ISSN: 2241-1275 2 IPRAS Journal www.ipras.org Issue 7 CONTENTS

• President’s Message ...... 5

• The PIP Breast Implant Scandal ...... 6

• General Secretary’s Message ...... 9

• Editor-in-Chief’s Message ...... 12 PAGE IPRAS Presentation from 14 Mr. Zacharias Kaplanidis (IPRAS • IPRAS Management office Report ...... 14 Executive Director) during the 48th Brazilian Congress of Plastic Surgery • Pioneers ...... 19

• Rising Star ...... 23

• Senior Ambassador ...... 24

• Humanitarian Works ...... 26 PAGE Humanitarian mission in Togo 36 • Surveys ...... 38

• National Associations’ & Plastic surgery organizations’ news ...... 50

• Historical Accounts ...... 63

• Certificate of Membership ...... 86 PAGE IPRAS Booth at the 1st Chinese 55 European Congress of Plastic • Congresses and Events ...... 90 Reconstructive and Aesthetic Surgery

• National & co-opted societies future events . . . 114

• IPRAS website ...... 116

• Industry news ...... 117

• IPRAS Benefits for National Associations PAGE & individual members ...... 119 Historical Account of BAPRAS 77

Issue 7 www.ipras.org IPRAS Journal 3 AIMS AND SCOPE

• To promote the art and science of plastic surgery

• To further plastic surgery education and research

• To protect the safety of the patient and the profession of Plastic, Reconstructive and Aesthetic Surgery

• To relieve as far as it is possible the world from human violence or natural calamities through its humanitarian bodies

• To encourage friendship among plastic surgeons and physicians of all countries

4 IPRAS Journal www.ipras.org Issue 7 PRESIDENT’SI P R A S JOURNAL MESSAGE

Prof. Marita Eisemann-Klein President of IPRAS Dear colleagues, 2011 was the year of solidarity. For all those who missed registration: We decided Solidarity with our brave colleagues in Japan to offer online-participation. Just watch out for – while we felt powerless and helpless; solidarity further announcements! with our colleagues during the unrests in the Arab Keep monitoring at our other congress world, with our colleagues in countries which had announcements too: exciting topics and exciting to face crisis and disasters. locations are offered to you. Solidarity with patients in developing countries: There is a lot to look forward to this year! the number of missions and the number of There is also a lot to thank for during the past year: active collaborators in our humanitarian projects Thanks, from the bottom of my heart, to all of you increase considerably every year. Solidarity with patients who became victims of the PIP crime, is our latest challenge. These patients need all our support in their anxieties and in their search for implant removal at affordable expenses. Solidarity with our young residents: the evaluation form about training conditions will be launched soon and the first “Residents World Congress” Board of Directors will be held on November 1st , 2012 in Athens, Greece. There, we also plan to start the Academy for Residents Training. President Marita Eisenmann-Klein - Germany With the foundation of our Board of Trustees, we span the generations from the youngest to Presentation of Prof. Marita Eisenmann-Klein, General Secretary our senior role models, our giants, our heroes. Germany (IPRAS President) during the 48th Brazilian Nelson Piccolo - Brazil Recently we honoured our new Board of Congress of Plastic Surgery Treasurer Trustees members during the Brazilian Congress Bruce Cunningham - USA of Plastic Surgery: Ricardo Baroudi and Ivo who supported and assisted to develop IPRAS Pitanguy. They do not only stand for progress further – our humanity, our skills, our identity. Deputy General Secretary and technical excellency in plastic surgery, they Thank you for your confidence in the IPRAS Yi Lin Cao - China are charismatic philosophers as well. leadership and in me personally. It is such a pleasure to serve you as your Deputy General Secretary 2012 will be the year of pioneers in Plastic Brian Kinney - USA Surgery: Sydney Coleman has composed a President. fantastic program for the 1st International I wish you all a year of happiness and joy and full Deputy General Secretary of chances to develop your identity as a plastic Ahmed Noureldin - Egypt Congress of ISPRES in Rome, March 9-11, 2012. I am excited about the incredible amount of surgeon even further! Deputy General Secretary research programs in plastic surgery which will Andreas Yiacoumettis - Greece be presented in Rome. Cordially yours Parliamentarian We feel overwhelmed by the interest of our Norbert Pallua - Germany members in these innovative future oriented techniques. Executive Director I never before experienced having to close the Zacharias Kaplanidis - Greece registration two months prior to the start of a Marita Eisenmann-Klein congress! IPRAS President

Issue 7 www.ipras.org IPRAS Journal 5 The PIP Breast Implant Scandal

Chronology: thorough evaluations the French Society of Plastic Surgery decided to recommend a prophylactic explantation of all As early as in May 2000 the US Food and Drug Administration PIP implants. performed an inspection of the PIP production site in Finally, on December 23rd 2011, AFSSAPS also announced, Southern France. As a result of this inspection the sale of PIP that all PIP implants should be removed prophylactically. implants was stopped in the US. In a letter to Jean-Claude Most of the Health Authorities in Europe were hesitant to Mas, the owner of PIP, the FDA stated that the implants follow this recommendation, while plastic surgery societies were “adulterated” along with eleven other deviations from took the lead and recommended explantation. For example, the good manufacturing practices such as lack of sufficient German Association of Plastic, Reconstructive and Aesthetic investigation of deflation rate and failure of reporting 120 Surgeons convinced the German Cancer Society and the complaints. Gynaecological Society to hold a press conference together Whether the French Health Authority AFSSAPS was on January 6, 2012 to announce the recommendation for informed by the FDA, about the results of their inspection explantation. BfArM, the German Health Authorities followed or not, is unclear. and released a recommendation for explantation a few hours PIP must have started to exchange the medical grade silicone later. In many other countries, health authorities are still for industrial silicone probably in 2003. For a while, PIP hesitant to come up with a recommendation for explantation. used both types of gel but probably stopped using medical In a telephone conference of most of the European Health grade gel around 2005. From that time on, most likely they Authorities the majority recommended to wait for more data. only used industrial silicone. Roughly estimated: there must They claim that the potential risks of surgery and anaesthesia have been around 200 000 kilograms of industrial silicone might be higher than the potential risk of leaving the delivered to PIP and nobody considered this suspicious! implants in. There is an error in this logic: considering the Inspections were performed by TÜV Rheinland regularly but high failure rate of these implants, the probability, that these they all were announced ten days prior to their visit, which implants rupture within the next few years is extremely is in accordance with the requirements of the European high, which means that there is an almost 100% probability Medical Device Law. that these implants will have to be removed within the life Starting in 2008, more and more plastic surgeons reported span of the patient, but then under much worse conditions. a high failure rate in PIP implants. After an investigation by AFSSAPS, the French Health Authorities banned PIP What do we know about the health risks implants in spring of 2010. of PIP implants? Obviously the PIP implant stock or at least part of it was sold to the Netherlands and the distribution was continued We can only estimate the number of PIP implant patients by Rofil Medical under the name “M-implant”. to be around 500.000 worldwide. We know that PIP also When the Dutch health authorities found out that PIP and M produced other implants such as Testicle implants, buttock were identical, M-implants were banned in June 2010. implants and chest implants for men. We know that the Obviously, it was still possible to continue with the industrial gel which was used by PIP has been tested and distribution of M-implants. The last report we received was found not to be toxic. However, there are signs that the gel about an M-implant inserted as late as October 2011! The might have been manipulated after it was delivered to PIP. distributing company claims that this M-implant has nothing So, in fact, we do not know for sure whether or not it contains to do with PIP. Only the name would be the same, but the new toxic elements. This issue is still under investigation. product would be produced in Cyprus. The report from our We know that the rupture rate of these implants is colleagues in Cyprus revealed that there was no production considerably higher than the normal rupture rate for breast site in Cyprus. Subsequently, the company claimed that the implants which is considered to be 1%. production site was in Korea (North Korea??). Most of the Health Authorities declared rupture rates There are also hints that these products were sold to Middle between 5 and 10% for PIP, but the declarations vary. and South America. Hopefully through our well functioning We also know that the inflammatory reaction in PIP implants network with the help of our colleagues we can trace them seems to be unusually high in case of rupture. But even down. without rupture, patients may develop lymphadenopathy In November of 2011 a patient with PIP implants in France with painful and enlarged lymph nodes as far away as in died from Anaplastic Large Cell Lymphoma, which developed the groin, mediastinum and neck. Axillary lymph nodes are in the scar capsular tissue around the implants. enlarged in many patients. Subsequently, AFSSAPS released a warning that patients Although there were 16 cases of breast carcinoma reported with PIP implants should be examined regularly but they in France in PIP implant patients, there seems to be no did not suggest a prophylactic implant removal. After relation between PIP and breast cancer. These cases are

6 IPRAS Journal www.ipras.org Issue 7 within the range of statistically expected cases. The high quality and safety standards of our breast Anaplastic Large Cell Lymphoma (ALCL) is a tumor of the implant industry deserve to be relied on. immune system. Worldwide 75 patients with breast implants 5. We have to negotiate with health insurance companies and out of an estimated number of more than 10 million patients convince them to provide the expenses for explantation. with breast implants have developed this disease. Four of We also have to negotiate with our managers to provide these patients died. replacement of implants at the lowest possible expenses. It seems that the pre-disposition to develop this very 6. We all need to cooperate in order to implement patient rare disease is multi-factorial and not yet completely registries in order to get reliable data and to have a tool understood. Chronic inflammation usually plays a role in for postmarket surveillance. the development of an ALCL. The risk of developing ALCL 7. Please bear in mind that our patients have to undergo a for patients with breast implants is, according to the FDA, 1 period of fear and insecurity. It is essential that we avoid in 500 000 to 1 million patients. The FDA states: “Patients public controversies regarding this issue. with breast implants may have a small but increased risk in Therefore we appeal to all of you to accept the following developing this disease”. organizations as the legitimate representation of all plastic surgeons in the world: What we still need to find out: 1. On national level: the national society of plastic surgery We still don`t know the exact number of patients with PIP exclusively. implants and M-implants. The national societies should also look for partners e.g. The estimation is around 500 000 worldwide. medical associations, health care providers, government, We still do not know whether more M-implants are still in cancer societies, other scientific societies and consumer use, may be even under a third name, either in Europe or groups, which could be involved. South America. The President of the German Association of Plastic, Reconstructive and Aesthetic Surgeons, Prof. Peter Vogt, IPRAS conclusions: was very successful in presenting the statement of the 1. There is no further room for discussion. It is mandatory society together with the German Cancer Society and the to recommend the explantation of PIP and M-implants. Gynaecological Society in a press conference. 2. Law suits against plastic surgeons should not be 2. On regional level (such as African, Asian Pacific, successful according to our legal advisors, since a European, Ibero-Latin-American, Pan-Arab): the section stockholder must rely on the quality of a product that to which this area belongs should be responsible for has been granted a CE mark. statements. 3. It is unnecessary to call for new laws. The existing 3. For global activities and cooperation with WHO: IPRAS Medical Device Laws are sufficient. and its quality assurance committee, IQUAM, are the The policies, however, should be changed e.g. inspections legitimate representatives of plastic surgeons. without previous announcements. IPRAS is committed to serve the national societies and the The European Commission invited me today to join their sections with its network and expertise. We continue to SCIENTIFIC COMMITTEE ON EMERGING AND prepare drafts for media releases and send them to you. We NEWLY IDENTIFIED HEALTH RISKS WORKING shall only approach the media if you ask us to do so. GROUP ON PIP IMPLANTS. Thank you all for reporting back to us. All the useful The first teleconference will be held tomorrow. I am very information we received from you helped to clarify the impressed by the ambitious time table of our chairman situation and come up with important information which no Philippe Martin, with a deadline for the scientific opinion other institution or organization can provide. to be completed by January 30. Please continue to inform us! 4. This is not a scandal of the breast implant industry. This Cordial thanks to all of you who supported our work. We are is a scandal of a group of criminal individuals who don`t very grateful for your cooperation and proud of our network mind to harm the health of 500 000 women. excellency!

Marita Eisenmann-Klein Nelson Piccolo Constance Neuhann-Lorenz President IPRAS IPRAS General Secretary IQUAM President

Daniel Marchac Andreas Yiacoumettis IQUAM General Secretary ESPRAS President

Issue 7 www.ipras.org IPRAS Journal 7 8 IPRAS Journal www.ipras.org Issue 7 GENERAL SECRETARY’S MESSAGE

Prof. Nelson Piccolo IPRAS General Secretary

I am very happy to say that, once more, Plastic Surgery has demonstrated its internationality and its boundless features. Over 2150 surgeons from 14 countries came to Goiania, in the central part of Brazil, to attend the 48th Brazilian Congress of Plastic Surgery. For me, this was an extra special moment, since I have been living in Goiania since 1963. Although I had lived away for 7 ½ years, coming back to establish my practice and also to continue my family’s work in burns, in 1989, I certainly consider this my town. And it was a great honor and and unique pleasure to see this mega event happen here. For the Sociedade Brasileira de Cirurgia Plástica it was also a most special moment. There was a great homage to Past Presidents, which brought honor and great value to their deeds in improving all aspects of Plastic During the plenary session on “Women in Plastic Surgery” Surgery in our country. Also, IPRAS President, Marita Eisenmann-Klein and IPRAS Executive Director, fields. Dr Eisenmann-Klein took a moment during the Zacharias Kaplanidis, were closely involved with all opening ceremony to honor Profs. Baroudi and Pitanguy official ceremonies and also had opportunities to present as Members of the IPRAS Board of Trustees – certainly their work, as well as the work of IPRAS, in several one of the night’s highlights.

