Surgery Notes

Archive for 2010

At present it is accepted that the field of action is for plastic surgery:

- Burns and their sequelae

- Surgical treatment of tumors in all those areas where reconstruction is required by plasty or grafting

- Surgical treatment of external congenital malformations of the cranio-cervical-facial and other regions requiring plasty or grafting

- Surgical treatment of those regions which require soft tissue reconstruction

- Hand Surgery

- Cosmetic Surgery

It is a specialty “unique” in that it covers the entire body and has no defined anatomic area. Therefore includes many “subspecialties,” with each service a portfolio of specific services is marked by:

care needs of the population

the existence of other hospital services to treat the disease that overlaps with areas that handle plastic surgeons (ENT, COT, Maxillofacial, etc.).

or treatment of serious burns.
The be a specialty as broad contours involves two essential characteristics:

on one hand the high degree of synergy or areas of increased interaction with other specialties, services or levels of care where a good cooperation scheme leads to a greater benefit for the patient,

On the other hand the development, either internally or in collaboration with other specialties, a range of activities, process lines and units super-clinics (formally recognized or not).

Various global, European and Spanish define the specialty of Plastic Surgery. These include the IPRAS (International Confederation for Plastic Reconstructive and Aesthetic Surgery) as an association of 88 national societies worldwide promotes the advancement and scientific exchange, sponsors meetings and works to improve the standards of the specialty, and FILACP (Federation Ibero-Latin) which includes Spain and Portugal and all Spanish-speaking countries in the Americas Lusa.

In Europe highlights the EURAPS (European Association of Plastic Súrgenos). In addition, Plastic Surgery is one of 24 specialties members of the European Union of Medical Specialists (UEMS).

In Spain, the Spanish Society of Plastic, Reconstructive and Aesthetic Surgery (SECPRE) is to contribute with all means available to scientific and practical knowledge of Plastic Surgery. This mission is accomplished by holding scientific meetings, publication and periodic publication of the magazine “Ibero-Latin American Plastic Surgery” and untimely publications and organization of courses, conferences, meetings, exhibitions.

Plastic Surgery in the Modern Era

In the second half of the twentieth century grows extremely Plastic Surgery developing new reconstructive procedures as well as aesthetics. Reconstructive Surgery.

In one of the most important advances has been the birth and development of microsurgery. With the creation of micro-instruments, ultra fine suture materials and manufacture of surgical binocular microscope in the 50’s, microsurgery has revolutionized the field of reconstructive surgery.

Microsurgery has dramatically expanded the possibilities of reconstruction with all kinds of flaps, the replantation of amputees or devitalized members revascularization.

In 1965, he made the first experminetacion Krizek with a free transplant the same year, in Japan, Tamai and Susumi described the first successful replantation of a digit amputee. In 1972, Harii and Ohmori Japanese also made the first free flaps in humans.

In 1969 the American Harry Buncke (father of microsurgery) held its first free microvascular omentum transplantation to repair a large scalp defect.

In this period of Cosmetic Surgery experience an explosion even more. Anesthetic and surgical safety, improved living standards and the growing importance of image in our society have contributed to the flowering of this branch. Currently the technique is the most common cosmetic liposuction, described by the Italian dermatologist Arpad early 70’s.

The second intervention is often breast augmentation with an estimated 25,000 procedures per year. From the first silicone gel implants by Cronin (1963) breast prostheses have evolved greatly and now has a wide variety of volumes, sizes and shapes. Also have been describing and harmonization and improved techniques of facial rejuvenation and body.

The Birth of Cosmetic Surgery

The improvement of reconstructive techniques and a drop of surgical risks offered anesthesia and sterile technique developed by Lister, were to be provided and begin to consider applying plastic procedures to enhance the appearance of facial structures, although these have not been injured or maimed.

The American John Roe is regarded as the first surgeon to perform a nasal aesthetic approach. Subsequently, the German Joseph published a comprehensive analysis of the nose, including a classification and repair techniques of the various nasal blemishes. For this important work is considered the father of nasal cosmetic surgery.

From the beginning there were problems and conflicts related to cosmetic surgery still fully in effect, such as body dysmorphic disorder (distorted perception of the image itself), which in the case of the nose is called rhinomanía.

Wars

Despite the enormous development of reconstructive and aesthetic techniques during the nineteenth century, the specialty did not exist as such. Almost no surgeon was devoted exclusively to this field, as it was considered that was not a priority and was not designed to save lives.

