Calabria : reconstruction of facial fractures

19. Tagliacozzi of bologna

20. 17th -18 th century Art of facial restoration was in much disrepute following false ideas and perceptions Reemergence from India : article published in Gentleman’s magazine in October 1794 in London

21. 19 th century Joseph Carpue : reconstructed 2 noses using Indian technique Von Graefe : “ Rhinoplasttik – reconstructed nose using 3 different method : lower eyelid reconstruction , cleft soft palate repair Dieffenback : leeches in nose reconstruction, bone flap for cleft of hard palate, nose creation in arm and transfer “ Die Operative Chirurgie ”

22. 19 th century Von Langenbeck : principles of modern cleft lip and palate surgeries Serre : advancement flap – French method of nasal reconstruction Dupuytrens : palmar fibromatosis, burn classification ( 6 degree according to depth , removal of lower jaw , wry neck treatment

23. 19 th century Z plasty : Denonvillers – lower lid ectropion Sir Astley cooper : 1 st human skin graft Jacques Reverdin : detached pinch grafts (STSG) Wolfe, Krause : full thickness grafts

24. 20 th century Morestin : French army surgeon – reconstruction, ear protrusion. Harold Gillies NZ Ent Surgeon – Father of modern plastic Surgery : tubed pedicle flap for facial reconstruction (done earlier by Filatov ) epithelial outlay technique, intranasal skin graft, replantation , cosmetic surgery, sex reassignment Kazanjian : IMF , facial clefts bone grafting for facial bone loss, prosthetic devices

25. He is called the "Father of Modern Plastic Surgery" (1882-1960). He was an otolaryngologist, golfer, motorist, fisherman, an actor, humorist, an artist with a brush as well as scalpel. He wrote 'Plastic surgery of face' (1920), and 'The principles & art of plastic surgery' (1957). He developed plastic surgery during his experience in World War-I at Aldersliot & Sidcup and World War- II at Basingstok . He described 16 principles of plastic surgery.

26. Principles of Plastic Surgery: 1. Observation is the basis of surgical diagnosis. 2. Diagnose before you treat. 3. Make a plan and a pattern for this plan. 4. Make a record- sketches and photographs. 5. The lifeboat- another flap or skin graft. 6. A good style will get you through- dexterity and gentleness. 7. Replace what is normal in normal position and retain it there. 8. Treat the primary defect first- borrow from Peter to pay Paul only when Peter can afford it. (Focus on the recipient site. Do not become preoccupied with the donor site. ) 9. Losses must be replaced in kind. 10. Do something positive. 11. Never throw anything away. 12. Never let routine methods become your master. 13. Consult other specialists. 14. Speed in surgery consists in not doing same thing twice. 15. After care is as important as planning. 16. Never do today what can honorably be put off till tomorrow-when in doubt, don't. (Procrastination principle).

27. These principles are to a large extent valid today except for the procrastination principle, which has largely been supplanted by the do it all at once’ principle-particularly for trauma and to a lesser extent even for cancer reconstruction.

28. Studied medicine at Gonville and Caius College, Cambridge University. During World War I he joined the Royal Army Medical Corps Inspired by work of Frenchman Auguste Valadier – Treating jaw wounds by experimenting with taking tissue from other parts of the body to reconstruct jaw. Later in Paris, he met surgeon Hippolyte Morestin . He saw him remove a tumour on a patient's face, and cover it with jaw skin. Gillies became enthusiastic about the work and on his return to England persuaded the army's chief surgeon and facial injury ward was established at the Cambridge Military Hospital, Aldershot. This rapidly proved inadequate and a new hospital devoted to facial repairs was developed at Sidcup, The Queen's Hospital opened in June 1917. There Gillies and his colleagues developed many techniques of plastic surgery.

29. Important work: Started face injury ward at the Cambridge Military Hospital, Aldershot. Started dedicated hospital for facial injuries - The Queen's Hospital, Sidcup. Organised and started many plastic surgery units in Britain. Brought importance of collaboration between Plastic surgery and surgical departments .