48th Brazilian Cοngress of Plastic Surgery Homage to ExPresidents

Issue 7 www.ipras.org IPRAS Journal 9 48th Brazilian Congress of Plastic Surgery Opening Ceremony

Another first was the plenary session on Women in Plastic continuously searching (and finding) ways of ensuring Surgery, when the audience had a chance to hear from that this very precious aspect of Plastic Surgery is Connie Neuhann-Lorenz (Germany), Lucie Lessard distributed as uniformly as possible. (Canada), Antonia Marcia Cupello (Rio de Janeiro) There is, however, a lot of work still to be done for us and Vera Lucia Cardim (São Paulo) presenting their to attain that goal – Sarah Lorenz of Munich, Germany experience and trajectory as Plastic Surgeons and the and some colleagues of her, also residents in Plastic differences and similarities with their male colleagues, Surgery, are launching a worldwide survey to ascertain in relation to career, profession and life. the quality, uniformity and content of training in Plastic As I have mentioned in the past, I believe one of the Surgery. When the survey reaches you, please make most beautiful aspects of Plastic Surgery as a Specialty sure you take a moment and help this dedicated group is its internationality – how one can perform procedures of young surgeons to plan the world map in Plastic aiming at similar benefits for the patient, with knowledge Surgery Training. We need to know, so we can continue acquired though training and collective experience of to improve the equality of our already established our colleagues and professors. We must, however, work internationality. harder to ensure adequate and uniform training for our residents, as well as adequate and uniform continuation of education for ourselves, practicing Plastic Surgeons.

IPRAS is truly engaged in this! Our Board of Directors, Prof. Nelson Piccolo under the leadership of Marita Eisenmann-Klein, is IPRAS General Secretary

10 IPRAS Journal www.ipras.org Issue 7 Issue 7 www.ipras.org IPRAS Journal 11 EDITOR-IN-CHIEF’SI P R A S JOURNAL MESSAGE The bonds that unite us

Dr. Thomas M. Biggs, M.D. Editor-In-Chief

During the fall months, from September into early December, your Editor-in Chief has had the pleasure and honor of travel to various parts of the world and lecture, as well as speak with, colleagues on four continents. My first stop was Lake Baikal, in Eastern Siberia, near the city of Irkutsk, which was a geographic experience. The meeting was hosted by our able colleague Vadim Zelenin and had an attendance that exceeded 300 Surgeons. The faculty consisted of Brian Kinney from Los Angeles, Roberto Pizzamiglio from Marbella, Spain and your Editor. Also on the faculty were strong representatives from St. Petersburg and Moscow, Irina Khrustaleva and Natalia Manturova. The vast majority of the attendees were Plastic Surgeons from all parts of Siberia and the major topic of discussion was the face, but all areas of Plastic Surgery were discussed. When I attend a meeting as a lecturer I always try to give valuable information to the attendees and at Lake Baikal I was told this was the case. But likewise, when I attend as a listener, I hear the points of view of the other faculty and I leave a net winner in the information exchange. In all my trips I try to learn something about the area to which I’ve come. Lake Baikal was a hidden treasure. Sadly for me, my knowledge of the geography of that part of the world was underdeveloped and I was not aware of the magnitude of Lake Baikal. There are too many aspects of it to be covered in this short essay but it is known as the second largest lake in the world (the Caspian Sea is larger). At one mile deep it is among the deepest and, by my own viewing, one of the clearest. It is a geographic masterpiece and relatively unknown to the Western World. After Siberia I went to Madrid, where I participated as the only non-faculty member in a meeting put on by Jose Luis Martin Del Yerro, unquestionably one of the most skillful and knowledgeable Plastic Surgeons I know and someone whose worldwide recognition will soon soar . EDITORIAL

Dr. Riccardo Mazzola, IPRAS Historian, Dr. Thomas Biggs, IPRAS Journal Editor in Chief

12 IPRAS Journal www.ipras.org Issue 7 After Madrid came Beijing, China, for the first Chinese- European Congress, with Yi Lin Cao as our host. Those who saw the Opening Ceremony of the 2008 Olympic Games immediately appreciated the powerful arrival of China as a world player, and this Congress was of similar style. Afterwards on to Puerto Vallarta for the 38th Annual Meeting of Jose Guerrerosanto, a major institution in the world of Latin American Plastic Surgery, put on by one of the titans of worldwide Plastic Surgery, who has been kind enough to invite me for many years. From Mexico, I went on to Goiania, Brazil, for their Annual Meeting and this, my 37th visit to Brazil, confirmed what I had learned on my first visit in 1972: that Brazil is inferior to none in Plastic Surgery. During this visit, I enjoyed the company of friends I have made over many decades. Among them was Ivo Pitanguy, who was my gracious host on my first visit there, 39 years ago. The multitude of friends there is too great to name individually, but I was pleased to visit with our Secretary General, Dr. Thomas Biggs, USA (IPRAS Journal Editor in Chief) with Ms. Nelson Piccolo, and felt the pleasure of knowing his hand will be Maria Petsa, Greece (IPRAS Assistant Executive Director) at the on the wheel of IPRAS for several years. IPRAS booth during the 48th Congress of the Brazilian Society of Finally I attended a meeting in the U.S. In New York City, Plastic Surgery. The Cutting Edge Meeting of old friends Sherrell Aston and Dan Baker. It was a booming success with attendees from 60 from their excellence. countries. They had a large and diverse faculty, each speaker What you’ve just read is true and extremely important to me…. being limited to 10-15 minutes, but each session being followed but there’s more. by an intense questioning by either Dr. Aston or Dr. Baker. During my travels, I have found a great similarity in my life The questions being those the moderators felt were probably and the lives of those colleagues from half a globe away…. foremost in the minds of the attendees. from people with whom I often need a translator to adequately Finally, this message is being written from Miami, where I’ve communicate. There’s a similarity in the fact that our patients come to visit Roger Khouri (the first “Frontiersman” in this come to us with a need and they carry with them the faith in Journal). I’ve been staying with him, seeing new patients, short us that we can help resolve that need. I’ve found we share the and long term follow ups, and spending many long hours in same deep misery when some aspect of our surgery doesn’t go the operating room. In between, I’ve been working to help him as we had planned, but we also share the same joy when we see assemble his thoughts for future publications. a smiling face walking into our clinic and we know things are All of the above experiences have added immensely to my going well. The pink nipple rather than a blue one…a finger body of Plastic Surgery knowledge. My travels have exposed with full flexion and extension….a soft, well-shaped breast rather than one that is firm and contracted…..a happy smile me to the fact that many of our colleagues around the world from a young girl whose retruded maxilla is now in the right are performing operations in a way very similar to the way we place. You, as surgeons, know what I mean…..the joys of our perform them in our own facilities; there are also colleagues work…the Holiday card that says “Thank You”. doing things differently, often with outstandingly good results. All these things we share…whether it may be in Houston I’ve met colleagues with huge experience, who have never or Hong Kong, Moscow or Montevideo, Denver or Dubai, spoken of their findings, nor have they published, but their Stockholm or Sydney. work is outstanding. As Editor-in Chief, I’m making it a project These are bonds, similarities of purpose, works done in to bring these people out into the light, so we can all benefit rooms that have a similar appearance the world over, the same relationship between the patient in need with the skillful physician who has the tools and experience to care for this human being with some kind of pain. We also share the knowledge, that in some areas our colleagues lack the tools to adequately play their role in healing and we share the desire to reach out and help. We, as Plastic Surgeons, are separated by languages, by borders and boundaries, and in some instances by cultures….. but the bonds that unite us are far, far greater than those factors that separate us. We truly are a family, brothers and sisters, all working to take care of the family business. What is the family business? The family business is to make people’s lives better through Plastic Surgery.

Prof. Ivo Pitanguy, Brazil (IPRAS Trustee), Dr. Thomas Biggs Dr. Thomas M. Biggs, M.D. (IPRAS Journal Editor in Chief) on 2007. Editor-In-Chief

Issue 7 www.ipras.org IPRAS Journal 13 IPRAS MANAGEMENT OFFICE REPORT October 2011 - December 2011 Let’s give our answers to the Challenges

Mr. Zacharias Kaplanidis IPRAS Executive Director

There is no doubt that the international community is And if all the above were not enough, the PIP scandal was facing multiple and, perhaps, the most complicated added to the list of issues that trouble the International challenges of the last decades. Plastic and Aesthetic Surgery Community. Europe continues to tackle, with limited success until now, So, where does all this lead us?? its fiscal issues; unemployment has reached dangerous - To the foresight of the Maya ancient tribe that the world levels, especially in Southern Europe (in Greece alone will come to an end in 2012??? it has reached 20%), Europe and America’s problems have began to burden China’s exports and developmental - Or, on the contrary, to the perception that the “ship of rate (less than 9% in 2011). Northern African and Middle humanity” needs a change of course, so that it is not East countries continue to be socially agitated, despite left stranded. the collapse of the dictatorship regimes (Egypt, Iraq, Despite my utmost respect for the advanced civilization Libya and Tunisia) of the Maya tribe, it is my belief that “we are going the wrong way”. It is entirely up to the leadership of the European countries to solve their economical problems immediately and, at the same time, Southern Europe must learn to comply with the rules of a prudent management. The “Arab Spring” must quickly come to the day-after decisions for the benefit of its people. China, Brazil and all the other rapidly developing countries must understand that they are not “de facto” almighty, but depend on the peace and financial progress of other countries. Regarding the PIP case, the industry must respect the common interest, especially public health and focus on meeting the needs of the public and not risk the public’s health in order to make a larger profit. Finally, we, the people, are obliged to visit our doctors on a regular basis, whether we have undergone surgery (even for aesthetic reasons) or not. The example was clearly set by our International Confederation (IPRAS) which responded immediately and positioned itself effectively on the PIP issue, by sending its assessments to 101 National Associations Dr. Gregory Evans, USA (ASPS President Elect) during his and 37000 Plastic Surgeons around the world. The main presentation at the 1st Chinese European Congress of Plastic, Reconstructive and Aesthetic Surgery. points of the IPRAS statement were the condemnation

14 IPRAS Journal www.ipras.org Issue 7 From the left: Dr. Theodoros Voukidis, Greece (ISPRES founding member), Mrs. Katherine Lee Tai, USA, Prof. Marita Eisenmann- Klein, Germany (IPRAS President), (at the back) Mr. Fabian Wyss (Crisalix Chief Marketing & Sales Officer), (at the front) Dr. Josef Fedeles, (member of the Training and Accreditation IPRAS sub-committee, IQUAM member), Prof. Yilin Cao, China (President of CSPS, IPRAS Deputy General Secretary), Dr. Paul Ling Tai, USA, Dr. Pericles Serafim Filho, Brazil (member of the Scientific Advisory Board of IPRAS), Dr. Ricardo Mazzola, Italy (IPRAS Historian).

of the irresponsible companies, the recommendation to all doctors and patients to keep a calm status, the support to the healthy and serious industry of Plastic Surgery and the urge towards preventive check-ups of the patients. Conclusion: All of the above complicated challenges can be confronted with a wise and willing attitude, but can also lead the “humanity ship” to much more “tranquil ports” with a social, political and economical complexion. IPRAS, in the last 3 months of 2011, came closer to its members and to the National Associations of nations such as China, Brazil, Russia and Italy. The 1st Chinese European Congress of Plastic, Reconstructive and Aesthetic Surgery took place in Beijing, China, from October 27th to October 29th with the utmost success and attracted approximately 200 Chinese and more than 300 distinguished foreign Plastic Surgeons. Apart from the scientific and organizing success, this Congress could certainly be characterized as a grand rehearsal for the IPRAS World Congress Mr. Zacharias Kaplanidis (IPRAS Executive Director). IPRAS of 2015. Important conclusions were drawn, which will presentation during the 48th Brazilian Congress of Plastic Surgery. be utilized when the time comes.

Issue 7 www.ipras.org IPRAS Journal 15 From the left: Mr Alexey Kovalsky, POLYTECH Health & Aesthetics Director POLYTECH Health & Aesthetics Ukraine, Mr. Wilfried Hüser, founder and owner of POLYTECH Health & Aesthetics, Mrs. Katherine Lee Tai, USA, Dr. Paul Ling Tai, USA, Prof. Yilin Cao, China (President of CSPS, IPRAS Deputy General Secretary), Prof. Marita Eisenmann- Klein, Germany (IPRAS President), Mrs. Vivian Breinhild, POLYTECH Health & Aesthetics Director International Sales, EMEA, Dr. Albert de Mey, Belgium (member of the Scientific Advisory Board of IPRAS), Dr. Philippe Blondeel, Belgium (member of the Scientific Advisory Board of IPRAS), Dr. Pericles Serafim Filho, Brazil (member of the Scientific Advisory Board of IPRAS).

