The History of Reconstructive Surgery

Plastic surgery dates back to ancient times when deformities were sometimes caused by punishment as well as by congenital anomalies, accidents, and the ravages of war and disease. Accidents, war, and diseases such as syphilis have always mutilated bodies, but noses, ears, eyelids, fingers, hands, and feet also were amputated as retribution in some societies. Adulterous wives, thieves, and captured soldiers were most likely to be subjected to these mortifications and resulting stigma.

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Ancient Times

The Sushruta Samhita , written in approximately 600 BCE and based on the Hindu hymn Rig Veda , which originated some nine hundred years before, contains the oldest known written account of surgical reconstruction of noses and ear lobes (Brown 1986). The procedures were done by a few families in the lowly Hindu castes of potters and bricklayers long before the development of anesthesia, asepsis, and antibiotics. To rebuild a nose they partially sliced a patch of skin from the cheek to form an attached flap, scarified it with a knife, and swung it over the “refreshed'' nose wound. They finished the procedure by inserting small pipes to maintain nostril openings and shaping the tissue with a bandage to resemble a nose. Ear lobes were similarly reconstructed using adjacent flaps of skin ( Rogers 1988).

By the mid-fifteenth century Hindu practitioners had substituted forehead flaps. This sophisticated procedure was introduced to the Western world in a 1794 edition of The Gentlemen's Magazine . Twenty years later, still long before anesthesia, blood transfusion, asepsis, and antibiotics, a British physician reported using the “Indian method.” Rogers (1988) regards this operation as the impetus for the development of every plastic surgery procedure since then.

There were, however, other important developments in the evolution of plastic surgery. In the only complete medical text to survive from antiquity, De medicina , Cornelius Celsus (25 BCE-50 CE) described the use of double-pedicled advancement flaps of skin to close gapping wounds and the excision of excess skin from “relaxed eyelids.” He even recommended using a woman's hair as thread for fine sutures on the face. Undoubtedly others continued at least simple reconstructions over the centuries. Paulus Aegineta, a Greek physician practicing in seventh-century Alexandria , described many of the same techniques as Celsus as well as treatments for jaw and nasal fractures. In the fifteenth century Serafeddin Sabuncuoglu authored the first known illustrated surgical textbook in the Turkish-Islamic literature, in which he described techniques for eyelid problems, facial fractures, and reduction mammoplasty for male gynecomastia(Dogan et al. 1997). However, the medieval Catholic Church opposed such operations on the grounds they interfered with Divine Will. As a result, few European records of reconstructive surgery exist before the Renaissance.