Dr Sanjay Sadhu
When I decided to go for super-specialisation in plastic surgery the first surprise that hit me was that I had to be a hand surgeon as it was part of plastic surgery. Talk to anyone about plastic surgery and they will talk about cosmetic surgery as the two have become synonymous for the public but few realise that cosmetic surgery is just one part of plastic surgery and plastic surgery extends much beyond cosmetic surgery.
Plastic word comes from Greek word “plastikos” which means “to mould”. So it is the speciality which specialises in the treatment of body deformities which may be congenital or acquired later because of trauma or disease. The vast number of jokes not withstanding it has hardly anything to do with plastic (material). So where does plastic surgery come in?
As I said talk about plastic surgery and the discussion is about cosmetic surgery. But as soon as somebody has burns, plastic surgeon is sought. For the large number of burn patients that we have, the treatment and relief providers are plastic surgeons. The burn treatment has developed a lot over time. With proper care many patients are surviving who previously would not. Treatment is also focussing on better function and aesthesis so that patients with major burns can live as normal a life as possible after their recovery.
Hand surgery is another complex field. From bony and soft tissue injuries of the hand to injury of specialised structures such as tendons, nerves and blood vessels, the challenges are intricate and complex. Restoration of hand function is one of the most satisfying things – both for the patient as well as the doctor. But the progress in treatment has gone much ahead with amputated parts being re-attached. For the less fortunate who couldn’t or don’t get re-implant, hands can be transplanted as is being done for other organs like kidneys. Some patients have deformed and dysfunctional hands following injuries for which more sophisticated procedures are required. Fortunately these facilities are becoming available at more number of places with time. Many children are born with deformed hands. The outlook for them is improving day by day.
The treatment of congenital anomalies is not limited to hand anomalies only but deformities elsewhere also stand to benefit from plastic surgery. The commonest such anomalies are cleft lip and cleft palate. They have an excellent prognosis if treated at proper time. Other anomalies treated frequently include cranio-facial deformities, anomalies of lower limbs, vascular anomalies and gynaecomastia.
Face is a region where skills of plastic surgeon are tested. It has a very complex anatomy. At the same time it is the most visible part of the body with slightest deviation being immediately visible and nowadays people are very conscious about their appearance. The combination of complex procedure with high expectations make it a daunting task for the surgeon. Besides cosmetic procedures, face requires surgery for injuries, congenital and acquired deformities and for various functional deficits.
The real expertise of a plastic surgeon lies in the treatment of wounds – from the simplest to the most complex. Complex trauma is a price we pay for modernisation. Road traffic accidents, industrial accidents and other accidents have led to manifold increase in the number of injuries and also the complexity of injuries. The treatment modalities have become equally sophisticated. These wounds require multi-pronged approaches for them to heal and to restore the function and appearance. The field is vast with newer modalities being developed every day.
Microsurgery, another skill of the plastic surgeons, is used to provide succour to many patients. Repair of small nerves and blood vessels, re-implantations and transplantations are all possible because of microsurgery.With more sophisticated equipment becoming available super-microsurgery has come into play with very small structures such as lymphatics being operated. This is a big relief for patients of lymphedema which till now did not have a satisfactory treatment. It is acommon consequence of surgery for breast cancer but can also be because of congenital conditions or parasitic infections.
Also amazing is the history of plastic surgery in India. Everyone has heard the name of Sushruta but few know he performed plastic surgery procedures in 600BC which are still used today as such or with modifications. Similarly nasal reconstruction methods practiced in India since old times have been adopted world over. In recent times hand transplants where both hands were transplanted to the patients have been done in India. These surgeries are being done in only a few countries in the world.
So next time somebody is asked to consult a plastic surgeon for other than cosmetology – don’t be surprised!!!
National Plastic Surgery day in India is celebrated on 15th July every year with the objective of spreading awareness among the public about plastic surgery.
(The author is Professor Plastic and Reconstructive Surgery Shri Guru Ram Rai Institute of Medical and Health Sciences Dehradun)
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