Furthermore, the IPRAS Executive Committee and the Board of Directors convened during that time, with a large participation of its members and important decisions were made, such as the 2012 Budget approval. Our President, Prof. Marita Eisenmann-Klein, our General Secretary, Dr. Nelson Piccolo, the Deputy General Secretaries, Dr. Yilin Cao and Dr. Ahmed Adel Noureldin, our Parliamentarian, Dr. Norbert Pallua and our Treasurer, Dr. Bruce Cunningham were all present at this very important event. Additionally, we must point out the impressive participation of the Brazilian Plastic Surgeons (approximately 60) and the Russian (approximately 70). We would like to thank the Scientific and Organizing Committee of the Congress, Prof. Yilin Cao, Prof. Andreas Yiacoumettis, the greatly missed (due to a personal issue) and NIKE Med, Polytech, Crisalix and Silimed for its substantial contribution. Immediately after China, we traveled to the other side of the planet, to Brazil, for the 48th Brazilian Congress of Plastic Surgery, which took place in the adorable city of Goiania, the homeplace and permanent Mr. Zacharias Kaplanidis (IPRAS Executive Director), Mrs. Carol residence of our General Secretary from November 10th L. Lazier, USA (Staff Vice President and Chief Membership Officer th American Society of Plastic Surgery), Dr. Phillip Haeck, USA ( to November 15 , Dr. Nelson Piccolo. With more than Former President of ASPS) at the IPRAS booth during 48th Brazilian 2000 participants, Brazil proved once more that, not Congress of Plastic Surgery only is it one of the largest associations (2nd after USA)

16 IPRAS Journal www.ipras.org Issue 7 Mr. Zacharias Kaplanidis (IPRAS Executive Director) with Mrs. Liudmila Antonova, Russia (General Director of Nike-Med) and Mrs. Anna Pimenova, Russia (Nike-Med) addressing to Russian Plastic Surgeons concerning IPRAS benefits at the “NIKE-MED’s 15th Anniversary Conference “Happy to be Together”. in the world, but also that it is a great country on a President of the congress Dr. Carlos Calixto the scientific level and dedicated to more ethical values. Scientific committee Member of the Brazilian Society For approximately 3 hours during the opening ceremony, of Plastic Surgery, Dr. Pericles Filho, and, of course, important personalities were honored, such as Prof. Ivo our General Secretary, Dr. Nelson Piccolo and his Pitanguy, Prof. Baroudi and all the past Presidents of the truly beautiful family. Association. In mid-December (12th - 15th), the executive Director, It was the most beautiful and emotional Opening Mr. Zacharias Kaplanidis, traveled to Moscow, where Ceremony that I have ever attended so far. he met with members of the Russian Association of Plastic and Aesthetic Surgery and discussed the CONGRATULATIONS potential for organizing a workshop based on new Let us hope that all the other National Associations developments in the field. Another great opportunity will follow this bright example of acknowledgement to exchange scientific knowledge with a great country. of personalities who have honored the field of Plastic We would like to express our gratitude to the NIKE Surgery in their countries with their achievements and med Company for its hospitality and support. ethos. Our last journey in these 3 months took us to Italy and th th The truth is that I indeed experienced that same atmosphere specifically Rome (December 15 to December 17 ), where again in Cesme, Turkey, during the Congress of the we participated in a special scientific event with highly Turkish Association of Plastic and Aesthetic Surgery. It distinguished scientists from the Italian and International World of Plastic Surgery, the 3rd International Conference is truly a remarkable feeling. on Regenerative Surgery. The President of the Our President, Prof. Marita Eisenmann-Klein, Conference, Prof. Valerio Cervelli, Dr. Sydney Coleman Executive Director, Mr. Zacharias Kaplanidis and and Prof. Marita Eisenmann-Klein, Dr. Dan Del Vecchio Assistant Executive Director, Mrs. Maria Petsa, and Dr. Gino Rigotti were just a few of the basic speakers represented IPRAS in Brazil and had the opportunity to of the Conference, which focused on the contemporary speak to hundreds of participants on issues concerning issue of Regenerative Surgery and Fat-Grafting. the Confederation’s co-operation with the Brazilian After all the above, 2011 comes to an end. It has been a Association and its members. year with tremendous challenges for all to face, but with We thank them all for their absolutely wonderful the appropriate response by the bodies of IPRAS and its hospitality, but especially we would like to thank the mechanisms. Zacharias Kaplanidis IPRAS Executive Director IPRAS Management Office ZITA Congress

Issue 7 www.ipras.org IPRAS Journal 17 18 IPRAS Journal www.ipras.org Issue 7 PIONEERS An interview with Dr. Rod Rohrich

Dr. Biggs: Dr. Rohrich, with your work as Editor-in- to always do the right thing: he was amazing. I was Chief of the official Journal of the American Society strongly encouraged by Drs. Grabb and Dingman to of Plastic Surgery, you play what I, and many others, write, to promote and to give back to Plastic Surgery, see as the most significant role in education of Plastic because we get so much from Plastic Surgery. There Surgeons in the world and thus, the course into the is always time to give back and to contribute to future of Plastic Surgery. For this, we are proud to the advancement of the art and science of Plastic designate you as our “PIONEER” for this issue of Surgery. I was then brought under the tutelage of the IPRAS Journal. Dr. Steve Mathes, who was my Chairman while I was Administrative Chief in Plastic Surgery at the We would like to use this interview as an opportunity University of Michigan. for the 37,000 recipients of our journal, to get a better understanding of you and what is behind your These were highly formative years. I also spent a drive…and how you see the future. significant amount of time doing Pediatric and Craniofacial Surgery in my elective year. I spent time Let’s begin by your giving us a bit on your at Oxford University with Dr. Michael Poole doing background. Craniofacial Surgery and then met Drs. Marshac Dr. Rohrich: I grew up on a ranch in North Dakota and Tessier, two outstanding Plastic Surgeons, in and did not speak English until the age of five. I multiple trips to Paris. I also had the opportunity to learned early on, that the best way to succeed was spend time with Dr. Fernando Ortiz-Monasterio in to be focused, work hard, and that it does not matter Mexico City, in the pinnacle of his career. where you are coming from, it’s where you are going At the Massachusetts General Hospital/Harvard that’s most important. This is indeed the ultimate in Boston, Dr. James May taught me to focus on American dream. excellence in all I do and always be better each I did my Plastic Surgery training at the University day. This continues to be a valuable life lesson. I of Michigan after completing Medical School at rapidly learned that Plastic Surgery, as a specialty, Baylor College of Medicine. I was highly motivated does not have its own organ, such as the prostate for and stimulated by Dr. Mel Spira, head of Plastic Urology or the brain in Neurosurgery. Instead, we Surgery at Baylor, who became one of my early have our own innovation and that is something that Plastic Surgery mentors. At the University of has been the glue that’s actually been the foundation Michigan, I worked with Drs. Grabb and Dingman for our specialty. This has guided me in my role as A and was vastly influenced by these gentlemen, who Plastic Surgeon and has motivated me to give back both subsequently died during my six-year Plastic to this wonderful specialty as a teacher, as a Program Surgery residency. I will never forget their total Director and as a Chairman. We must teach the next focus and dedication to the excellence in Plastic generation to pursue excellence, be innovative, create Surgery. Dr. Dingman instilled a sense of duty and an environment for innovation and to give back by

Issue 7 www.ipras.org IPRAS Journal 19 doing, not only superb clinical work, but to give and dedicate a significant part of your career to this back by innovating and publishing in peer-reviewed effort. The time to start doing this is now, while you journals, as well as presenting our work worldwide. are a young Plastic Surgeon. My interest in writing began as a medical student at As I mentioned previously, I spent my formative Baylor College of Medicine, while working with Dr. years growing up on our ranch in North Dakota, with Mel Spira. limited resources, but my parents wanted a better life Dr. Biggs: I certainly agree with you about Mel Spira. for all of us. They imparted to my two brothers and I met him in the emergency room the afternoon of me a tremendous work ethic and that one must lead my first day as a resident at Baylor in Houston. I was by example, like my parents did for us. I certainly the Surgery resident on call and he was the plastic never ask a faculty member, resident, or anyone surgery resident on call, on his first day working else to do anything I would not do myself. It keeps there, like me. We became great friends then and still me grounded as well. One must lead by example to are. He will always be my number one mentor…. become a role model or mentor. We are influenced but to get on with the interview: tell us about what by and pattern our lives after these role models and you’re doing in Dallas. You run probably the most mentors. I certainly remember one of my earliest proficient and productive training programs in the role models, besides my parents, was one of my U.S. and even the world. Tell us about it. science teachers, Mr. Schimcke, who challenged Dr. Rohrich: You can always become and be me to find a new way to study Mendelian Genetics better, no matter how good you are at what you using fruit flies. He allowed me to do things I had do. It is helpful always to surround yourself with never done before and to do them by myself. Just people that have the same philosophy. I find that remember that you have to aim high in life if you the key to success is in picking great people, both want to succeed. Therefore, aim very high because in residency and faculty, that are better than myself. you will get where you aim. If you don’t aim high, You have to be very selective and selfless in doing you’ll always get there, too, and you will not be so; it demands conducting a regular 360-degree happy for aiming so low. You must aim higher than re-evaluation of yourself, so you can re-focus and you think is attainable and it will get you there. A rethink on areas which are important. You have good work ethic is strong encouragement both at to be focused long-term. For example, at UTSW, home, at school and in your personal life and we we have taken a small division of Plastic Surgery certainly try and gender that into our residents. with a couple of faculty and staff, to a staff of Coming from a high school class of twenty four over one hundred and thirty, with twenty full-time students, where I was one of the only ones that faculty, nine part-time faculty, six residents per actually finished college and went on to higher year and multiple fellows in Craniofacial, Hand, education, helped me focus on setting high goals, Cosmetic, Micro and Breast Surgery and research. working hard, and pushing myself to a higher level. We have multiple NIH grants and one of the most That is what makes you succeed in life. largely productive clinical and academic faculty departments in the U.S. Becoming a Department Dr. Biggs: For the past few years I’ve heard you of Plastic Surgery at UT Southwestern was pivotal speak passionately about Evidence-based Medicine. and has provided us with a basis for growth and Please bring us up to date on that matter and how it’s an example for other divisions and departments being reflected in the Journal: around the country to succeed as well. Dr. Rohrich: I think one of the epic changes in How can we become better at what we do in Plastic Medicine and in Plastic Surgery is that we are Surgery? An “expert” is someone who is focused on owning our specialty, as we become more evidence- excellence through practice, focus and dedication based. Plastic Surgery has been an “expert-based” for over 10,000 hours. This type of training and specialty, where experts have driven the specialty commitment holds true whether you want to be a through innovation. These experts are incredibly concert pianist or Plastic Surgeon. If you want to valuable and continue to be, but we must now go be an expert in what you do, you have to focus on it to the next level of excellence. That next level

20 IPRAS Journal www.ipras.org Issue 7 of excellence is that of evidence-based medicine Evidence-Based Medicine Summit in Colorado (EBM), where we must prove that what we learned Springs, Colorado in August 2010 (see Figure as experts can truly be done, not only by ourselves, 1). At that meeting we strongly encouraged all of but by others and can be shown to work in both a the journal editors to work with the ASPS and the prospective and randomized manner. Whether it is journal of Plastic and Reconstructive Surgery to a product, a technique or a technology, it must now have a single grading system for evidence-based be shown to truly work sufficiently, in a scientific medicine, similar to what we use in PRS, so we can manner. That is the next level of excellence we move forward together. A year later, in May 2011, must achieve. Since becoming Editor-in-Chief of at the Plastic Surgery Journals Editor Round Table the journal of Plastic and Reconstructive Surgery in Meeting in Vancouver, Canada (see Figure 2), PRS 2005, we have pushed the technological envelope, was joined by other international Plastic Surgery evolving the journal from being a print-only version journals and we all agreed to work on establishing to being online in all aspects (including the peer uniform global EBM standards and Levels of review process to the upcoming development of the Evidence grading systems. At the Vancouver iPad app). Today, you can see, feel, and look at our meeting, we agreed to invite all of the world editors videos in the PRS journal instantaneously. That is of Plastic Surgery journals, as well as those of our the natural evolution. Innovation, aiming high and other related specialties, in Facial Plastic Surgery, seeking new challenges brings you higher caliber Dermatology, Oculoplastic Surgery, to attend our articles, as well as a higher caliber type of evidence- next EBM strategic planning meeting in Colorado based Plastic Surgery, which will help drive Plastic Springs in July, 2012. EBM is for Plastic Surgery Surgery to a better place in Medicine. The bar in worldwide, and Plastic and Reconstructive Surgery Plastic Surgery is being raised and we are pushing stands as an advocate for unified, global EBM that bar with evidence-based medicine. We need to standards among all Plastic Surgery and sister- push our entire specialty of Plastic Surgery to come specialty journals. and join us, to make sure that we truly are and remain Dr. Biggs: How do you see the future of Plastic at the cutting edge, not only of innovation but that Surgery? of EBM, so we can show the rest of Medicine that what we have done and what we continue to do is Dr. Rohrich: The future of Plastic Surgery is very evidence-based. bright. It lies in innovation, autonomy, becoming departments, developing and expanding evidence- So, as a Plastic Surgery leader in the United States, based medicine through the entire world, and I think it is important for us to show and lead developing a uniform platform for the language in by example, not only by our journal, but now in space medicine. We will focus on where we are going our clinical practice. EBM is rapidly changing to take EBM in Plastic Surgery in the future, how we how we practice Medicine and how we practice will become better: better in what we do, better in Plastic Surgery. It will make us better. The goal our practice and better in improving EBM, because is to provide a foundation for doing evidence- that is our future. After all, the goal is to improve based Plastic Surgery. There is no better way than patient care, drive innovation, drive cost efficiencies mandating that Plastic Surgery programs become and only then can we say we have given our best, their own departments; this must be solidified, so given back and left the world a better place, both for we can allow for true innovation to occur, separate Medicine and for PLASTIC SURGERY. That is my and apart from General Surgery, which, I think, is goal and that is what I will continue to do. so critical. We are now, and have been for a long time, our own specialty. Because EBM has proven It pleases me to get this message out to your 37,000 to be a highly effective methodology, the American recipients and I want them to join me in this adventure Society of Plastic Surgeons and the American of the EBM world of Plastic Surgery. It will be a Society of Aesthetic Plastic Surgery, along with better place for all of us as Plastic Surgeons and for other Plastic Surgery and related specialty journals Plastic Surgery as well. and societies, convened at the first Plastic Surgery Dr. Biggs: Thank you Dr. Rohrich

Issue 7 www.ipras.org IPRAS Journal 21 22 IPRAS Journal www.ipras.org Issue 7 R I S I N G S T A R An interview with Dr. Bouraoui Kotti

Dr. Biggs: Congratulations on being chosen as our of the unit of Plastic Surgery in the Surgery Department. RISING STAR for this issue of the IPRAS Journal. As Dr. Biggs: What Societies do you belong to? you know, we select someone under the age of 45, who has shown great promise in their pursuit of excellence in Dr. Kotti: Tunisian Society of Plastic, Reconstructive, Plastic Surgery. Tell the readers a bit about yourself. Begin Maxillofacial, and Aesthetic Surgery (STCPRMFE), by telling us your background and your education. ASPS, SOFCPRE, and ISAPS of which I’m National Dr. Kotti: I was born in 1977 in Tunisia, a country of Secretary. 11 million people and 80 plastic surgeons. My primary Dr. Biggs: I looked over your list of publications and education was undertaken there, as well as my medical presentations, over twenty in all, and fifteen posters. education. I graduated in June, 2000, from the Medical I noticed you have run the table on topics from digital School of Tunis and followed that by a broad medical/ reattachment to abdominoplasty and blepharoplasty, surgical internship for one year. breast reduction and reconstruction, to extensive From 2002 to 2006 I did a residency in Plastic Surgery maxillofacial reconstructions, and to burns. That’s a lot and completed a dissertation on “Plastic Surgery for the of production for a young man and very impressive. Management of Pressure Sores”. I graduated Summa Cum Laude from the Tunisian Public Health Department Dr. Kotti: And there is a lot more to do and the Tunisian Higher Education, Scientific research Dr. Biggs: Tell me about that. What do you predict and and Technology Department in Plastic Reconstructive & where do you see yourself in five years? Aesthetic Surgery (October 2007) and made the decision to move to France, where I continued my studies. I Dr. Kotti: I see myself still in pursuit of better ways to do worked in Nice and Paris in services including breast more for people. My interest lies more in reconstruction, reconstruction, maxillofacial surgery, head and neck but with an increased attention to its aesthetic aspects. surgery, and general Plastic Surgery, including Aesthetic My great hope is that the political situation in Tunisia will Surgery. I spent most of last year (to February, 2009) be such, that I can expand my research capabilities and with Dr. Claude Lassus in Nice. My studies and work impart progress made there into clinical applications. in France allowed me to be Certified from the French Dr Biggs: Thank you Dr. Kotti. Your great hope is College of Plastic Reconstructive and Aesthetic Surgery shared by members of our Plastic Surgery family around (November 2007) and, in May 2008, by the European the globe and this is why I so often say that “the bonds Board of Plastic Reconstructive and Aesthetic Surgery. that unite us are greater than the borders, boundaries, and Dr Biggs: And then you returned to Tunisia ? languages that divide us” Dr. Kotti: Yes, and in 2009 I joined the “Salah Azaiz” Again, congratulations on being chosen our “RISING institute (an anti-cancer centre) and have become Head STAR”.