30. CONTRIBUTIONS: Defined principles that still guide the use of flaps and grafts. Bilateral and Unilateral Gillies Fan flap for Lip reconstruction. Cocked-hat (thumb- stall) flap for Thumb reconstruction. Hemi-Gilles Excision of upper lip to create Cupid’s bow. Start of microtia repair concept, buried costal cartilage under mastoid skin. Nasolabial turn in flaps. Tubed Pedicle flaps. L-strut bone graft for Midline nasal support.

31. Approach for Zygoma fracture management – Transcutaneous, Hair bearing temple. Gillies near-far pulley stitch for wound closure(In tension). Retrograde temporalis muscle transplantation in facial nerve paralysis. Carried out one of the first sex reassignment surgery. Face lift surgery initial techniques. Subcranial Le Fort III osteotomy, originally described by Gillies .

32. Other contributions: Invented the skin hook and needle holder. Endotracheal intubation for cleft lip and palate children. Post nasal inlay for syphilitic nose. Epithelial inlay for reconstructing eyelids and lining mouth. Up and down scalp flap for nasal reconstruction. Gull wing median forehead flap for nasal reconstruction. V shaped abdominal flap for syndactyly. Tube within a tube for penile reconstruction. Toe to finger transfer as a flap.

33. Starting as a separate speciality Education was not standardized Resistance from traditional Surgeons 1921:American association of oral and plastic surgery 1931:American society of plastic and reconstructive surgeons 1937 : American board of Plastic Surgeons

34. Dufourmentel : rhomboid flap, lower maxillary and condylar resection 1931: First journal – Revue de chirurgiae Plastique 1936: European Society of Structive Surgery Esser : Island flap

35. World war II Refinement in plastic surgery McIndoe : early skin grafting for burns Sterling Bunnell: Reconstructive hand surgery Converse : Scalping flap

36. Developments Earl Padgett & George Hood : development of dermatome Work on transplantation : Joseph Murray received noble prize for work on renal transplantation Millard and Marks: better approach to cleft lip and palate Paul Tessier et al : development of craniofacial surgery

37. Mcgregor groin flap , Bakamjians dp flap Ralph ger : Muscle flap Malt 1962 reattached an amputated arm Komatsu and Tamai 1968: digital replantation McClean and Buncke 1972: microvascular omental transfer

38. Development in Aesthetic surgery Sheen : improvement in rhinoplasty Cronin and Gerow : silicone gel Botswick : LD flap for Breast Reconstruction Hartrampf : RA for Breast reconstruction Illouz : Fat aspiration through hollow canulas

39. PIONEERS Norman Mcomish Dott : C shaped mouth gag for Plastic surgery Thomas Pomphret Kilner : incorporated anaesthetic tube in tongue depressor of Dott’s gag. He added spring coil to hold sutures in mouth gag. Suggested Z – Plasty of soft palte . Refused to divide posterior Platine vessels and freed them from their attachment at foramen Reed Dingman : Modified dots gag and framed rectangular gag David Ralph Millard , Jr: technique used in cleft lip and palate surgeries Professor Frantisek Burian : described an upper buccal sulcus flap to aid in two layer closure of alveolar cleft

40. Veau : advocated Ganzer’s incision , described nasal mucoperiosteal closure of hard palate and closure by metallic suture Wardill : described palatal insertion of superior constrictor muscle. He advocated transverse to longitudinal pharyngoplasty. He used three flap method for incomplete clefts and four flap method for complete clefts. He fractured the hamulus and divided posterior palatine vessels. Wardill and Kilner independently perfected V-Y retro positioning operations originally described by Veau . V-W-K is a four flap procedure for complete cleft of palate. described palatal insertion

41. Karl Thiersch: associated with "Thiersch's graft", a method of split-skin grafting that he developed. He was first to apply graft to a varicose ulcer. John Wolfe: described the full thickness graft. F.V. Esmarch: developed the bandage during the Franco- Prusian war to control hemorrhage . Sir Ivan Magill: designed one of the first endotracheal tube. John Watson: modified Humby's knife. F. Braithwaite: devised skin grafting knife with moveable rod.

