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Reconstructive surgery

Set of 50 artificial eyes, Liverpool, England, 1900-1940

Set of 50 artificial eyes, Liverpool, England, 1900-1940

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Plastic surgery since 1600 BCE

Surgery has the power to cure and repair. It can also be used to minimise deformity after injury or illness. This is called reconstructive or plastic surgery and, surprisingly, has been with us since around 1600 BCE - surgical papyri have been found describing methods for repairing a broken nose and providing instruction in suturing to minimise scarring.

The spread of nose surgery

Reconstructive surgery was also practised in India from around 500 BCE. A Hindu doctor, Susrata, developed a technique to reform noses that had been cut off as a punishment or hacked off during battle. Called rhinoplasty, this technique spread widely - the Byzantine Emperor Justinian's statues bear evidence of the scars of his rhinoplasty after he suffered a traumatic nasal amputation some time around 700 CE.

The affects of syphilis

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Such techniques spread to Europe and Britain in the 1700s and other innovations followed, including an improved treatment for those with syphilis. One of syphilis’s appalling consequences could be the loss of one’s nose. This was so stigmatising that many patients were willing to undergo surgery without anaesthetic in an effort to repair the damage.

The long history of reconstructive surgery

But reconstructive surgery had first appeared in Europe as far back as the 1400s. A Sicilian family of surgeons, the Brancas, practised new suturing techniques and developed methods to repair wounds to ears and lips. Later in Bologna a surgeon called Gaspare Tagliacozzi experimented with cutting flaps of skin, called pedicles, from one part of the body and sewing them to another. Even so, the procedure was not performed regularly until the 1800s. The first successful skin graft was attributed to Sir Astley Cooper in 1817.

Plastic surgery with antiseptic and anaesthetics

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The name ‘plastic surgery’ was not actually coined until the 1800s, and the first book describing the surgical techniques was published in 1845. Antiseptic techniques and anaesthetics allowed the surgeon to operate with far greater precision, which naturally had less disfiguring results.

The impact of war on plastic surgery from the 1900s

The 1900s saw many significant changes in reconstructive surgery. War was a catalyst for improvements in techniques in this field. Shrapnel wounds, burns and traumatic amputation were common and plastic surgeons such as Harold Gillies in the First World War (1914-18) and Archibald McIndoe in the Second World War (1939-45) developed new methods to repair disfiguring wounds.

Isabelle Dinoire - the first successful face transplant

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Reconstructive surgery continues to make a huge difference to the quality of people's lives. In 2006 the first successful face transplant was performed in France on Isabelle Dinoire.

Cosmetic surgery

Cosmetic surgery, which is often confused with plastic surgery, is an elective procedure designed to alter a person’s appearance. Individuals can now choose to undergo cosmetic surgery for a number of reasons: to conform to contemporary notions of beauty, to preserve a youthful appearance, or for other personal reasons - a choice few would have made when surgery was in its infancy.

Bibliography

J P Bennett, `Aspects of the history of plastic surgery since the 16th century', Journal of the Royal Society of Medicine, 76 (February 1983), pp 152- 56

S Gilman, Making the Body Beautiful: A Cultural History of Aesthetic Surgery (Princeton: Princeton University Press, 1999)

E Haiken, Venus Envy, A History of Cosmetic Surgery (Baltimore: John Hopkins University Press, 2000)

N Handley, `Artificial Eyes and the Artificialisation of the Human Face', in Timmermann and Anderson, Devices and Designs: Medical Technologies in Historical Perspective (Basingstoke: Palgrave, 2006), pp 97-111

G M Lawrence, Hospital Beds by Design: A Socio-Historical Account of the 'King's Fund Bed', 1960-1975 / PhD Dissertation (London: University of London, 2001)

B O Rogers, `A Chronologic History of Cosmetic Surgery', Bulletin of the New York Academy of Medicine, 47/3 (March 1971), pp 265-302

Novels and Patient Experiences:

M Crank, `What I see in the Mirror', The Guardian Weekend (March 1, 2008)

L Grealy, Autobiography of a Face (Boston: Houghton Mifflin, 1994)

B Zephaniah, Face (London: Bloomsbury, 1999)

Glossary:

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