Plastic Surgery: A Poorly Understood Specialty by Both General Public And Medical Professionals : The first question people ask me when I say I am a plastic surgeon is always, Can you help me look better? (Of course my answer is, you already look good). Plastic surgery is considered almost synonymous to cosmetic surgery. Plastic surgeons are often portrayed in the media as glamorous beings who give people a new lease of life through a “nip and a tuck”. If you have watched the series “Nip Tuck” you can better relate this statement. Many people are unaware that plastic surgery deals with wide range of diseases and conditions. Some people even think that plastic surgery is called so because we use plastic in our surgeries. Actually, Plastic surgery was derived from Greek word “Plastikos” meaning the ability to mold. However, the reconstructive side of our work goes largely unreported. One study done in Pune, India among the medical doctors and medical students reported that plastic surgery as specialty is poorly understood by medical doctors . The condition is quite similar in Nepal and other developing world.
Historically plastic surgery techniques were reported in India by Sushruta in 6th century BC. There are reports of nose reconstruction with forehead flap (tissue with its own blood supply). Sir Harold Gillies is considered the father of modern plastic surgery. He developed many of the techniques of modern facial surgery in caring for soldiers suffering from disfiguring facial injuries during the First World War. Then after, plastic surgery has made rapid progress and ever evolving. Joseph Murray a famous plastic surgeon from America received Nobel Prize for 1st successful kidney transplantation in 1990.
Plastic surgery is quite new in Nepal. Till few years back, there was no program to train plastic surgeons in Nepal. Now, there are 2 centers providing plastic surgery .Mch program since few years. So it’s not a big surprise that most of the hospitals in Nepal don’t have plastic surgery department. And most of the Plastic surgeons are working in Kathmandu itself; therefore plastic surgery is even unknown to many people outside valley. I was trained as plastic surgeon in Nanjing(if you don’t know it’s an old capital of China ), China. There were 12 Plastic surgeons and 4 residents in my department. It was comparatively small department in terms of manpower but our department used to generate 2nd highest income for hospital after orthopedics department which has almost 3 times the manpower and patients bed. So, if the hospital administration truly understand, Plastic surgery its quite lucrative department. Similarly, I got an opportunity to do Plastic surgery fellowship in Tokyo, Japan. Plastic surgery was one of the biggest and busiest department in hospital in term of outpatients, inpatients, surgery and research work. . There were 7 units in Plastic surgery department namely Burn reconstruction and pathological scar (keloid) management, Hand surgery, Head and neck reconstruction, Breast reconstruction, Chronic wound treatment, Craniofacial surgery and Aesthetic surgery. I was lucky enough to visit plastic surgery department affiliated to Frankfurt University in Germany as a fellow. There were 17 doctors in plastic surgery department and performing high volume of hand surgery along with other reconstructive surgeries. These examples show that, there is high volume of patient in plastic surgery department. Definitely, there is also high volume of plastic surgery patients in Nepal. But because of lack of department or poor understanding of department, patients are not being optimally treated.
Plastic surgery is a unique speciality that defies definition, has no organ system of its own, and is based on principles rather than specific procedures. It deals with everything from head to toe but is associated with the prefix plastic which symbolizes nothing to the common man and medical community at large. Plastic surgeons deal with some of the most devastating form of Trauma like Burn and complex reconstruction after trauma like road traffic accident. More complicated surgeries like face transplantation are also performed by plastic surgeons. Plastic surgery is a very evolving field. Plastic surgeon and neurosurgeon are credited for developing microsurgery (surgery done with microscope or loupe magnification). Now, plastic surgeons are ever digging deeper into so called super-microsurgery. Plastic surgeons are now even performing replantation of the very distal end of finger tip. Plastic surgeons are treating lymphedema(lymphatic obstruction, is a long-term condition where excess fluid collects in tissues causing swelling ) which involves connecting lymphatic vessel into venous system which is only 0.8mm(little thicker than hair strand). This is one of the finest forms of surgery.