42. the first kidney transplant was performed by Dr. Joseph Murray, a plastic surgeon at the Peter Bent Brigham Hospital in Boston,10 now the Brigham and Women’s Hospital. People are generally intrigued by this snippet of information. What was a plastic surgeon doing transplanting kidneys? How could this be? His practice as a plastic surgeon raised questions in his mind surrounding transplantation. His experience treating burn patients sent back from the war during World War II gave him wide exposure to skin grafting and raised issues of immune rejection that he would later find ways to address. In trying to work out the immunology of skin grafts, he moved to a single organ model, the kidney, in order to answer the question he had originally conceived. This culminated in the first successful kidney transplant performed from one twin to another by Dr. Murray at the Peter Bent Brigham Hospital in Boston in 1954. Having helped develop the specialty of transplantation, he went on to perform the world’s first successful allograft in 1959 and the world’s first cadaveric renal transplant in 1962. Dr. Murray ultimately returned to his roots, the practice of plastic surgery, and was awarded the Nobel Prize in Physiology or Medicine in 1990 for his contribution to the science of transplantation.

43. Plastic surgery In India Sushruta samhita and tilemaker method Maharaishoi Atreya modified the forehead flap Description of Rhinoplasty by Tribhovan and Keegan in late 19 th century 1945: maxillofacial surgical units at Kirkee and Secunderabad 1950 : Plastic surgery dept at Patna and Nagpur

44. 4 th century Vaghbhatt wrote ashtanga Sangraha and Astanga hridyans Description of rhinoplasty as done by Maharisahi Atreya emphasized on need on inner lining from nasal skin The Traditional Indian Method of Rhinoplasty’. This was kept a secret for centuries in India, and practiced by Marattas of Kumar near Poona, certain Nepalese families and Kanghairas of Kangra (Himachal Pradesh). Dr. S. C. Almast personally met the last Hakim of Kangra, Mr. Dinanath Kanghaira whose family was practicing the art of rhinoplasty since the war of Kurukshetra and at Kangra since 1440 AD. Those with cut noses and deformed noses due to leprosy and syphilis were operated by them. The patient was given wine to drink. A pattern of the defect was made on a paper.The forehead flap was folded in itself to form the inner lining.

45. The knowledge of rhinoplasty spread from India to Arabia and Persia and from there to Egypt and Italy in the 15th century. The translation of Sushruta Samhita done in Latin by Hessler in 1844 and in Arabic by Ibn Abi Usaybia (1203-1269 AD) and into German by Vellurs . Bhishagratna translated it in English in 1907. Cowasjee, was a bullock driver with the English Army in the war of 1792, and was made prisoner by Tipu Sultan, who cut off his nose and one of his hands. He joined the Bombay Army near Seringapatam. For about 1 year he remained without a nose, when he had a new one put on by a man near Poona.

46. In 1793 Mr. James Findlay and Mr. Thomas Crusoe who were surgeons at the British Residency in Poona in 1793 witnessed the operation on “Cowasjee” and reported the details of the operation in the Madras Gazette. The same operation on Cowasjee was later published in Gentleman’s magazine, London, Oct. 1794

47. Towards the end of the 19th century, two important works were published in India. One was titled “Rhinoplasty” by Tribhovandas Motichand Shah in 1889, who was then the Chief Medical Officer of Junagadh. He described over a hundred cases treated by him in 4 years and gave minute operative details and discussed the advantages of forehead rhinoplasty. He used paper to make a pattern and used anesthesia. The other book was “Rhinoplasty operations, with a description of recent improvements in the Indian method” by Keegan in 1900. Even today, the western world gives credit to India for rhinoplasty called as the Indian Rhinoplasty. This of course, later received a few modifications, but the basic principles as laid down by Sushruta remain the same.

48. In 1957 plastic surgery section of ASI attended by Dr Gillies MS degree in 1960 in Nagpur Dr C Balakrishnan gave Nagpur classification for cleft lip and palate In 1966 1 st microvascular surgery in human in world done by Dr Antia and Dr Buch In 1961 Dr Charles Pinto gave hole in one procedure in KEM hospital

49. Plastic Surgery in modern India owes a great deal to Sir Harold Gillies, Eric Peet and B.K. Rank for developing this speciality . In 1945, two Indian maxillofacial surgical units were established. No. l unit at Kirkee under Fitzgibbon and later under Gibson. No. 2 unit was at Secunderabad under Eric Peet. In 1946, Dr. C. Balakrishnan was posted at the No. 1 unit. The two units later merged to form a maxillofacial center for the Indian Army at Bangalore. In 1950, the first two Plastic Surgery departments were established in India. One at Patna under Dr. R. N. Sinha and the other at Nagpur under Dr. C. Balakrishnan. Sir Harold Gillies paid a visit to India and he was pleased with the work being done by Indian surgeons, especially Major Sukh, at the Armed Forces Medical College, Pune.

