Introduction to Plastic Surgery

Although repair is essential to all fields of surgical work, plastic surgery (from the Greek word ‘Lastikos’, meaning to mold, or to shape) is the surgery of repair. Due to the importance of reconstruction in this surgery, plastic surgeons have self–consciously added the qualifier “Reconstructive” to plastic surgery. The plastic surgeon treats patients with somatic deformity inflicted by nature, such as the congenital malformation of Crouzon’s disease, cleft lip and palate, or hemi–facial microsomia, or patients with deformities left in the wake of trauma, bums, avulsion injury, excision of a neoplasm, or irradiation. In a large surgical center, the plastic surgeon also plays a supporting role for other surgical areas when special repair and reconstruction is needed, e.g. the perineal wound after a proctocolectomy for Crohn’s disease, the pharyngocutaneous fistula complicated by irradiation, the bronchopleural fistula in the obdurate empyema cavity, the open median sternotomy wound, or the open tibia of chronic osteomyelitis.

The field of plastic surgery as an organized discipline which breathed its first during the First World War, when hospitals in the U.K. were confronted with unprecedented numbers of complex war wounds. Facial injuries presented a particular problem with difficulties in eating, speaking and even in administering an anesthetic. In addition, sometimes the extreme disfigurement of many victims was a powerful incentive to concentrate these cases in special units in an effort to provide the best possible care.

Harold Gillies, a young ENT surgeon, headed (and established) the first such specialized unit at ‘The Queens Hospital’, Sidcup. Many of the subsequent ‘Fathers’ of plastic surgery in the USA and the Commonwealth received training in this unit at some stage during the War. Dr. Vilray Blair, of St. Louis, a general surgeon who had a national reputation for surgery of the face, mouth, and jaws, was made chief of plastic and maxillofacial surgery in the United States Army. Dr. Robert Ivy, of Philadelphia, who had degrees in both dentistry and medicine and was also a plastic and maxillofacial surgeon, was second in command.

From these origins plastic surgery emerged as a reconstructive discipline associated with the rehabilitation of soldiers disfigured from trench warfare. Aesthetic surgery – This being the last area has attracted a great deal of popular attention in recent years, and there has certainly been an explosion of new technology and techniques. Apart from countering the ravages of age and gravity, many ‘Cosmetic’ techniques can be applied to deformities acquired less happily. Moreover, it can become an extremely difficult matter to define that line which separates the purely vain from the truly deformed.