[Application of synthetic implants in orbit surgery. Plastics and orbital wall plastic surgery].
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Plastic surgical operations are among the oldest and have been developed increasingly from ancient times down to the present. However, the age of medical specialization did not begin until the latter part of the nineteenth century, and the specialty of plastic surgery is largely a child of the twentieth century. Most of the operations we do today have been created by plastic surgeons with the past 50 years, but were made possible only by the rapid developments in other surgical specialties and in all of medicine and science. The relationship with other specialties has been an interdependent one, and this is likely to be the pattern of the future. Plastic surgery, bridging the anatomical specialties as it does, must continue to draw bits of information here and there from them and to synthesize these into major contributions of great benefit to all. The specialty will grow in direct proportion to the success of the innovators within it in fulfilling their crucial role.
The plastic surgery begins with rhinoplastic methods in the early medieval India and was unknown to Western medicine until 1400. The first European surgeon, who restored a lost nose, was Branca de'Branca in Sicily. He took the flap from the cheek, but his son Antonio Branca took the reparative flap from the upper arm, and this "Italian method" was first described by the knight of Teutonic Order Heinrich von Pfalzpaint in 1460. Antonio Branca repaired also mutilated lips and ears, and the methods employed by him and by the Vianeo family in Calabria are described by various authors, most extensively by Gaspare Tagliacozzi in his "Chirurgia Curtorum" (1597). -Soon after Tagliacozzi's death, plastic surgery fell into disuse, until in 1794 the description of a rhinoplastic operation in India brought the methods again to the attention of European surgeons and initiated the revival of the practice. German surgeons as Carl Ferdinand Graefe, Johann Friedrich Dieffenbach and Bernhard Langenbeck leaded it to its full modern development.
The paper deals with the three main areas of indications for plastic surgery: 1. Reconstructive plastic surgery or treatment of defects resulting from trauma or disease. 2. Constructive plastic surgery or treatment of innate defects. 3. Anaplastic surgery or treatment of disfunction of appearance. By defining these different branches of plastic surgery criteria are elaborated that govern all plastic surgery. Differences between the general surgical approach and the plastic surgical approach are explained and emphasis is put on the patients' subjective situation and possible pressures from outside as well as environmental influences that may have bearing on the indication.
Methods of anastomosing small blood vessels are presented, together with an account of the authors' own experiences in the field of microvascular surgery. Practical suggestions are made to avoid pitfalls. The modern literature on experimental and clinical applications of microvascular technique in plastic and reconstructive surgery is reviewed. An extensive bibliography is offered as an aid to the interested reader.
The aim of plastic surgery in children with Down-syndrome is the improvement of speech as well as improvement of cosmetic appearance. Altering the typical mongoloid physiognomy facilitates the integration of these children into the community. In our Department during the past 6 months plastic surgery was performed in 27 children for the correction of macroglossia, saddle nose deformity, epicanthic folds, receding chin, fatty neck and deformity of the ears. Macroglossia was present in every case, the extent of further surgery varies according to the clinical deformity. It is essential to discuss the implications of surgery in these children with the parents in order to avoid later disappointment.
The use of supratarsal fixation in ophthalmic plastic surgery is discussed. New anatomical terms for the external upper eyelid are described. Technique, complications, and illustrative cases are presented.
AIMS AND BACKGROUNDS: The objectives of this study are to examine the emerging role of personalized medicine in facial plastic surgery and to consider how biologically, anatomically, and psychologically tailored approaches may refine both aesthetic and reconstructive care. HISTORICAL ASPECTS: Facial plastic surgery has traditionally relied on anatomical principles, surgical expertise, and population-based evidence. Personalized medicine represents a shift toward more individualized care by incorporating patient-specific biological and phenotypic variation into clinical decision-making. ANATOMY: Facial plastic surgery is uniquely dependent on subtle anatomical variation, soft tissue characteristics, wound healing behavior, and age-related change. These factors differ considerably between individuals and have a direct impact on both surgical planning and outcomes. TECHNOLOGY: Advances in genomics, pharmacogenomics, artificial intelligence, tissue engineering, and three-dimensional modelling are expanding the scope of personalized care. These technologies may improve prediction of healing, treatment response, complication risk, and reconstructive requirements. PATIENT SELECTION: Personalized medicine may support more accurate patient selection by identifying those at increased risk of adverse scarring, variable response to injectables or pharmacotherapy, or differential reconstructive needs, thereby improving counselling and expectation management. TECHNIQUES: Potential applications include tailored incision planning, individualized facial rejuvenation strategies, personalized perioperative pharmacological regimens, and patient-specific reconstructive scaffolds, grafts, and implants. POSTOPERATIVE CARE: Postoperative management may also become more individualized through better prediction of inflammatory response, scar formation, analgesic requirements, and recovery trajectory, allowing more precise surveillance and adjunctive treatment. CURRENT AND FUTURE DEVELOPMENT: Although many applications remain investigational, continued progress in regenerative medicine, molecular profiling, and predictive analytics is likely to accelerate clinical translation. Ethical challenges relating to privacy, bias, and equitable access must, however, remain central. CONCLUSION AND CLINICAL RELEVANCE: Personalized medicine has the potential to enhance precision, safety, and patient-centered care in facial plastic surgery. Its future value will depend on thoughtful integration into practice as an adjunct to, rather than a replacement for, surgical judgement and aesthetic insight.
A major problem in reconstructive and plastic surgery of the face is the assessment of exact distances between certain points of reference across facial contours. Incorrect estimation of these variables produces unsatisfactory postoperative anatomical results. Therefore a method, which permits exact measurements using stereoscopic photography of models, was tested. On the models quantitative studies of the effects of surgical techniques were made. Facial asymmetry and various phases of facial animation can be assessed and documented, and the progress of expanding tumours can likewise be followed.
11 years of anaesthesiological experience in maxillofacial and reconstructive plastic surgery (1-4-1966/1-4-1977) are reviewed. The problems connected with these operations are examined. On the basis of localizations, types of operation and surgical requirements, the problems of greatest importance in these branches of surgery may be indicated in the following 5 parameters: 1. Control of the respiratory ways with naso-tracheal intubation under direct view or blind (more than a thousand cases), oro-tracheal intubation: their indications and contraindications as alternatives to pre- intra- and postoperative tracheotomy. 2. Local control of bleeding. 3. Arousal and prevention of possible postnarcotic complications. 4. Prevention and treatment of postoperative oedema. 5. Nutrition of the patient undergoing surgery. In the interests of history, the superseded problem of whether to use local anaesthesia and general anaesthesia in maxillofacial surgery is mentioned and the various problems are discussed exhaustively. Personal anaesthesiological conduct is then specified in relation to the parameters examined and results reported. The importance in certain endo- and extraoral operations of prolonged intubation in the immediate postoperative period (10-15-30 hours) with respect to the indication for postoperative tracheostomy is highlighted. Apart from certain special pathological situations, tracheostomy is rather exceptional and is no longer employed on a routine basis as it was 2-3 years ago.