India is the land where Plastic Surgery
HISTORY OF PLASTIC SURGERY IN
The earliest replantations were
done by Lord Shiva by attaching an elephant’s head on his son’s
body and by Ashwini Kumars who successfully replanted the
severed head of Yagna. Thus the history of plastic surgery in
India dates as far back or before the Vedic times nearly 4000
Brahma, the creator of the universe evolved, Ayurveda (the
science of life) by meditation and imparted it to Daksha
Prajapati, who in turn taught the Ashwini Kumars (twin gods).
Lord Indra, the celestial ruler, learnt it from Ashwini Kumars
and in turn passed on the knowledge to many rishis, namely, Sage
Bharadwaja (Guru of Atreya), and King Divadaasa of Banaras (Lord
Dhanvantri). Sushruta, who was Vishwamitra’s son, along with
others approached Dhanvantri and requested him to accept them as
his “shishyas” and teach them the science of Ayurveda.
Sushruta Samhita is believed to be part of one of the four Vedas
(part of Atharva-veda) and was written by Sushruta in
approximately 600 BC compiling what he had learnt from his Guru
Dhanwantri and his predecessors. It is said that Sushruta taught
surgery at the Banaras University.
He has very succinctly described the reconstruction of the nose
by cheek flap, repair of cut earlobe, piercing of earlobe,
repair of cut lip, skin grafting, classification of burns, wound
care and wound healing. Sushruta has been rightly called the
“Father of Plastic Surgery” and “Hippocrates” of the 6th or 7th
century BC. He described rhinoplasty for a cut nose as follows:
1) The leaf of a creeper, long and broad enough to fully cover
the whole of the severed or clipped off part, should be
2) A patch of living flesh, equal in dimension to the preceding
leaf should be sliced off from the region of the cheek.
3) After scarifying the severed nose with a knife, the flesh is
swiftly adhered to it.
4) Insert two small pipes in the nostrils to facilitate
respiration and to prevent flesh from hanging down.
5) The adhesioned part is dusted with the powders of Pattanga,
Yashtimadhukam and Rasanjana pulverized
6) The nose should be enveloped in Karpasa cotton and several
times sprinkled over with the refined oil of pure sesamum.
7) When the healing is complete and parts have united, remove
the excess skin.”
Even in those days he had emphasized the accurate cutting of the
pattern to the size of the defect, the accurate cutting and
suturing of the flap to the nose and maintenance of airway with
Frank McDowell has very aptly described Sushruta in the book
“The source book of plastic surgery”
“Through all of Sushruta’s flowery language, incantations and
irrelevancies, there shines the unmistakable picture of a great
surgeon. Undaunted by his failures, unimpressed by his
successes, he sought the truth unceasingly and passed it on to
those who followed. He attacked disease and deformity
definitively, with reasoned and logical methods. When the path
did not exist, he made one.”
There was a second method of rhinoplasty in India as practiced
by Tilemakers. This involved using a free graft from the
buttock. The skin and the underlying tissue of the shape of the
defect on the nose was beaten with wooden slippers and applied
on the defect with some “cement”.
In the 4th century, another scholar named Vaghbat wrote Ashtanga
Sangraha and Ashtanga Hridyans. In Ashtanga Hridyans, he
described rhinoplasty as done by Maharishi Atreya and emphasized
the need for the provision of an inner lining by turning down
the nasal skin.
The classical cheek flap rhinoplasty of Sushruta and Vaghbat was
later modified by using a rotation flap from the adjacent
forehead, The Traditional Indian Method of Rhinoplasty. This was
kept a secret for centuries in India, and practiced by Marattas
of Kumar near Poona, certain Nepali families and Kanghairas of
Kangra (Himachal Pradesh).
Dr. S. C. Almast personally met the last Hakim of Kangra, Mr.
Dinanath Kanghaira whose family was practicing the art of
rhinoplasty since the war of Kurukshetra and at Kangra since
1440 AD. Those with cut noses and deformed noses due to leprosy
and syphilis were operated by them. The patient was given wine
to drink to put him to sleep (since anesthesia did not exist in
those days). A pattern of the defect was made on a paper. A
handkerchief was tied around the neck to make the veins of the
forehead prominent, and the flap was marked including the vein
on the forehead (in the pedicle between the eyebrows). The
forehead flap was folded in itself to form the inner lining.
The knowledge of rhinoplasty spread from India to Arabia and
Persia and from there to Egypt and Italy in the 15th century.
The first translation of Sushruta Samhita was in Latin by
Hessler in 1844 and in Arabic by Ibn Abi Usaybia (1203-1269 AD)
and later into German by Vellurs. Bhishagratna translated it in
English in 1907.
Although the British lived in India for a long time, they were
not aware of Indian Rhinoplasty till 1793. Mr. James Findlay and
Mr. Thomas Crusoe who were surgeons at the British Residency in
Poona in 1793 witnessed the operation on “Cowasjee” and reported
the details of the operation in the Madras Gazette. The same
operation on Cowasjee was later published in Gentleman’s
magazine, London, Oct. 1794 by a letter from Mr. Lucas
as follows: “Cowasjee, a Mahratta of the caste of the
husbandmen, he was a bullock driver with the English Army in the
war of 1792, and was made prisoner by Tipu Sultan, who cut off
his nose and one of his hands. He joined the Bombay Army near
Seringapatam. For about 1 year he remained without a nose, when
he had a new one put on by a man of the Brickmaker (potter’s)
caste near Poona”.
Towards the end of the 19th century, two important works were
published in India. One was titled “Rhinoplasty” by Tribhovandas
Motichand Shah in 1889, who was then the Chief Medical Officer
of Junagadh. He described over a hundred cases treated by him in
4 years and gave minute operative details and discussed the
advantages of forehead rhinoplasty. He used paper to make a
pattern and used anesthesia. (Till now there was no mention of
anaesthesia. Patients were just given wine to drink before
surgery.) His name became a legend and it was said that “Kalu
cuts the nose and Tribhovan reconstructs it”. Kalu was a local
dacoit of that time who used to cut off people’s noses. The
other book was “Rhinoplasty operations, with a description of
recent improvements in the Indian method” by Keegan in 1900.Even
today, the western world gives credit to India for rhinoplasty
called as the Indian Rhinoplasty. This of course, later received
a few modifications, but the basic principles as laid down by
Sushruta remain the same
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