Issue 7 www.ipras.org IPRAS Journal 23 SENIOR AMBASSADOR Dr. Riccardo F. Mazzola

Dr. Biggs: Dr. Mazzola, to those of us who have been on and Courses. the Plastic Surgery scene for a while you are a legend, but I’ve been honoured to be the Keynote speaker in numerous this is an International Journal and many of our readers are International Congresses, and was awarded the Maliniac somewhat new to the field, so please give us a review of lectureship at the 2006 ASPRS Congress in San Francisco, your educational and training background. USA. Dr. Mazzola: I obtained my medical degree at the University I am the co-Author of 3 textbooks (“Craniofacial of Pavia in 1967, magna cum laude. I passed my Board Malformations”, Churchill Livingstone 1990; “Velopharyngel examination in ENT in 1970 at the University of Ferrara Incompetence”, Masson 1995, in Italian, “Fat Injection, and my Board in Plastic Surgery at the University of Milan from Filling to Regeneration”, Quality Medical Publishing, in 1974 (head Prof. G. Sanvenero Rosselli). I became an 2009), 12 book chapters and 112 publications, 38 of them in Assistant Professor of Plastic Surgery at the University peer reviewed scientific journals. of Milan in 1971 and I am currently Professor for Plastic Dr. Biggs: What are your primary surgical interests now? and Reconstructive Surgery at the Postgraduate School of Dr. Mazzola: My primary interests include Cleft Lip and ENT, and Maxillofacial and Plastic Surgery at the School of Palate, Head and Neck reconstruction, Nasal Reconstruction, Medicine of the University of Milan. Fat injection, Rhinoplasty and History of Plastic Surgery. Dr. Biggs: Tell us about your Foundation. Dr. Biggs: Where do you see us going in Plastic Surgery? Dr Mazzola: In April 1975, I established the “Fondazione Dr. Mazzola: That is a good question, because I am both G. Sanvenero Rosselli” for Plastic Surgery, as a tribute to my optimistic and, at the same time, somewhat despondent. I’m late uncle Gustavo Sanvenero Rosselli, founder of Plastic the latter because Plastic Surgery, by not being independent, Surgery in Italy. The institution promotes various forms has less opportunity for research. Modern day Plastic Surgery of teaching, fulfilling a continuous postgraduate training began with a collection of ENTs, General Surgeons, and several program, by arranging meetings, seminars and courses in others who had a common talent: innovation. Innovation the field of Plastic Surgery. Directed by a Board of Trustees, was necessary to deal with the massive wounds resulting the Fondazione has coordinated more than 150 meetings from World War I, wounds never seen before, because these and seminars and organized 48 theoretical and practical unfortunate victims were the beneficiaries of medicine which courses, with live surgery over the years. I am currently the was advanced enough to keep them alive but still lacking in Vice-President of this Institution. The Fondazione houses skills to reconstruct them. My despondency lies in the fact that more than 4,000 books and boasts certainly one of the most our lack of independence limits us in our quest for advanced important rare book collections on Plastic Surgery in the solutions plaguing modern surgical problems. world. We have volumes dating from 1490 onward. My optimism lies in the wonders that await us. These Dr, Biggs: Tell us about your professional life. wonders include wound healing, tissue regeneration, Dr. Mazzola: I am a Founding Member, Secretary General concepts of neurogenesis, and many others. (from 1995 to 2001) and President (from 2005 to 2006) of the Dr. Biggs: Do you have any advice for our younger EURAPS (European Association of Plastic Surgeons). I was readers? Secretary of the Italian Society of Plastic Surgery (SICPRE) Dr. Mazzola: Yes. Go back several centuries and see how from 2001 to 2004, and am a member of over 15 National brilliant minds were dealing with some of the same problems and International societies, among them the prestigious we are dealing with now. See how Leonardo Da Vinci American Association of Plastic Surgeons (AAPS). understood anatomy, how concepts of wound healing have Dr. Biggs: How about presentations and authorships? evolved. Study the Masters and extrapolate their creative Dr. Mazzola: I have participated in 450 invited panels, thought processes into your own. lectures, conferences and courses at National or International Dr. Biggs: Thank you Dr. Mazzola. You truly are a Senior Meetings and Congresses. I have organised 52 Congresses Ambassador for IPRAS and for physicians of all types.

24 IPRAS Journal www.ipras.org Issue 7 © 2011 POLYTECH Health & Aesthetics, Germany. Aesthetics, & Health POLYTECH 2011 © Issue 7 www.ipras.org IPRAS Journal 25 HUMANITARIAN WORKS How to conciliate religion and humanitarian surgery in Islamic developing countries

Dr. Christian Echinard President, HumaniTerra International President, IPRAS Foundation

Developing Islamic countries are quiet and peaceful predominant religion geographically extends, more or areas, most of the time. In some cases however, the less horizontally, from the western part of Africa to the work of humanitarian teams is not as easy as that… The Far East end of the southern Asian continent, including following lines try to analyze the specific problems that Malaysia and Indonesia. Historically and theologically, could be encountered in some places, where the religion there are several “families” of Islam, such as Shiites, is dominating and ruling the public life and the cultural Sunnites, Kharijists… all of these groups coexist in a habits in such a way, that things are becoming so different more or less complex harmony in the many developing and thus more difficult to understand for an occidental countries, where humanitarian teams are performing mind. And after all, if we want to help them, we first have surgical camps or missions. to understand them…. Moreover, Islam is, most of the time, a state religion and therefore this religion often becomes a real SPECIFICITY OF WORKING CONDITIONS political-religious rule. FOR THE HUMANITARIAN TEAMS In fact, there are, as far as geography and culture are The teams are faced, most of the time, with a triple concerned, several Islams… Because of local political specific deal: the religion, the women’s condition and the and cultural factors, Islam in Maghreb is not exactly corruption … the same as the one in Indonesia and is also different from the Islamic beliefs of central Asia or Turkey, for The religion instance. • About Islam: Islam is a beautiful religion, spread all The medical and surgical humanitarian teams working over the world. However, the territory where it is the in different parts of the world will be faced with a “soft” or “moderate” Islam in some places, or with a “hard” or “strong” Islam in other countries… • The Muslim population: it seems that the actual number of Muslims in the world reaches approximately 1.5 billion people. Etymologically, the word Muslim comes from the Persian “Musilman”, plural of Musilm, whose root is the verb “Aslama” (to be resigned, to be submitted … to God, of course). This great number of people and the strength of their faith put Islam as one of the major religions in the world, especially in the poorest parts of the world. • Their position towards illness and medical care is not identical everywhere. Muslims of the world, though they cannot really read and deeply study the enormous amount of rules of the Koran, are very faithful and, most of the time, respect the 5 main rules (five prayers a day, pilgrimage, Ramadan…) As far as illness A man in Kabul… and medical care are concerned, there is, in fact, no

26 IPRAS Journal www.ipras.org Issue 7 Women from the mountains in Afghanistan

specific rule. For some of them, illness is considered • Materity mortality: in Afghanistan, one woman dies as a punition of God and requires little care, for some every 21 minutes due to delivery problems! In central others, on the opposite, it is something that must be Asia Islamic areas, 2000 female patients die in 100 000 treated absolutely immediately. births! In Europe the average is only 10-20/100 000. The women, of course, have a special status… In • Violence towards women is also an important cause of some remote places they should not be touched by a female over-mortality. male doctor… The problem is that, very often, there It can be in the form of domestic and marital abuse. It is no female doctor… This is very frequently the reaches 50% in some of these countries, the champion case in Afghanistan, where women die because their being Bangladesh, where more than one wife out of husbands refuse the help of a male doctor, especially two is regularly beaten. In Pakistan, 300 women are for delivery. This is, of course, an extreme point of killed every year by their husband, brother or son, in view. In most cases things are much simpler and the the name of honor. real rule in the Islamic religion is that, when there is a Among the worst crimes, forced or induced suicides necessity, women can be treated by any male doctor, by flame are very frequent in Iran, Afghanistan Muslim or of any religion. Necessity creates the law (especially the Herat area), Pakistan, Iraq, but also in and the rule… a safe and good advice… Africa (Zimbabwe, Egypt…) In Pakistan and Bangladesh, there are many acid attacks The women’s condition: female mortality against women, committed by jealous or unsatisfied creates a terrible disorder husbands. This type of acid burn on the face leads to • Gender mortality: this is a real economical and extremely severe contractures and real disfigurations of demographical problem. In most of the Islamic the wives. Two NGOs have been created to fight against developing countries, the female to male ratio is, on that, the “Acid Survivors Foundation” ran by Valerie average, 900/1000; It is the opposite in occidental Khan in Pakistan and Monira Rahman in Bangladesh. areas: 100 females for 90 males in Europe, whereas Apart from marital aggressions, these gender crimes can in Bangladesh and Pakistan the ratio is 100 women for also be the result of abusive punishment or usual violence 106 males. Another interesting sign is that, in those two such as stoning, rape, excision, any kind of mutilation countries, the average duration of life is the same in men (hand or nose…), sexual slavery and forced pregnancy. and women (56 years); in Europe and America females Moreover, many rapes have been committed in these live approximately ten years longer than males… countries as a war weapon, in order to humiliate the This over-mortality in the female population is due to enemy. In Kuwait, over 5000 rapes were committed several factors, such as the way of life, the number of against the local women by the Iraqi forces, when they children, the amount work done by women… but also invaded this country in 1990. In Algeria, between 1995 due to the high maternity mortality and the increased and 1998, rapes were committed in the name of the Jihad level of violence towards them. in order to render the females impure and dishonored…

Issue 7 www.ipras.org IPRAS Journal 27 rules of our action. We must understand what they are and what they need and therefore respect their identity. But we must never betray our principles. We must adapt them to the local situation. The most important rule is to respect three important things: the political and religious authorities, the local medical teams and, above all, the patients whom we are suppose to treat.

Respect of the political and religious authorities • In every one of these countries the humanitarian teams, or their delegates, must try to have a meeting with the local or regional political authorities (governor, president of local assemblies, Shuras…). A complete agreement Teaching women rights in Bangladesh must be established before any action is taken on the field. This makes things much easier for the rest of the The corruption and … the narcotics business missions and always clarifies the situation. • Corruption: last year, the UNDP (United Nations • Mullahs and religious assemblies should also be Development Program) classified Afghanistan at contacted, in order to explain to these dignitaries what the 155th rank out of 169 countries in the world for the aim of the mission is and get a complete approval development and economy. Meanwhile, the NGO from them. This is particularly useful when a NGO is “Transparency International” stated that this country working on a prevention campaign, in which women was placed third as far as corruption is concerned ! are involved, such as campaign against suicide by • Narcotic trafficking: most of the time, corruption is flame or against acid attacks. It is very important to connected to drug trafficking … Afghanistan is by far discuss with them, explain to them the work that will the firstopium producer in the world; before the Taliban be done, ask their opinion, see how they can help… period (during the soviet domination) production was Communication is extremely important and, with estimated at 2500 tons per year. In 1999, at the end the consent of the Mullahs, the behavior of men and of the dramatic Taliban government, it reached 4600 women in the area will be very much in favor of the tons per year, proving that they did not do anything NGO. On one hand we must absolutely avoid being against drug trafficking… In 2007, under the current considered as neo-colonizers by the local population. government, opium production in Afghanistan nearly On the other hand, when we are supposed to deal with doubled, and was evaluated yearly to 8200 tons! And situations related to women, we must avoid any kind of this was of course very much to the benefit of the frustration or dishonor from the men. This is also the political elite. The resulting gain from opium trafficking reason why it might be useful to work in collaboration is probably one billion dollar per year. One gram is with a local NGO. sold in the country about 2 or 3 dollars. It is re-sold in Europe or America for 70 dollars. At the same time, Respect of the local surgical teams we found that it is still difficult to find narcoleptics for • Most of the time, the NGO surgical team is totally anesthesia in a hospital in Kabul or Herat … welcome by the local medical teams, which are • Position of the medical team faced to this problem: this shows how the task of the humanitarian medical teams can be difficult in such countries… corruption must not touch our teams. Everything possible must be done in order to avoid any kind of collision with anyone. And everyone must be aware that the manipulation of the team about this problem can be very easy and can be a source of conflicts…

WHAT MUST BE THE BEHAVIOR OF THE HUMANITARIAN TEAM? In the face of such a situation, the behavior of the foreign surgical team must comprise of understanding and adaptation, as long as we keep in minds the ethical A men session during the anti self immolation campaign