Plastic Surgery: A Poorly Understood Specialty by Both General Public And Medical Professionals
Plastic surgery deals with wide variety of conditions and diseases. Many procedures do overlap with other departments like Dermatology, ENT, Maxilofacial surgery ,Orthopaedics, etc. Here, I would like to present broadly, what plastic surgeons do under subspeciality of plastic surgery.
- Burn surgery– treating acute burn patients and also post burn contracture and scars.
- Hand surgery-all from of hand surgery ranging from replantation of amputed hand or finger, tendon transfer, fracture, neuromas, nerve graft, fracture, arthritis,carpal tunnel syndrome,infection, nerve compression, brachial plexus injury and so on.
- Craniofacial surgery– It can be divided into pediatric and adult craniofacial surgery. Pediatric craniofacial surgery mostly revolves around the treatment of congenital anomalies of the craniofacial skeleton and soft tissues, such as cleft lip and palate, craniosynostosis,microtia and pediatric fractures. Adult craniofacial surgery deals mostly with fractures and secondary surgeries (such as orbital reconstruction) along with orthognathic surgery.
- Onchoplastic surgery and Supermicrosurgery– deals with treating skin cancer excision and reconstruction. More complex tumor involving larynx, mandible ,tongue are done along with other departments like ENT or Maxillofacial surgeons. Mostly the microsurgical procedure is used to harvest the free flap and cover the defect by insetting the flap and anastomosing the vessels and in many cases nerves. Supermicrosurgery is defined as a technique of microneurovascular anastomosis for vessels and single nerve fascicles of 0.3 to 0.8 mm. It is mostly used to treat lymphedema and also in hand surgery.
- Breast Surgery– Breast surgery is divided into aesthetic and reconstructive. Aesthetic part deals mostly with breast augmentation with the help of fat graft or implants. The other is mostly related to breast reconstruction after cancer excision with the help of free flap or tissue expander. Other breast surgeries include breast reduction, gynecomastia in male, mastopexy(breast lift surgery).
- Chronic wound treatment-Chronic wound like bed shores, diabetic foot syndrome(DFS) are also dealt with plastic surgeons.
- Trauma Surgery– Mostly deals with local, regional and free flap to cover the exposed body parts (like exposed bone, muscle, vessel.)
- Aesthetic Surgery-All form of aesthetic surgery ranging from hair transplant, botox for wrinkles, blepharoplasty (eyelid surgery),rhinoplasty (nose surgery), facelift, breast implant, buttock lift, vaginal rejuvenation surgery,liposuction,etc are performed by plastic surgeons.
- Miscelloneous– Scars, keloids, hypospadias (is a condition in which the opening of the urethra is on the underside of the penis instead of at the tip), laser procedures for tattoo,scars,moles,hair removal,etc.
Medical professional and general public should be more informed about the plastic surgery. So that doctors and nurses could mutually benefit working together. Also doctors and medical professionals can refer patients to plastic surgery department when needed. Patients could benefit themselves by directly going to the plastic surgeons rather than roaming around. Also, hospital administration need to know more about Plastic surgery department as they are more reluctant to establish department, but it could be a most lucrative department for hospitals. This could benefit both the hospitals and patients.
Plastic surgery is in state of infancy in Nepal with very limited doctors. There is need of more plastic surgeons in all parts of Nepal. More and more medical students need to be well informed about the field, so that they can choose this field as the career in future. Hospitals and we plastic surgeons should regularly organize public awareness programs to better inform general public.
About Author of Plastic Surgery: A Poorly Understood Specialty by Both General Public And Medical Professionals
- ✍️ Dr. Sanjib Tripathee
Recommended Citation : Tripathee, S., 2021. Plastic Surgery: A Poorly Understood Specialty by Both General Public And Medical Professionals[online] Nepal Health Magazine. Available at: <https://nepalhealthmag.com/plastic-surgery-a-poorly-understood-specialty-by-both-general-public-and-medical-professionals/> [Accessed 15 May 2021].
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