Plastic and reconstructive surgery

Reconstructive plastic (from the ancient Greek plassein, to mould or shape – also the stem for our modern use of the materials termed plastics) surgery involves using various techniques to restore form and function to the body when tissues have been damaged by injury, cancer or congenital loss. Its origins can be traced back to ancient Egypt, with wound care depicted in hieroglyphs on papyrus, to India in the sixth century BC, where Sushruta described using the forehead flap to reconstruct a nose, and to Al-Zahrawi, the tenth-century Islamic surgical scholar from Cordoba. Modern techniques were developed after the First World War, especially with Sir Harold Gillies’ work on reconstructing facial injuries (Fig. 29.1), which was enabled by new safe anaesthetic intubation (Sir Ivan Magill). Later in the twentieth century, renewed understanding of detailed soft tissue anatomy led to an explosion in the use of new flaps, which with microsurgical methods, craniofacial surgery and tissue expansion resulted in an entirely new set of techniques becoming available to surgeons for reconstructing parts.