28 IPRAS Journal www.ipras.org Issue 7 very often requesting this collaboration. Sometimes, and habits (showing that we are open-minded people, however, there is no local medical team and the which, at first glance, is not evident to them) and problem is different… Sometimes the local team is therefore will be, in return, very open to our treatment. not really expecting the arrival of a foreign team of Culturally, philosophically and for religious reasons surgeons and, therefore, is not in complete empathy women (and men sometimes) are very shy and pudic. with the NGO and vice versa… Some of them are naturally modest and chaste. Others In any case, there must not be any rivalry with the are extremely reluctant to be clinically examined and local medical group. The NGO is there to take care to be shown half naked … More often, the reason for of the patients together with the local surgeons and to this is that their husband strictly forbids this. Some teach them how to do better and how to improve the men are totally opposed to the fact that a male doctor quality of surgery and hospitalization. Religion must (Muslim or non-Muslim) can even touch their wife. not be a brake to relationship. The NGO team must In some parts of Afghanistan, they would prefer that absolutely respect the faith of the local host: prayers the pregnant mother dies and sometimes the baby too, during the day, Ramadan period, alimentary habits, instead of consulting a male doctor or gynecologist, in time and menus of the meals… case of emergency or imminent delivery! Fortunately, There usually are few women surgeons or anesthetists this is less and less often the case and this behavior can in these countries. However, in some of them, when only be seen in some remote areas, for instance high we have to work or train a female doctor, care must be in the mountain. In Chagcharan, 3200 meters high in strictly taken not to disturb her in her religion habits the Afghan mountains, we have seen that it sometimes (no direct contact, no rudeness, respect of the veil, the took two or three days for a mother to reach the nearest hidjab or the burka…) hospital on her own means…! Moreover, there must be complete cooperation between In any case, the attitude of the surgical team must pay the two teams, with respect, friendship, harmony and attention to all this and always respect the chastity and mutual comprehension. The NGO teams must be very modesty of the patients. humble. Respecting the religion and the culture of • We must always show great professionalism: surgical our medical partners is essential. They must become NGOs are considered as a type of ultra specialized friends and feel a complete cohesion between the two NGO. People constituting the team are very often senior teams. surgeons or very well trained practitioners. And this is In many cases, we have invited them to come to Europe always the case. Our attitude towards the patients is to (France in particular) for a more complete training in prove to them that we are good professionals. Nothing is surgery or hospital management, with their expenses worse than doubt. If we are top level at home, we must covered. For instance, HumaniTerra has completed the also be top level in missions. Good training of the local medical or surgical training of 12 Afghan doctors in doctors can only be achieved under these conditions. France for two months or more. In each case, we paid attention to their religion and faith when they were in our universities or hospitals. • Nurses and paramedical teams must also be treated with a great deal of deference, respect and kindness. This does not exclude friendship and convivial behavior. We all need that. Again, total respect of their religious convictions must be observed, particularly concerning the the female dresses or the veil that they can wear on their head. On the same topic, it seems normal to us that our own nurses, female paramedics or doctors wear a veil in public or when they work at the hospital.

Respect of the patients • A veil for the women of the NGO team is, as mentioned before, an important thing if our nurses and women surgeons want to be in perfect harmony with the Muslim female patients. It makes the patients more confident and it becomes easier to take care of them. They will indeed appreciate the fact that we respect their beliefs A young woman after a suicide attempt by flame

Issue 7 www.ipras.org IPRAS Journal 29 They must be confident. Security is one of the most can be treated. HumaniTerra, for instance, has built a important things. We must not appear as arrogant pilot burn center, in which women have a completely cowboys invading the country, and giving orders. Our separate ward from the men, just as if we had build role is to do the job as well as we do at home, or better, two burn centers… Physical rehabilitation is also done although the conditions are often much more difficult, in a specific area. due to a precarious situation or a lack of modern We have also been the leaders and initiators of the material. Of course, professionalism goes together with HOT program (Herat Operating theatre, 6 very safety… “Safety first” is one of the phrases that we modern operating rooms), together with the help of the must keep in mind. A small number of operations with Japanese and Italian cooperation. This allows women good results and good functional outcome is always to be operated in conditions as good as the men… better than many operated cases with bad or mediocre An adapted help is, to try to study what will fit the best results… bad results are always interpreted and felt as to a specific situation, integrating the Islamic laws and bad work or, sometimes, as a humiliation. habits… To women, treatment is given by women. • Prevent them from bad habits and help them to get PROVIDE AN ADAPTED HELP: a better life: are we allowed to change the rules…? Considering all these parameters… what can we do…? Certainly not… just because we are foreigners there • Build or Rebuild and help them to work in good is no reason why we should try to make new laws. conditions: very poor countries, often belonging to Nothing is justifying the fact that democracy is better the Islamic area, have rather seldom good hospital for countries that are used to live under tribal laws… accommodations. There is often a lack of hospitals or why would we interfere…? And after all, is Islam surgical wards, a lack of well trained surgeons, a lack compatible with democracy…? This is a question of paramedics… difficult to answer, although Turkey, for instance, is a A good occidental NGO must be aware of that. good example showing that it is possible… on the other Therefore, it is important for them to restore or even hand, the Islamic countries of the “Arabic Spring” ( to build specific wards for surgery. Reconstructive Libya, Tunisia, Egypt…) have also shown proof of surgery in particular is not well developed in these that… but we still don’t know what the outcome will countries. Our goal must be to help them to get new be in a few months… buildings. In Islamic countries we try to build or restore However, even if we do not feel authorized to give them specific departments where physically abused women lessons in life, the role of a NGO is to try to induce a better way of life, a better equity between women and men, a more reasonable sharing of knowledge, an equal chance of happiness for everyone and dignity for every human being. Towards this aim, we have set up several Campaigns for the dignity of women. In Afghanistan Two campaigns were organized, in cooperation with the local NGO “Voice of Women”, in order to fight against this horrible endemic disaster of women forced to commit suicide by flame. During the first campaign, Lectures and discussions were organized for Women and for men, separately, pointing out the unjustified reasons of the crime, the expansive, long and painful treatment and the horrible outcome with so many sequelae … after one year, the percentage of suicide by burn in the Herat Province, decreased from 43% of the total amount of burn patients to 11%... very good results, but still not sufficient.. A second campaign is currently under way with TV videos and meeting, aimed at an even larger amount of people. In Bangladesh, a campaign against acid attack is also actually being set up, for the numerous women attacked by jealous men… This type of action from the occidental NGOs must, Teaching afghan women how to fold the gauze however, not be too visible to the public, as this can

30 IPRAS Journal www.ipras.org Issue 7 countries, we see a lot of congenital malformations, traumas, awful burns, post-delivery problems… Our goal must be to reach these isolated people who cannot pay for a hospital stay and get in touch with them, wherever they are. Illness must not be considered for them as a malediction or a fatality anymore. The poorest of them don’t even know that they can be treated. Burn contractures can be treated, acid attacks must be cured, post delivery vaginal fistulas must be operated, care should be taken of cleft palates at any age, in any of these remote areas… whatever the religion is, whatever the strength and the power of religious fanaticism is… Together with its partner NGO, Friendship, HumaniTerra is providing high quality proximity Afghan women outside the mosque surgical care in northern Bangladesh, where the Chars population cannot move from their semi-flooded lead to local problems with the NGO. This is a reason islands, using two river hospital boats, on which they why actions should only be performed after a total can be operated in good conditions. This hands-on agreement with the political and religious authorities. surgery, in the small Islamic villages, is also performed They should also be carried out mostly by local NGOs, in Pakistan, and southern Bangladesh, close to the under the control of the occidental NGO. sea. Very soon it will be also done in the Bengal gulf, • Provide them with better surgical care and help thanks to a new sea hospital boat , the former “Rainbow them to survive: In the remote areas of some Islamic Warrior”, that has actually been transformed into a countries, illness or trauma are sometimes still surgical boat, on which every NGO teams of SHARE considered a normal thing or a punishment of god (Surgical Humanitarian Aid Resources Europe) and (remember that the word Islam comes from the word HUGS ( Humanitarian Union for Global Surgery) will Aslama, “to be submitted”…) In the poorest Islamic be able to operate all year long.

Consulting the local assembly in Asad Kashmere , Pakistan

Issue 7 www.ipras.org IPRAS Journal 31 IPRAS (Asia-Pacific Section) organized a free Plastic Surgery Camp at the Dr. Rajindra Prashad Government Medical College of Kangra, at Tanda (Himachal Pradesh) India from 21st to 28th (31st)August 2011.

The Concept was the first mission of its kind in the area and the Hospital is a governmental facility, the organizers went through a It was during the visit of Dr. Rajeev B. Ahuja, to inspect lot of red tape to make arrangements for the camp. the newly introduced burn unit at the Tanda Medical The team co-ordinated with the Lions Club of the nearby College, on behalf of the Government of India, that town of Dharamshala to publicize the event and to the idea of having a surgical camp at this location was accomodate the visiting team. The Lions Club did extremely mutually discussed between him and the Principal, Prof. well in sending out information to district hospitals in the Anil Chauhan. The Principal showed enthusiasm for a region, and publicized the camp to the public through free Plastic Surgery camp, as the area has a lot of poor banners and posters. Their efforts landed an overwhelming patients requiring Plastic Surgery and such facilities are number of patients for surgery at the camp. not available in the region, including the college. Dr.Chanjiv Singh visited the college again in July to The Location oversee the boarding and lodging arrangements, to co- ordinate with the hospital authorities for the provision The historical town of Kangra nestles in the valley of supplies, to discuss with the anaesthetists and to co- of Himachal Pradesh. For the believers it is a place of ordinate with the Lions Club. pilgrimage, devoted to the Goddess Parvati, the consort of Lord Shiva. Over the years it has seen numerous The Teams invasions, a grim reminder of its strength being the Kangra The Indian team, lead by Dr. Rajeev B. Ahuja, comprised Fort, which sits atop a steep 1000-foot cliff, rising like a of other senior Plastic Surgeons, Dr. Vimla Rajan, from phoenix from the river bed. Kangra is derived from word New Delhi and Dr. Chanjiv Singh from Jalandhar. Senior “Kanghara” which means “doctors who repair ears”. As residents from Lok Nayak Hospital, New Delhi (Dr. per hearsay, in ancient times, this town was famous for its Dhirendra Suman, Dr Vinish Shrivastava, Dr Manish Plastic Surgeons. The RPG Medical College is a fledgling Chopra); DMC & Hospital, Ludhiana (Dr. Manish College, which has only recently introduced post-graduate Sehgal); Amandeep Hospital, Amritsar (Dr. Seema courses. The College is a boon for the city and the Mittal, Dr.Sandeep Kansal); and PGIMER, Chandigarh surrounding areas, which have scarce health care. (Dr. Anil Kumar, Dr.Raja Tiwari) had volunteered for the camp through their respective Heads of Department. The Planning OT assistants Mr. Harpreet, Mr. Gurnam Singh and Mr. Dr. Ahuja requested Dr. Chanjiv Singh (Chairman, Vikramjit Singh volunteered from DMC Ludhiana, Civil Humanitarian Committee, IPRAS) from Jalandhar to visit hospital, Jalandhar and Amandeep Hospital, Amritsar, the college and issue a feasibility report. Dr. Chanjiv visited respectively. The staff of the College itself worked the college in June 2011. He assessed the patient load around the clock, beyond their duty time to assist in the and the facilities available for the venture. The Principal camp. deputed Prof. Sanjeev Sharma (General Surgery) to co- The team from Thailand was headed by Prof. Apirag ordinate the planning of this camp with Dr. Chanjiv. Chuangsuwanich from Mahidol University, the President Dr. Ahuja, as Secretary General of IPRAS (Asia-Pacific of the Association of Plastic Surgeons of Thailand. The Section), invited senior surgeons from the Asia- Pacific team consisted of a Plastic surgeon, an Anaesthesiologist, region to volunteer for this humanitarian mission. As this an OT assistant, nurses and volunteers and included

32 IPRAS Journal www.ipras.org Issue 7 Team members

Mr. Sirichai Kamnerdnakta, Mr. Thara Tritrakarn, Mr. was done on the 22nd, with the visitors being welcomed Poom Tritrakarn, Mrs. Pensri Noocharoen, Ms. Thitima by the Principal and the President of the Lions Club, Mr. Channawa, Ms. Susiri Charloenmit, Mr. Thanatpant P.C. Dhiman. Although patient registration had started in Manosittisak and Ms. Panipak Vareevanichaphan. July, the formal OPD for short-listing patients for surgery Dr. Fong Poh Him from the Institute of Plastic Surgery and registering fresh patients started in the morning of represented Singapore. The foreign teams provided August 22nd. In spite of bad weather and constant rain, their own instruments and materials. All overseas team the OPD was bursting at the seams with the crowds. members covered their own expenses of travel to the More than 140 patients were examined on the first day of surgical camp site. the camp. Nearly 100 more patients were seen during the next few days. Seeing the gush of patients, it was decided The Mission to have four OT tables, as there were enough surgeons The firstday,August 21st, was used to inspect all facilities, and supporting staff. Dr Sudarshan Choudhary (HOD instruments, autoclaving procedure, and instrument Dept. of Anaesthesia) and his senior colleague, Dr Shelly, turnaround after surgery, and the number of theatres that joined with Dr Thara’s team and anaesthetists from Delhi could be available. An informal inauguration of the camp to manage anaesthesia for the four tables.

Camp inauguration in the hospital corridor.

Issue 7 www.ipras.org IPRAS Journal 33 Entertainment The organizers were particularly concerned about providing quality leisure time for all volunteers, to avoid fatigue set-in over the week, especially for foreign participants. The evenings were occupied by visits to Mcleod Ganj (abode of His Holiness The Dalai Lama), Dharamshala, nearby temples and rivers. A couple of popular Bollywood movies (with English subtitles) were screened on two days. A lot of friendship and bonding developed between all participants and all of them pledged to attend future camps also. Press Coverage Dr Fong Poh Him lighting the inaugural lamp. There was extensive coverage in the press and media Dr Apirag Chuwangsuwanich on extreme left. about the camp. This further generated keen enquiries about future camps. The surgeries started on the 23rd and continued until the 26th. A total of 91 surgeries were performed. The Organizational structure OPD continued seeing the patient inflow on all days. The hospital authorities admitted all patients free of Publicity charge and also did not charge for the investigations. The The Lions Club played a major role in the publicity documentation and case recording was also done on the campaign for the camp, which started about a month and a hospital stationery as per the prescribed norms. half earlier. The pamphlets were distributed to peripheral The spectrum of surgeries included patients with severe hospitals and schools. The routine patients visiting the post-burn contracture and deforming disabilities, cleft surgical OPD were also handed pamphlets. lip and palate, syndactly, deforming scars, non healing ulcers etc. Thirty-three beds were made available by the hospital exclusively for this camp. Due to the sheer numbers of patients that were operated, many of them had to be accommodated as day care patients. Postoperative examinations and change of dressings started on the 25th in the OPD area and in the wards. Patients were instructed in post op care and physiotherapy. Two residents stayed back after the camp for postoperative care, stitch removal and advice on follow up until August 31st.

