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Plastic surgery: a story of transformation and life. First part

Plastic surgery: a story of transformation and life.

First part


The essential nature of being human implies the pursuit of fulfillment through self-improvement. From its beginnings, mankind has sought to overcome obstacles and improve life in all spheres: biological, psychological, and social. In the struggle to preserve, restore, and enhance form and function, plastic surgery is undoubtedly one of the oldest healing arts of humanity.


The origins of plastic surgery are lost in the mists of history, but the ancient Egyptians provide us with the first clues. There is evidence of surgical procedures used for the reconstruction of facial wounds about 4,000 years ago. The Edwin Smith Papyrus, the oldest medical document that has survived to our time, was written between 3,000 and 2,500 years before our era and details the cases of 48 patients, all of surgical nature, including wounds, fractures, dislocations, ulcers, abscesses, and tumors. Three of the cases describe procedures for repairing nasal fractures, and others refer to the way to treat injuries in the neck, upper limbs, thorax, and spine.


Another great civilization where there was a spectacular advance in plastic surgery was India. In the 7th century BC, amputating the nose or ears to punish adulterers, criminals, or those defeated in wars was a very popular practice. Sushruta, the most notable of the surgeons of his time, devised an ingenious method to reconstruct the nose: he used a flap of forehead skin, rotated and sutured to the rest of the existing nose. When this skin had adequately integrated into its new bed, he cut the pedicle and returned the excess to its place of origin (fig. 1). Incredibly, this procedure, originated 2,800 years ago, continues to be used today - with minimal variations - by plastic surgeons around the world.


Fig. 1. Indian flap


This knowledge was translated into Arabic, adopted by some of the great physicians of the Middle East like Avicenna and Abulcasis, and later transmitted to Greece and Italy. In the 1st century of our era, Celsus, in his book "De Re Medica", writes about tissue transplantation. A century later, Galen of Pergamon, as stated in one of his more than 600 treatises, “Corpus Medicorum Graecorum”, gives precise instructions for the reconstruction of facial defects, as well as how to address the multiple wounds suffered by gladiators – those few who managed to survive.


With the fall of the Western Roman Empire and the advent of the Middle Ages, humanity fell into a long period of darkness, during which advances in all branches of science almost completely halted. Pope Innocent III, in 1215, proclaimed the "blood bull", which strictly prohibited doctors from practicing surgery and dissecting corpses, considering them barbaric acts that desecrated the human body.


It was not until the Renaissance that a new era of advances in the field of plastic surgery emerged. Gaspare Tagliacozzi (fig. 2), a famous Italian surgeon born in Bologna, published in 1597 his work "De Curtorum Chirurgia per Insitionem Libri Duo", where he describes a curious method to reconstruct the nose using a skin flap from the arm. In this book, Tagliacozzi describes the work of the plastic surgeon: "We restore, repair, and remake those parts of the body that nature gave but misfortune has taken away, sometimes not so much to delight the eye, but enough to lift the spirit and help the mind of the afflicted."


Fig. 2 Gaspare Tagliacozzi


Tagliacozzi, who also excelled in reconstructing patients with congenital defects, and is considered by many as the father of plastic surgery, was condemned by the Church for supposedly interfering with God's creation. His successes were attributed to the grace of Satan. His body was exhumed and buried in unconsecrated ground, and his work fell almost into oblivion until the 18th century.


"There are only two infinite things: the universe and human stupidity. And I'm not so sure about the first."

- Albert Einstein


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