World War I is the crucial point where it begins to recognize the importance of what we consider plastic surgery. The huge number of patients injured by bullets forced the organization of specialized centers in Europe and the United States. Of these centers emerge the “fathers” of many of the techniques currently used by us and the instruments required for them. With peace and relative prosperity of the postwar period appeared a new branch of Plastic Surgery: Surgery “Beauty” or “cosmetic.”

U.S. Vilray Papin Blair, a surgeon from San Luis, establishing the first special department of Plastic Surgery at Barnes Hospital of Washington University. Public reference works on mandibular reconstruction with Barret Brown and perfeccionron developed the technique of partial-thickness skin graft.

In France Morestin creates and manages one of the first teams dedicated to Plastic Surgery at the military hospital Val de Grace in Paris where the light gives one of his greatest contributions to the field: the idea of subcutaneous dissection to close defects without tension, serial excision of large lesions, or the refinement of the Z-plasty for correction of linear contractions. Morestin work inspired his disciples who continued the work begun. One was the British Harold Gillies, who later founded the Center for Reconstructive Queen Mary Hospital in Kent. For his impressive work both in developing new techniques such as in education of plastic surgeons around the world, was knighted by the Queen of England.

With World War II and its horrors the field of Plastic Surgery greatly expanded and is no longer confined more or less maxillofacial reconstruction. After the war began the publication of “Plastic and Reconstructive Surgery” in the U.S. and the British Journal of Plastic Surgery. ” Also created successive Plastic Surgery Societies.

In Spain some general surgeons began, for personal interest or is required to use basic techniques of plastic surgery in the treatment of their patients. In the nineteenth century and Argumosa Hysern stressed that developed original techniques of tissue transplantation. In the early twentieth Cortes Llado Professor, Professor of Surgical Pathology, Faculty of Medicine of Sevilla visited the French school led by Morestin and knowledge embodied in his book entitled “Facial Plastic Surgery.” In the previously noted “good hit of gathering Individualized surgeons who have demonstrated passion and aptitude for this kind of surgery so special that it is based on the ability to mobilize and transplant tissues.” In the same book defines the objective Plastic Surgery as the “preservation of the shape or morphological perfection that most often is coupled with a physiological goal as the preservation or recovery of function.”

It was not until the Civil War of 1936-1939 when the great demand for war amputees promoted the development of plastic surgery in our country. Captain Sanchez Galindo visited prestigious Blair serves as the United States since his return he established the first Department of Plastic Surgery at the Hospital General Mola “in San Sebastian. After the war he moved to the Gomez Ulla Hospital of Madrid. Almost simultaneously the Red Cross began creating services Plastic Surgery in Madrid, Barcelona, Sevilla and Valencia.

Since then the following dates have marked important progress in our specialty:

In 1955, Plastic Surgery is recognized in law under the name Specialty Reconstructive Surgery, which later changed to Plastic and Reconstructive Surgery. Currently the Ministry of Health is considering a new name change to Plastic, Reconstructive and Aesthetic Surgery, since the latter is an essential part of the Specialty.

On May 21, 1956 was officially established by the Spanish Society of Plastic Surgery.

In 1960 the National Insurance Institute in Madrid created the National Plastic and Reconstructive Surgery. Thereafter, coinciding with the socio-economic development of the country, Social Security begins to create a network of Departments and Services Hospital Plastic Surgery.

In 1978 the National Commission of the Specialty of Plastic Surgery, who is an advisor to the Ministries of Education and Science and Health and on issues such as training of specialists, program development, certification, etc.

In 1986 he started the publication of the “Spanish Journal of Plastic Surgery, which later changed its name to the” Ibero-Latin American Plastic Surgery “to be the official organ of the Ibero-Latin American Federation of Plastic and Reconstructive Surgery. Currently the magazine is distributed to 24 countries and has a circulation of 12,800 copies a year.

History, Evolution and Current

Plastic surgery is a specialized branch of surgery dedicated to the repair of deformities and correction of functional defects.

Etymologically, the name derives from two Greek words: “Girurguiki” (surgery, labor, work) and “Plastikos” (mold). Already in 1798 Desault used the term “Plastique.” Von Graefe subsequently incorporated it in their monograph “Rhinoplastik” (Berlin, 1818), but it was a German surgeon, Edmund Zeis who popularized by publishing in 1838 his treatise “Plastiche Handbuch der Chirurgie”, named this branch surgery, she experienced a great development from the First World War.