Press Conference Press reports

34 IPRAS Journal www.ipras.org Issue 7 Manpower Future and Past The visiting team comprised of 22 members (14 doctors, As this area has no facility for Plastic Surgery, it is proposed 6 paramedics and 2 volunteers). to have a camp at this same location every year. Earlier, Ten staff nurses from the Medical College were posted Dr. K.S. Goleria had been conducting free Plastic Surgery with the team for operations and there were separate camps with his team at Zonal hospital, Dharamshala for nurses on shift duties for postoperative wards. 22 years, in association with the Lions Club. This was Two OT assistants were deputed from the hospital discontinued due to health reasons about 4 years ago. strength. Two consultant anaesthetists and two residents from Seeing the need of the people, IPRAS “Women for Women” the hospital joined an equal number of anaesthetists team also did a free camp in Jannani Hospital at Paprola of the visiting team to provide anaesthesia on 4 tables (Palampur) a few years ago. You can view the documentary simultaneously. on www.youtube.com. The camp was the brainchild of Dr. Autoclaving was managed by one linear autoclave and one Marita Eisenmann-Klein, Secretary General of IPRAS and table top autoclave in the side room of the operation theatre. was organized by Dr. Chanjiv Singh. All autoclave linen and dressing material was prepared in The idea of “Mission India”, a NGO, was floated by Dr. the evening just after the day’s work was over. Chanjiv Singh, so that American Plastic Surgeons of Indian Boarding & Lodging arrangements origin could work for the poor. It was created by Dr. Kusuma Shashidhar, President of ASIPS and his colleagues. They All visiting members were accommodated by the Principal did a free Plastic Surgery camp in SR Hospital, Kalheli, in the guest house of the Medical College. A kitchen was Bajaura, dist Kullu, Himachal Pradesh last year. The camp set up in the guest house by the Lions Club for all catering report is on www.facebook.com as Kullu mission. requirements. Pictures from the Kangra camp can be viewed at www. Expenses iprasaps.org The hospital spent more than 0.4 million Rupees on medicines, sutures and accessories for the patients. Sponsoring: Publicity and boarding costs was borne by the Lions 1. Principal, Dr. Rajindra Prashad Govt. Medical Club, Dharamshala. College, Kangra International travel expenses were covered by individuals or sponsors. 2. IPRAS-Asia Pacific Section IPRAS Asia- Pacific Section covered license fees for 3. Lions club, Dharamshala overseas doctors, transport of Indian teams and other miscellaneous expenses. 4. Bangkok Botanica, Thailand

Report submitted by: Report prepared by:

Dr Rajeev B. Ahuja Prof. Anil Chauhan Dr Chanjiv Singh Prof. Sanjeev Sharma (Secretary General, (Principal, RPG Chairman-IPRAS, (Dept. of Surgery, IPRAS-APS) Medical College, Tanda) Humanitarian Committee RPGMC, Tanda)

Issue 7 www.ipras.org IPRAS Journal 35 Plastic Surgery Mission in Togo, Claudio Bernardi, MD (Italy) Togo is a “strip of land” between Ghana and Benin, in sub- of traumatic pathologies: the almost total absence of light in the Saharan Africa. In the small village of Afagnan, 80 km from the streets is responsible for several road accidents; children are often capital Lomè, there is the renowned Saint Jean de Dieu Hospital, left without any surveillance, running very close to fireplaces or which is one of the most famous hospitals in the country. It was big pots of hot water, where there is a considerably high risk built in 1964 by the Hospitaller Order of Saint John of God. of burns. Infections are never recognized in time but only at a Since the early 1980’s several doctors and nurses from the Italian late stage, with striking symptoms (e.g. bowel perforation due to St John Calabita Hospital have participated in mission trips, typhus or flexed limbs for post-burn scar contracture, etc). After offering voluntary medical assistance and teaching local staff as a trauma, due to poor health education, they look for curers or well. Plastic Surgery missions have been carried out in the past by French and Swiss surgeons, but these missions ended ten years ago; therefore, my first mission in January 2007 was particularly appreciated by local colleagues. Since then, I have been there six times, for two to three weeks on each mission, trying to enlist the help of other “friends”, with the aim of ensuring further and regular Plastic Surgery missions in the future. Saint Jean de Dieu Hospital - The hospital has a capacity of 269 beds and serves a population of 100,000 inhabitants. It performs more than 8,000 admissions a year with more than 3,000 surgical operations. Patients come from the surrounding area, from the capital Lomè, as well as from the rest of the country and abroad. The surgical block is made up of four operating rooms which are in acceptable condition, considering the poor economic situation of the country and the hospitals, but it is very difficult to find surgical instruments, drugs and medical equipment. A new operating block has already been planned for the future and will sorcerers rather than doctors and, after months or years, when be constructed as soon as the funds are found. they decide to go to the hospital, it often takes days to reach it. Close to the units there is a social area, where mothers or sisters Plastic Surgery procedures – I have generally found four kinds live during the patients’ medical stay, washing, cooking and of pathologies in Plastic surgery: Keloids, scar contractures, lip resting together. The patients are informed of the humanitarian and palate clefts, wounds and loss of skin. During my 2-week missions of specialists by bill posting or relevant announcements stay, I operate on about 40 patients, which means more than 50 on the local radio, so that they can come to the Hospital for a first plastic surgery procedures performed, as associated pathologies medical examination and for surgical treatment, if required. are quite common in the same patient (i.e. post-burn contracture Patients - A common characteristic among all the patients requiring affecting all the fingers or different parts of the body). In medical assistance is that they have not sought medical assistance addition, the clinical cases are always complex, thus: no simples at an early stage, so their symptoms have worsened, limiting the procedures are performed in Africa! Co-operation with the local possibility of immediate medical or surgical treatments. A focus staff is good: I am frequently asked for consultation by other local on their social and cultural life may explain the high incidence specialists or, when necessary, assistance in General Surgery. In this sense, a broad surgical mind is helpful! Humanitarian personal experience – After each mission, I return to Italy with a great personal satisfaction that I rarely feel in my daily work, although I really love it. Plastic Surgery missions are of vital importance for patients in underdeveloped countries but, at the same time, they are extremely useful experiences for the surgeons too, even spiritually. I still have in front of my eyes the image of the children after cleft lip repair, smiling for their first time, and their mothers, too. This is the best gift that a Plastic Surgeon may receive from his work. Claudio Bernardi, M.D. Plastic Surgery, Rome, Italy Via Ennio Quirino Visconti, 55 00193 – Rome - Italy www.claudiobernardi.it

36 IPRAS Journal www.ipras.org Issue 7 Third International Conference on Regenerative Surgery The Lazio Regional Agency for Organ and Tissue S.Coleman, G. Rigotti, D. Del Vecchio, M. Lafontan focused Transplantation, in collaboration with the University of their speeches on fat transplantation, while E. Anitua, I. Martin, Rome “Tor Vergata”, has organized the Third International M. Marazzi, G. Stacy, G. Bauer, together with other researchers, Conference on Regenerative Surgery, which took place on presented the edge of progress on laboratory work. 14th - 16th December 2011, in Rome. Plastic Surgeons, such as J. Planas, R. Mazzola, T. Tiryaki,

From the left: Dr. Dan Del Vecchio, USA (ISPRES Founding Member), Mr. Zacharias Kaplanidis, Greece (IPRAS Executive Director), Dr. Gino Rigotti, Italy (ISPRES President), Prof. Marita Eisenmann-Klein (IPRAS President), Dr Sydney Coleman, USA (ISPRES General Secretary), Dr. Theodore Voukidis, Greece (ISPRES Founding member) The Conference President, Prof. Valerio Cervelli, Director P. Gentile, V. Cervelli, F. Moschella, M. Klinger, K. of the Plastic Surgery Department at the University of Rome Schlaudraff, T. Voukidis shared their experience on everyday “Tor Vergata”, offered the participants a unique opportunity surgical praxis, emphasizing Aesthetic Regeneration on new to follow the lectures of some of the world’s most prominent critical areas. authorities in the field of Regenerative Surgery. Laboratory researchers, such as S. Pek, S. Akita, M. Dominici Not only Plastic Surgeons, but also the most active scientists and A. Orlandi gave their lectures on Bioengineering and on the relative topics, biologists, ENT, orthopedics, Nanotechnology and the new ways of pharmaceutical gynecologists, hematologists, dermatologists and trauma administration through new regenerative technologies. surgeons, were present there, to announce and discuss their Practical issues on the application of the new medical latest achievements and experience, on the most promising procedures, in Europe and worldwide, were raised and and upraising field of tissue regeneration, bioengineering answered by experts, according to the present status on and nanotechnology. moral, ethical and of course legislative data. The rich Faculty of more than 80 scientists and doctors have The Conference, strongly supported by the Province of thoroughly covered all the topics of the meeting. Rome, the Lazio Region and the Italian Ministry of Health, offered the opportunity to all the participants to enjoy the famous excellent Italian hospitality together with typical Roman entertainment. The appointment has been renewed for December next year and the organizers guarantee a scientific meeting of equally high standards. In the meantime, a more Plastic Surgery-orientated meeting will be organized by the newly founded ISPRES (International Society of Regenerative Surgery) on the 9th– 12th of March in Rome, where all the new ideas and developments on Regenerative Plastic Surgery will be presented and discussed by an international faculty of experts. Prof. Valerio Cervelli, Director of the Plastic Surgery Department at the University of Rome “Tor Vergata” during the conference dinner of the Theodore Voukidis MD, PhD, FACS 3rd International Conference on Regenerative Surgery ISPRES Founding member

Issue 7 www.ipras.org IPRAS Journal 37 SURVEYS

Honoured with the award of “Ivo Pitanguy” during the 48th Brazilian congress of plastic surgery Liposuction induces a compensatory increase of visceral fat which is effectively counteracted by physical activity Author: Eduardo Montaga Sub-authors: Fabiana Braga Benattib; Fábio Lopes Saitoa; Rolf Gemperlia; Antonio Herbert Lancha Juniorb a) Division of Plastic Surgery and Breast Surgery Group, University of São Paulo School of Medicine b) School of Physical Education and Sport – University of Sao Paulo

Liposuction is one of the most popular aesthetic surgeries weight, fat mass, and subcutaneous abdominal fat (SAT) performed worldwide, but its long-term impact on body (PRE vs. POST2, p=0.0001). Despite the sustained SAT composition and on the metabolic profile remains unclear. decrease at POST6 (p=0.0001), body weight returned to It has been speculated that the immediate decrease in body baseline values in both groups. The NT group showed fat may trigger feedback mechanisms of body-fat regain. a significant 10% increase in visceral fat (p=0.04) and In several species, surgical fat removal is accompanied by decreased energy expenditure (p=0.01) when compared fat regain within a few weeks, mostly due to compensatory with TR. TR showed an increased fat-free mass (p=0.03) fat growth in the intact depots. Recent data has confirmed and improved physical capacity (p<0.05) when compared that women undergoing liposuction gain upper-body with NT at POST6. The dietary intake was not different fat within six months, which may be associated with between groups and remained unchanged over time. In increased cardiovascular risk. Importantly, no study conclusion, abdominal liposuction does not induce re- of the long-term effects of liposuction has controlled growth of fat, but it does trigger a compensatory increase for the subjects’ physical activity levels which may be of visceral fat, which is effectively counteracted by considered an important confounder because exercise physical activity. Given the clinical significance of these per se is believed to improve body composition. Thus, findings, Plastic Surgeons and health professionals are the purpose of this study was to investigate the effects strongly advised to recommend exercise training as a of small-volume abdominal liposuction on body fat mandatory intervention for those subjects submitted to distribution in normal-weight women, who were either liposuction to avoid the possible long-term deleterious exercise-trained or not after surgery. We hypothesized effects of body fat redistribution to the visceral cavity. that liposuction surgery would cause body-fat regain in This study was supported by FAPESP (2007/53318-7). physically inactive subjects, whereas a supervised exercise training program would counteract such detrimental outcomes. A six-month randomized controlled trial was conducted. Thirty-six women underwent a small-volume abdominal liposuction (20 to 35 years old; BMI: 23,8 ± 2.2 Kg/m2). Two months after surgery, the subjects were randomly allocated into one of the two groups (trained, T, n=18; or non-trained, NT, n=18). Trained subjects undertook a four-month exercise program. Non-trained subjects remained physically inactive throughout the study period. Prior to the intervention (PRE), immediately before the beginning of the exercise program (i.e., two months after surgery, or POST2) and at the end of the study (POST6), food intake and body composition were assessed. Energy expenditure, dynamic strength and aerobic fitness were assessed at PRE and POST6. POST 6 assessments were performed 60 to 72 hours after the last training session in the trained group. Subjects were CT scan images showing the compensatory growth instructed to maintain their food intake pattern throughout of adipose tissue in the abdominal cavity (arrows) the study. Liposuction was effective in reducing body at 6 months post op (above right).