50. In 1955, the Govt. of India invited Mr. B. K. Rank, from Australia, to advise on the development of Plastic Surgery in India. He welcomed the idea of forming a plastic surgery section of Association of Surgeons of India. In 1957 Sir Harold Gillies visited India again. During his visit to Pune, he demonstrated various operations and techniques. He visited and lectured at several centre in various parts of the country, namely, Calcutta, Delhi, Patna, Jaipur and lastly Nagpur where he formally inaugurated the Plastic Surgery section of Association of Surgeons of India. The members were Dr. R. N. Cooper, Dr. C. Balakrishnan, Dr. M. Mukerjee , Dr. R. N. Sharma, Dr. N. H. Antia, and Dr. Hiveda .

51. The late Dr. C. Balkrishnan , was a devoted and dynamic plastic surgeon. He succeeded in establishing the first Department of Plastic and Maxillofacial surgery at the Govt. Medical College and Hospital, Nagpur. M. S. degree in Plastic Surgery was started in 1960, for the first time in India. Dr. Balkrishnan described Z- plasty for the nasal lining in cleft palate, classification of cleft lip and palate called as the “Nagpur classification” and skin grafting in total avulsion of testes. In the same year, another department of Plastic Surgery was established at Patna under Dr. R. N. Sinha. Later, two more departments were started at Calcutta under Dr. M. Mukerjee and at Lucknow under Dr. R. N. Sharma.

52. Dr. Antia, the 3rd generation trained Plastic Surgeon under Sir Harold Gillies worked at the Leprosy home in Khandala (near Pune) in 1958. He was the first surgeon to succeed in the integration of leprosy in general hospital practice. He is credited for chondrocutaneous advancement flap for the helical rim defect. Abdominal bipedicle flap for dorsal defects of hand was described by him. The unit at Sir J. J. Hospital, Mumbai, was started in 1959 under Dr. N. H. Antia. In 1964, Tata Trusts provided a substantial grant to carry out two projects - one on Leprosy and other on Burns. The world’s first microvascular surgery on humans, a free flap transfer using microvascular anastomosis was done in 1966 by Dr. Antia and Dr. Buch (Scandinavian journal of Plastic surgery 1977). In 1961, another plastic surgery unit in Mumbai was established at K. E. M. Hospital, under Dr. Charles Pinto. Eric Peet from Oxford was a regular visitor to this department for the first 3 months. Dr. Pinto advocated one stage repair of cleft lip and palate, called as the “Hole-in-one” procedure. Hole' word taken from the game of Golf where in first stroke the player pots the ball. "Pinto's modification of WardiII's repair" uses two long flaps instead of four flaps. In 1964 one more department was started in Mumbai at G. T. Hospital, under Dr. R. J. Manekshaw .

53. In 1963, Safdarjung Hospital, Delhi started a department of Burns, Plastic and maxillofacial surgery, with Dr. J. L. Gupta, as its head. Gradually, multiple centers in Plastic Surgery were established all over the country and various associations were formed

54. Burns association of India: 1971 Indian association of Hand surgery : 1974 Association of microsurgery reconstruction : 1992

55. In 1971, Burns Association of India was formed during the 1st Congress of Burns at the J. J. Hospital. Dr. M. H. Keswani was the secretary. Later under his leadership, the Burns Association flourished with contributions like potato peel dressings, prevention campaigns by way of radio and TV talks, small documentary ads, etc. “Pour water on Burns” has received worldwide popularity. In 1974, Indian society of surgery of the hand was formed with Dr. Ashok Sen Gupta as the president. A hand surgery unit was started at the Stanley Medical College at Madras under Dr. R. Venkataswami . Today it is one of the biggest and best hand surgery units in the world. Indian Society for Reconstructive Microsurgery was also formed at Madras in 1992 with Dr. R. Venkataswami as the president.