The origins

The bases of Plastic Surgery can be found in the ancient history and represent man’s effort to treat wounds and defects inflicted by nature or by other human beings. The Ebers Papyrus (1500 BC) shows that the transplantation of tissues was practiced by the Egyptians in 3500 BC The Vedas, the sacred books of the same age, have both flaps (1) as grafting (2) were known in India. In the seventh century B.C. Susruta describes some techniques for reconstruction of the nose, ears and lips that were made in India 2500 years BC It was customary to punish prisoners of war, adulterers and criminals with the mutilation of the nose. The frequency of the procedure was that developed an ingenious method of repairing such loss, with some modifications, still used today. In Roman times, Celso (25 aJ) used in their classic designs to mobilize Demedicina writings we now call tissue advancement flaps.

Even the royal physician Byzantine Orbasio, picked her medical encyclopedia Synagogue Medicae 2 volumes devoted to the reconstruction of facial defects, especially of the nose. In addition, many procedures have been described after treatment of facial fractures to interventions urinary tract malformations such as hypospadias.

At that time, those engaged in such activity were the Kooma skilled or potters, who possessed the secret of living tissue manipulation. With the skin of the forehead flap performed, spinning and incorporated the rest of the existing nose. When the distal end was “stuck” to the recipient bed, sectioning the pedicle and the surplus was returned to its place of origin. In India this knowledge is passed on to Persia and Arabia and later to Greece and the Arab Italia.Posteriormente work Sushruta brought to the West.

In the Middle Ages, and despite the continued use of established methods, the fall of the Roman Empire in the V century and the subsequent extension of the barbarian tribes desafrotunadamente caused a stop in the development of reconstructive surgery. Christianity is not allowed to continue progress in this field. In the thirteenth century Pope Innocent III specifically prohibited surgical procedures.
By then the practice of medicine became an ethereal experience that should not come into contact with the patient. Manual labor required for operations was considered dishonorable and showed baseness. This accompanied the beginning of the era of barber surgeons still worse reputation
surgery.

Renaissance, Resurgence of Surgery

In the fourteenth century revived Sciences and with them the surgery, this time with important contributions from both East and West. The Turk was who described techniques for the treatment of gynecomastia (breast development in men), considered the first signs of glandular breast tissue removed for cosmetic reasons, and based on current techniques of breast reduction.

Branca brothers were in Sicily (s. XV), who reintroduced the Hindu practice of nasal reconstruction and modified using a skin flap of the arm. Tagliacozzi Gaspar (1545) is considered a key figure in the development of plastic surgery for his detailed work on pedicle flaps, especially for nasal reconstruction. But at the end of XVI century Europe enters a new stage of cultural decadence, superstition and ignorance of science.

In the nineteenth century, however, was followed by a resurgence of this surgery, probably related to advances in anesthesia (the century of the surgeon). Von Graefe uses the techniques of nasal reconstruction during the Napoleonic Wars; Dupuytren palmar fibromatosis describes and classifies burns according to depth, von Langenbeck develop treatment of cleft palate, Sir Astley Cooper performed the first skin graft … important contributions have come until today. It is also the time when the term “Plastic Surgery” became popular and appears as such in various treaties.

· Facial telangiectasias. Facial telangiectasias are small dilated superficial veins visible and may appear as an isolated entity or as part of another process such as rosacea dermatological, immunological diseases, associated with liver disease, etc … All of them are treated with this laser system using the same criteria regardless of its cause, origin or location. It takes 2-4 sessions at intervals of 6-8 weeks to achieve results in 90-100% of clearance.

· Facial erythema (flushing). Microdilatation is the surface vessel, resulting in the classic appearance of a red face. People with facial erythema and flushing had very few options to improve their condition before the advances in laser systems or light-based, because the treatment was limited to the electro-cautery and sclerotherapy. Fortunately, this type of vascular lesions are good candidates for laser therapy, requiring 4 to 6 sessions at intervals of 3 to 4 weeks to achieve satisfactory results.

· Points ruby. Are well defined small red papules, which are formed by vascular ectasia. They appear in early adulthood and tend to increase in size with age and can appear anywhere on the body (especially on the trunk). Laser treatment is one of the least invasive methods and more effective, reaching an almost complete elimination with 4-6 sessions at intervals of 6 to 8 weeks.

· Lakes vein. Are dilated vessels that result from the weakening of preexisting vascular walls. Elastosis of the vascular wall induced by sun damage weakens the glass, causing expansion. They are presented with blue papules.