38 IPRAS Journal www.ipras.org Issue 7 Honoured with the award of “Evaldo D’Assumpção” during the 48th Brazilian congress of plastic surgery Development of experimental model of avulsion of the flaps in the lower limbs of rats

Authors: Dimas André Milcheski, MD a Hugo Alberto Nakamoto, MD a Paulo Tuma Jr, MD a Lucas Nóbrega, Medical Student b Marcus Castro Ferreira, Professor and Chairman a a) Division of Plastic Surgery, Faculty of Medicine, University of São Paulo, São Paulo, Brazil b) Faculty of Medicine, University of São Paulo, São Paulo, Brazil

Introduction 4). Photographs were taken of each rat and analyzed using Degloving injuries of the lower limbs are frequently ImageJ software2, which is suited for area calculation. characterized as severe injuries and there is difficulty in Total flaparea (cm2), area of necrosis in the flap (cm2) and deciding what the best surgical approach is1. the ratio between the necrotic and total areas (percentage) were determined. Purpose Statistical analysis was performed using Kruskal-Wallis nonparametric test for independent samples among the The aim of this study was to develop a degloving four groups. The Dunn test of multiple comparisons was experimental model in rat hind limbs and to observe the used to assess differences between matched group pairs. viability of the flap after its repositioning to the bed wound, Significance level was 95% (p < 0.05). The statistical in order to study the changes related to this injury. analysis was done with the software Prism 4b for Macintosh, version 4.0 (Graphpad Software, Inc, USA). Method Ninety male Wistar rats were divided into four Results experimental groups (G1 = 22, G2 = 24, G3 = 22, G4 = After exclusion of animals by flap autophagy and death, 22). A degloving model was performed in the rats’ hind 17 rats remained in the G1 and G2 groups, 15 rats in the limb based on four different pedicles as follows: G1 - G3 group and 16 rats in the G4 group. The total flap area proximal flow, G2 – distal flow, G3 – lateral flow, and G4 was 12.41 cm2 for the G1 group, 5.63 cm2 for the G2 – medial flow (Figures 1 and 2). group, 3.88 cm2 for the G3 group and 4.25 cm2 for the After the incision mark, the skin and subcutaneous tissue were incised. Four Backhaus clamps were positioned at the edge of the skin incision margin and progressive contrary traction was applied, strong enough to produce a degloved flap of the subcutaneous tissue and skin of the hind limb, resulting in a partial avulsion flap. After five minutes the flap was repositioned in its original situation and the incision was closed with continuous skin suture (nylon 5.0). The rats were observed daily for signs of flap necrosis for 7 days (Figure 3), after which they were sacrificed by overdose of thiopental. Measurements of the areas of necrosis in the flap, as well as the total area of the flap, were performed after total removal of the avulsed flap. The flap was Ratio between the necrotic area then laid on the operating table and photographed (Figure and total area of the avulsed flap.

Issue 7 www.ipras.org IPRAS Journal 39 1). The Dunn test showed significant differences between pairs G1 and G2, G2 and G3, and G2 and G4 (p < 0.05). There was no statistical difference between G1 and G3, G1 and G4 and G3 and G4 groups (p > 0.05). Discussion The simple repositioning of the avulsed flap in clinical practice often results in partial or total necrosis of tissue repositioned3. Thus, it is useful to develop an experimental avulsion flap model so that it is possible to test therapeutic modalities, in order to improve the outcome of the repositioned flap. We could find three avulsion flap models4,5,6. None of these models were performed in the lower limbs. It was considered important to develop a hind limb degloving Degloving injury performed. Proximal flow flap (A and B) and distal flow flap (C and D). model in rats, closer to that observed in clinical practice in trauma centers, because the lower limb is the area most often affected in this type of injury. In addition, by using four different flap orientations, it was observed that the distal flow flaps were the most affected, having the poorest prognosis. The avulsion model with distal flow (G2) represents a more severe injury, compared to other flap orientations (proximal, medial or lateral flows). It presents a greater degree of ischemia and congestion, resulting in a more extensive necrotic area. Thus, we suggest the use of the distal flowgroupmodel(G2) to test drugs with potential improvement of flap viability, since this reverse flow flap allows easier observation of the drug effects in decreasing the necrotic flap area. Conclusion

Degloving injury performed. Lateral flow flap (A and B) The distal flow group (G2) had a larger area of necrosis and medial flow flap (C and D). in relation to the total flap area and is considered the most suitable for testing therapeutic agents in avulsed flaps. G4 group. The necrotic flap area (cm2) was 0.51 for the References. G1 group, 3.64 for the G2 group, 0.39 for the G3 group and 0.75 for the G4 group (p = 0.0001). The ratio between 1. Mandel M. The Management of Lower Extremity the avulsed flap necrotic area and total area in the G1 Degloving Injuries. Ann Plast Surg. 1981; 6 (1): 1-5. group was 0.041 (4.1%), 0.39 (39%) in G2, 0.09 (9%) 2. Image J 1.42q for Macintosh. Versão 10.2. Wayne in G3 and 0.08 (8%) in the G4 group. The comparison Resband National Institutes of Health, USA. Available between the means showed a statistically significant at: http://rsbweb.nih.gov/ij/download.html. difference among the four groups (p = 0.0001) (Graphic 3. Milcheski DA, Ferreira MC, Nakamorto HA, Tuma Jr P, Gemperli R. Tratamento cirúrgico de ferimentos descolantes nos membros inferiores – proposta de protocolo de atendimento. Rev Col Bras Cir. 2010; 37(3): 195-203. 4. Oztuna V, Eskandari MM, Unal S, et al. The effect of pentoxifylline in treatment of skin degloving injuries: an experimental study. Injury 2006;37:638-641. 5. Kurata T, O’Brien BM, Black MJ. Microvascular surgery in degloving injuries: an experimental study. Br J Plast Surg 1978;31:117-120. 6. Wang ZT, Guo SZ, Xiu ZF, et al. A new model of Partial flap necrosis Flap removed and placed skin avulsion injuries in rats. Chin J Plast Surg on postoperative day 7. on operative table. 2008;24:212-215.

40 IPRAS Journal www.ipras.org Issue 7 Syndactyly Correction by “Duoderm-plasty”: An Original Model for Mastering Plastic Surgery

G.V. Yaghjyan, D.O. Abrahamyan Plastic Reconstructive Surgery and Microsurgery Centre, University Hospital № 1. 58 Abovyan street, Yerevan, 375025, Republic of Armenia e-mail: [email protected]

Summary gain insight into surgical outcomes through simulation.1 It is known that learners retain 10 to 15% of what is read, А novel technique is presented for mastering skills in 10-20% of what they hear, and 20-30% of what they see, Plastic Surgery, using only improvised means, particularly but when audiovisual materials are integrated, knowledge the self-adhesive Duoderm®CGF®, which is very similar retention increases to 40-50%.2 to the human skin. An example of its application for Therefore, simple inanimate models have been developed syndactyly correction by trilobed flap is shown. The for practice of basic surgical skills. Synthetic skin so-called Duoderm-plasty is an easy and cost-effective suturing models and computer simulations of surgery are method, which allows mastering and perfection of emerging as a prime education tool at several surgical different Plastic Surgery ‘tricks’, planning a scheduled skills centres in the West.5,6 surgery and can also serve as a measure for such skills of Despite all these advances, the system of surgical skills the medical students and residents. teaching in Armenia, as well as in many other developing Keywords countries still remains on the 1980’s level because the abovementioned training systems are too expensive. Residency training; Surgery planning; Z-plasty; Maintenance of well-equipped dissecting rooms and Syndactyly biomedical laboratories is impossible in the present economic status. Residents can hone their skills only Introduction at the OR, which is not so simple, because each expert Training in the specialty of Plastic Surgery deals with the surgeons seek to achieve the best results and he/she will resection, repair, replacement and reconstruction of defects rarely agree to ‘rely’ on a novice’s skills. On the other of form and function of the integument and its underlying hand, patients or patients’ relatives always want to be anatomic structures. It is a long-lasting and laborious operated by the best, famous expert surgeons. Another process, requiring not merely an excellent, advanced problem is that trainees often ‘wait’ for a specific case for knowledge of medical science, but also a well-developed a long time: there are many residents and trainees, more spatial reasoning and ‘sleight of hand’. The latter can be than the specific cases. improved using different contemporary technologies and All this forced the authors to propose a model, which equipment offered by many companies. would facilitate and improve the skill acquisition process, Prior to the 1950’s, the operating room (OR) represented at least to some extent, in one of the basic sections of the only place to visualize surgery outside the classroom. Plastic Surgery – integument (cutaneous) surgery. The introduction of film allowed residents to build and integrate verbal and pictorial representations of disease. Model description Movies became particularly useful in surgical learning to The proposed model is based on the use of self-adhesive help describe anatomic relationships and procedures. In hydrocolloid dressings (Duoderm®CGF®) as human-skin- the 1980’s computers became an additional tool, with the substitutes. That is why we called this method ‘Duoderm- potential to model the complexity of real tissues and to plasty’. The unique elastic properties of Duoderm®CGF®

Issue 7 www.ipras.org IPRAS Journal 41 are very similar to those of human skin, allowing one to perform incisions, dissections and suturing on it. Since 2003 we have used Duoderm-plasty to illustrate and explain to medical students and residents the different techniques of plastic skin-surgery (Z-plasty, V-Y-plasty, syndactyly correction etc.), in order for the residents and trainees to master their skills. A ‘case’ of Duoderm-plasty for correction of ‘syndactyly’ is presented below (Fig. 1-5). Syndactyly is obtained by pasting the Duoderm®CGF® on the 3rd and 4th fingers of the hand model (Internal Hand Structure Model, American 3B Scientific, Tucker, GA, USA) (Fig. 2). Flap markings are done as per description of the Niranjan and De Carpentier trilobed-flap technique 6 According to Niranjan and our experience with patients (Figures 6-7), skin grafting is not required in all cases Duoderm®CGF® and Hand model

Duoderm®CGF® pasted on the middle and ring fingers to achieve syndactyly. (A) Dorsal view. (B) Palmar view.

Flap markings. (A) Dorsal view. (B) Palmar view.

42 IPRAS Journal www.ipras.org Issue 7 Prepared trilobed and triangular flaps. (A) Dorsal view. (B) Palmar view.

Flaps ‘sutured’ (pasted) in place. (A) Dorsal view. (B) Palmar view.

Flap markings on patient Preparation of trilobed and triangular flaps on patient

Issue 7 www.ipras.org IPRAS Journal 43 where the trilobed flap6 is used. Therefore, if any uncovered as well as to show and explain to the patient and his/her ‘defect’ remains after the performed Duoderm-plasty, it relatives the plan of the surgery to be performed. means that there has been an omission in the technique Thus, the so-called Duoderm-plasty is an easy and cost- of flap harvesting and one should repeat the Duoderm- effective method allowing the mastering and perfection plasty until the ideal result is obtained. of different Plastic Surgery skills and the planning of a scheduled surgery and can also serve as a measure for Discussion such skills of the trainees. Research shows that motor skill acquisition occurs in References three phases.7 Ideally, only the last phase of learning should be performed on actual patients. In the first phase 1. Kawabata H, Kawai H, Masada K, Ono K. Computer- of motor-skill acquisition, or ‘cognitive phase’, the learner aided analysis of Z-plasties. Plast Reconstr Surg gains an understanding of the task through explanation 1989;83:319–325. and demonstrations. Cognitive science studies show 2. Mehrabi A, Gluckstein C, Benner A, Hashemi B, that the power of a teaching tool is directly related to Herfarth C, Kallinowski F. A new way for surgical the level of interactivity and the method of information education--development and evaluation of a delivery.8 The second phase of motor-skill learning is the computer-based training module. Comput Biol Med ‘associative phase’, where the learner practices the task 2000;30:97–109. and eliminates error from the performance. This phase could utilize the suggested ‘Duoderm-plasty’ model that 3. Dunnington GL, DaRosa DA. Changing surgical places the learner in a lifelike situation providing almost education strategies in an environment of changing real-time feedback on decisions, actions and questions. health care delivery systems. World J Surg Our choice focused on Duoderm®CGF® as this was the 1994;18:734–737; discussion 733. only dressing available at our Centre at that time. In other 4. Scott DJ, Young WN, Tesfay ST, Frawley WH, Rege words, any self-adhesive hydrocolloid dressing similar to RV, Jones DB. Laparoscopic skills training. Am J Duoderm®CGF® can be used for Duoderm-plasty. Surg 2001;182:137–142. The benefits of this model are different for novices and experts. Residents in training can avoid causing iatrogenic 5. Wanzel KR, Matsumoto ED, Hamstra SJ, Anastakis complications in real patients, while still being exposed to DJ. Teaching technical skills: training on a simple, a wide range of scenarios and complications posed by the inexpensive, and portable model. Plast Reconstr expert surgeon. It helps to develop the manual dexterity Surg 2002;109:258–263. of the future Plastic Surgeon. Repetition and learner feedback, neither of which are easily accomplished in the 6. Niranjan NS, Azad SM, Fleming AN, Liew SH. OR, improve skill acquisition. Wanzel and Matsumoto Long-term results of primary syndactyly correction found improved execution of Z-plasty skin closure by by the trilobed flap technique. Br J Plast Surg residents in response to immediate faculty feedback.5 2005;58:14–21. Scott and Young showed it took an average of 32 7. Rogers DA, Elstein AS, Bordage G. Improving th 4 repetitions to reach the 90 percentile in performance. continuing medical education for surgical techniques: Thus, Duoderm-plasty can serve as a measure for skills applying the lessons learned in the first decade of of the residents. minimal access surgery. Ann Surg 2001;233:159–166. For expert surgeons, Duoderm-plasty can be used to maintain proficiency during times of absence from the 8. Edmond CV, Jr, Wiet GJ, Bolger B. Virtual operating room, an academic sabbatical or family leave. It environments. Surgical simulation in otolaryngology. is also very useful for planning the scheduled operations, Otolaryngol Clin North Am 1998;31:369–381.