56. R. Venkataswami : He described the oblique triangular flap for fingertip injuries and staged neurovascular island flap from middle finger to the thumb. M. Narayanan: He described bilobar and trilobar forehead and scalp flap for reconstruction of oral cancer. K.S. Goleria : He popularised the 'Hole-in-one' repair of cleft lip & palate. Described modified Randall-Tennison method for the repair of cleft lip when the cleft is too wide or the lateral element too small. Described the application of skin graft after releasing trismus in submucous fibrosis. C. V. Mehendale : He devised collapsible vaginal mould for vaginoplasty. He developed a palate needle holder (generally useful for deep suture). He developed a pencil wire twister. He worked on the preparation of plaster moulages. He developed a new musical instrument "Anil Vadyam ”

57. Dr B.B. Joshi: described dorsolateral neurovascular skin flap of the finger. • Tendocutaneous dorsal finger flap. • Dorsal branch of digital nerve innervated cross finger flap. • Dorsolateral island skin flap to the fingertip, palmar and thenar skin flaps to the hand. • JESS fixator system. Dr S. Bhattacharya: Described medial upper arm fasciocutaneous flap for hand and forearm defect and island nasolabial flap. Dr R.L. Thatte : He is credited for • Venous flaps. • Cephalic venous flap. • Saphenous vein flap. • The combined use of the superficial external pudendal artery flap with a flap of the anterior rectus sheath for the simultaneous cover of dorsal and volar defects on the hand. • De- epithelialised turn-over flaps for "salvage" operations. • Two flag flaps based on the supratrochlear vessels for nasal reconstruction. Dr Ramakrishnan K.M.: Described denervated palmaris longus tendon as a skeletal muscle transplant in circumferential pharyngoplasty. Published many articles in field of burns and scars.

58. Dr Bhattacharya V.: • An island flap based on the anterior branch of the superficial temporal artery for perioral defects. • Retrograde perforator-based cross-leg fasciocutaneous flaps for distal leg and foot defects. • Angiographic evaluation of fasciocutaneous flaps. • Skeletonised retrograde distal perforator island fasciocutaneous flaps for leg and foot defects. • Per-operative evaluation of vascularity of various flaps by fluorescein technique. • Distal perforator based cross leg flaps for leg and foot defects. Dr Tripathi F.M. and Sinha J.K.: Described treatment by open palm technique for Dupuytrens contracture of the hand. Tripathi's contribution on lymphoedema is remarkable. Dr M.R. Thatte : Described venous flap, Use of type III venous flaps: single and multistaged procedures. Static and dynamic computerised radioactive tracer studies, vital dye staining and theoretical mathematical calculations to ascertain the mode of survival of single cephalad channel venous island flaps.

59. Dr Umesh Shah: Devised a skin graft mesher . Dr R.J. Manikshaw : Devised a metal dermabrader. Dr Atul Shah: Credited for: a) One in four FDS lasso for correction of claw deformity. b) Use of ring finger FDS for correction of ulnar claw deformity. Dr Sawhney: Work includes: a) Cleft lip repair (Tennison's modification). b) Classification of TMJ ankylosis based on pathological changes. Dr Ahuja RB: Contribution includes de- epithelialised 'turnover dartos flap', and remarkable work in field of burns, cleft and general plastic surgery.

60. Neube used fat graft for the first time 1893 Carrel described Triangular method of anastomosis in 1902 Microscope used first time in 1920 by Nylen and Holmgrenin 1920 Craniofacial clefts were described by Paul Tessier Neumann used rubber balloon as tisuue expander in 1957 Mathes and Nahai Gave classification of flap in 1981 The first hand transplant was performed in 1998 The first face transplant was conducted in 2005

61. No craftsman should work on an object without knowing it. Being the human body the object of the whole medical art, of which surgery is one of the instruments, it is obvious that a surgeon who practices incisions on the different areas of the body and on its limbs without being aware of their anatomy will never operate well.” - Henry de Mondeville

62. Thank you…..