44 IPRAS Journal www.ipras.org Issue 7 iPhone and iPad applications for plastic surgeons

Issue 7 www.ipras.org IPRAS Journal 45 46 IPRAS Journal www.ipras.org Issue 7 By kind permission of JPRAS

Issue 7 www.ipras.org IPRAS Journal 47 Plastic Surgery Hyperguide: An Interactive Continuing Medical Education Web Site

Dr. Mimis Cohen Dr. Seth Thaller MD, FACS, FAAP MD, DMD, FACS Associate Chief Medical Editor Chief Medical Editor of the Plastic Surgery Hyperguide® of the Plastic Surgery Hyperguide® Professor and Chief Chief and Professor Division of Plastic, Reconstructive and Division of Plastic Surgery Cosmetic Surgery The DeWitt Daughtry Family And Director Craniofacial Center Department of Surgery University of Illinois Medical Center University Of Miami Health System Chicago, Illinois Miami, Florida

The Plastic Surgery Hyperguide® is a free interactive Craniofacial, Craniofacial Trauma, Head and Neck continuing medical education (CME) Web site for plastic Tumors, Patient Safety. Each module contains peer- surgery professionals. It is available at any time from reviewed educational content focusing on cutting-edge any computer with an Internet connection. This site was treatments, novel surgical techniques, and clinical reviews. established in 2006 and is sponsored by Vindico Medical All content submitted for publication goes through a Education, an ACCME level 3 accredited provider of rigorous editorial and review process, which includes a AMA PRACategory 1 Credit(s)TM . peer-reviewed step where the content is reviewed by 1-2 plastic surgery physicians. The Plastic Surgery Hyperguide® is overseen by Chief Medical Editor Seth Thaller MD, DMD, Professor and To register, one just needs to go to: www.plasticsurgery. Chief of Plastic Surgery at the University of Miami, hyperguides.com, select the Login button and follow the Florida, and Associate Chief Medical Editor Mimis Cohen, instructions. Once registered and logged in, you will have MD, FACS, FAAP, Professor and Chief of Plastic Surgery access to hundreds of articles, lectures and video’s to help at the University of Illinois at Chicago. Assisted by an keep you updated in the field of plastic surgery. Much of Editorial Board of experts from across the plastic surgery the content on the site is available for CME credit; you will specialty, we ensure that the Plastic Surgery Hyperguide® just need to complete a pretest, posttest and evaluation in contains the most recent educational material that will order to receive your credit. All credit earned on the site benefit the practice of any plastic surgeon. The site is will be stored in your “MyCME” section so that you can constantly updated and expanded to ensure that the most always go back and print out the certificates when you recent information is available, allowing users to target need to submit them for you maintenance of certification the information that is most relevant to their practice. or maintenance of licensure. The Plastic SurgeryHyperguide® currently contains We hope that members of IPRAS will take advantage educational material in the following modules: Aesthetic of this opportunity and register to the Plastic surgery Surgery, Bariatric Surgery, Breast, Congenital; Cleft/ Hyperguide®.

48 IPRAS Journal www.ipras.org Issue 7 Issue 7 www.ipras.org IPRAS Journal 49 NATIONAL ASSOCIATIONS’ & PLASTIC SURGERY ORGANIZATIONS’ NEWS

New symposium aims to confront complications, offer concrete fixes

By Mike Stokes, Plastic Surgery News

Plastic surgeons are perfectionists by nature. As such, it scars and managing complications in the areas breast makes sense that complications associated with cosmetic augmentation, breast reconstruction, body contouring and reconstructive surgical procedures performed by procedures and abdominoplasty. A wide range of panels board-certified plastic surgeons are rare; it’s also why, and case discussions will cover subjects such as “tips when something does go wrong, it can be devastating for and traps” in the management of capsular contracture, both physician and patient. flap salvage and alternative approaches when a flap dies, cardinal rules for liposuction safety and revision surgery While no plastic surgeon expects a complication to for recurrent laxity after body contouring. surface in his or her O.R., no procedure is 100 percent safe – and the best surgeons need to be prepared to deal “This meeting will be far more concrete than theoretical,” with problems as they arise. adds Dr. Rubin. “Attendees will receive information that can be implemented overnight and used to make A new symposium developed by ASPS members Maurice an immediate impact on their practices by managing Nahabedian, MD, Washington, D.C., and J. Peter Rubin, techniques and communication.” MD, Pittsburgh, takes a bold approach toward a subject few want to discuss by shining a light on plastic surgical The meeting will also feature a module dedicated to complications. Challenging Complications in Plastic abdominoplasty complications, the area of plastic Surgery: Successful Management Strategies, slated for surgery in which problems are statistically most likely July 13-14 in Washington, D.C., is designed to foster a to occur. Course topics include “The Seven Deadly frank discussion of what goes wrong in common plastic Sins of Abdominoplasty,” managing and avoiding surgery procedures and challenge surgeons to re-think wound breakdown and infectious complications, and their various approaches on issues ranging from where to a comprehensive approach to diagnosing and treating place a scar to how they communicate with patients. The abdominoplasty complications. symposium is supported by an educational grant from Synovis Surgical Innovations. A complicated faculty “Complications are underemphasized in most meetings The esteemed faculty members assembled for Challenging where the focus is primarily on how to do a specific Complications in Plastic Surgery are renowned for their procedure,” says Dr. Nahabedian. “This meeting will exemplary surgical techniques, but this meeting will call focus on providing useful information to help the average on them to share what has gone wrong with their patients surgeon in the day-to-day management of complications and subject their own problematic cases to analysis and with an emphasis on breast and body contouring – two debate. areas in which the number of operations is increasing “The faculty is an outstanding group of thought leaders every year.” who can provide up-to-date and useful algorithms in managing complications,” says Dr. Nahabedian. “They Specific solutions were hand-picked for their experience, integrity and More than anything, Challenging Complications in standing in the specialty – these are people who aren’t Plastic Surgery intends to dive deep into specific, afraid to air their dirty laundry and know how to treat algorithmic approaches to correcting unfavorable complications.”

50 IPRAS Journal www.ipras.org Issue 7 Attendees are also encouraged to submit questions and The meeting will also feature medico-legal tips to their own challenging cases as part of what organizers “bulletproof” your informed-consent process and the “do’s expect to be a truly interactive dialogue between the and don’ts” of going on the record when a complication faculty and those in attendance. occurs. A keynote lecture on VTE prophylaxis as well as For many ASPS members, an increasingly common source panels that explore outcomes measurement in breast and of surgical complications is the population of patients body procedures, establishing your own quality measures seeking corrective surgery for operations performed by in your practice and techniques for benchmarking someone else. Amid the current climate of “white coat complications will also be included in the symposium. deception” – where practitioners without core training Additional meetings offered by ASPS include: in plastic surgery are dabbling in cosmetic procedures • From Residency To Tenure: A Road Map For Success – organizers hope the symposium will also give ASPS for the Academic Surgeon , June 16-17, 2012, Ann members greater confidence in dealing with the surgical Arbor, Michigan mistakes of others by bringing these complications into • Breast & Body Symposium: August 22-25, 2012/ the open where surgeons can discuss how to correct them Downtown Santa Fe, New Mexico if – and when – they occur. • Annual meeting: Plastic Surgery THE Meeting: A cut above October 26-30, 2012/New Orleans, Louisiana The symposium will also cover the fundamentals of For information on how to register for any of these evidence-based medicine and its potential impact on conferences, visit www.plasticsurgery.org/meetings, health quality and pay-for-performance metrics amid a email [email protected] or call 847-228- changing regulatory landscape. 9900, ext. 471.

July 2012 CHALLENGING COMPLICATIONS IN PLASTIC SURGERY SYMPOSIUM: SUCCESSFUL MANAGEMENT STRATEGIES Dates: 7/13/2012 - 7/14/2012 Meeting Location: Grand Hyatt Washington, Washington DC Contact: American Society of Plastic Surgeons 444 E. Algonquin Road Arlington Heights, IL 60005 P: 847-228-9900 F: 847-228-9131 Sponsored by: ASPS

Issue 7 www.ipras.org IPRAS Journal 51 48th Brazilian Congress of Plastic Surgery Goiania, Brazil, November 10-15, 2011

Brazilian Society of Plastic Surgery (SBCP)

Plastic Surgery Continued Education events on the planet. It took place at the Brazilian The Brazilian Society of Plastic Surgery, founded in 1948, has topped the 5000-member mark, and currently “Planalto Central”... certifies 81 plastic surgery training facilities throughout the nation. Today, with many different departments to It was a sunny begining of the southern hemisphere fullfil its needs, simultaneous translation to English in summer, between November 10th and 15th, when the all the presentation rooms and an ever growing number 48th edition of the Brazilian Congress of Plastic Surgery of foreign registered participants, its main goal is to go took place in Goiania, Brazil. The host city, Goiania, global. boasts to be the heart of the huge brazilian agricultural Evidence-based Medicine has played a key role in the infrastructure, the birthplace of important traditions that, selection of the topics and new, different presentation even to this day, markedly permeates the brazilian culture formats were introduced with a variable degree of with flavors, colors, accents, trends and fados. Hospitality overall satisfaction. This certainly reflects a worldwide was a the most abundant comodity! trend towards boosting the credibilty of our Specialty, With 2146 registered participants this year, the Brazilian saves money and assures that our patients will have Congress has secured its place between the most acclaimed good Medicine at their disposal. The Brazilian Scientific

Opening ceremony of the 48th Brazilian Congress of Plastic Surgery. Next to Prof. Marita Eisenmann-Klein (IPRAS President) on the left Prof. Sebastiao Nelson Edy Guerra, Brazil (Former President of the Brazilian Society of Plastic Surgery), and on the right, Prof. Ivo Pitanguy (IPRAS Trustee)

52 IPRAS Journal www.ipras.org Issue 7 coming back to the scene has everything to do with a display of good management principles and orthodoxy. IPRAS has recently pursued its goals by means of what seems to be a mix of pragmatism and a globally oriented vision, focused on inclusion. For the years to come, the project of the Brazilian Society is to upgrade its ties with other national Plastic Surgery Societies in order to be able to share the expertise in Aesthetic Plastic Surgery and other related topics that we have acquired through the years, with colleagues from

During the opening ceremony of the 48th Brazilian Congress of Plastic Surgery. Prof. Ricardo Baroudi (IPRAS Trustee), Prof. Sebastiao Nelson Edy Guerra, Brazil (Former President of the Prof. Marita Eisenmann-Klein (IPRAS President) Brazilian Society of Plastic Surgery) with Ms. Maria Petsa, Greece (IPRAS Assistant Executive Director) at the IPRAS Booth. Commitee, composed by seven members and chaired by Dr. Osvaldo Saldanha, is actively involved with distant corners of the world. We all, who compose the Continued Education and has worked hard to innovate, body of the Brazilian Society of Plastic Surgery, await stimulate, access and control the processes involved in our colleagues from different countries, to visit us in the this large Plastic Surgery gathering. This was the result Brazilian Plastic Surgery booth, which is set to be present of a complex series of brainstorming and benchmarking at major Plastic Surgery Congress venues, during the from previous editions, along with the knowledge year of 2012. acquired from other national Plastic Surgery Societies. For the colleagues who came to Goiania this year, thank This Congress also marked, during the opening you once again for your invaluable presence and for those ceremony, the triumphant come-back of IPRAS as an who couldn’t make this year, our hearts and minds will active world confederation and major player. Dr. Marita allways be open to receive you in future meetings. Eisenmann-Klein, IPRAS President, alongside Goiania- “Planalto Central” stands for “Central Highlands” in born Dr. Nelson Piccolo, IPRAS Secretary General, on Portuguese. behalf of our World Confederation, together with Dr. Love from Brazil! Sebastião Nelson Guerra, President of the Brazilian Society of Plastic Surgery, honored colleagues like Dr. Ivo Pitanguy and Dr. Ricardo Baroudi for their body of work throughout their lives as Plastic Surgeons. Former Presidents of the Brazilian Society of Plastic Surgery were also honored during that ceremony. The IPRAS

Pericles Serafim Filho Brazilian Society of Plastic Surgery, Scientific Committee Member IPRAS, EXCO Member IPRAS, Scientific Committee Member

Issue 7 www.ipras.org IPRAS Journal 53 1st International Meeting of the Cyprus Society of Plastic Reconstructive and Aesthetic Surgery

Dear Colleagues, meeting has been hosted in Cyprus, and we hope that this It gives me great pleasure to report back on the success will be the start of a fruitful and productive cooperation of the 1st International Meeting of the Cyprus Society of between our society and IPRAS. Plastic Reconstructive and Aesthetic Surgery, which took Close to 45 delegates participated in the Conference, with place under the auspices of IPRAS on the 14th and 15th a large number of international attendees and over these October 2011, in Limassol. This is the first time such a 2 days, a variety of extremely interesting topics were presented by our invited speakers, as well as by local Plastic Surgeons. Of great interest were the talks pertaining to the exciting field of stem cell research and fat grafting, as related to all aspects of Reconstructive Surgery. Such meetings are of great importance to our Society and its members, not only because they provide us with a unique chance to present our work to the wider medical community, but more importantly because we have the opportunity to expand our knowledge, interact with experts and discuss clinical issues within an appropriate setting.

From the left: Dr. Dana Jianu, Romania, Dr. Katharina Russe- Wilflingseder, Austria, Dr. Marco Klinger, Italy, Prof. Marita Eisenmann-Klein, Germany (IPRAS President), Prof. Andreas Yiacoumettis, Greece (IPRAS Deputy General Secretary), Dr. Roger Khouri, USA (ISPRES Vice President), Dr. Theodoros Voukidis, Greece ( ISPRES Founding member), Dr. Hatem May, Lebanon

From the left: Dr. Christos Merezas, Cyprus (President of the Symposium), Dr. Kenan Arifoglu, Cyprus, Prof. Marita Eisenmann-Klein, Germany (IPRAS President), Prof. Andreas Yiacoumettis, Greece (IPRAS Deputy General Secretary), Dr. Borman Huseyin, Turkey

The breadth and variation of Plastic Surgery makes it the central link between many other medical disciplines and Among others: Dr. Kenan Arifoglu, Cyprus, Dr. Andreas it is our duty to ensure that we maintain this diversity and Foustanos, Greece (Former President of HESPRAS), Dr. Lefteris educate our colleagues correctly. Aesthetic Surgery forms Dimitriou, Cyprus, Dr. Georgia Koulermou, Greece, Dr. Michail a small part of our profession, and it is therefore essential Stampos, Greece, Dr. Zavrides Harris, Cyprus, Dr. Anastasios that, as Plastic Surgeons, we protect this multifaceted Tsekouras, Greece, Prof. Andreas Yiacoumettis, Greece (IPRAS specialty and expand our autonomy. Through such Deputy General Secretary), Prof. Marita Eisenmann-Klein, meetings we are able to stay up to date with ever changing Germany (IPRAS President), Dr. Marco Klinger, Italy, Dr. practices, share our experiences and join forces on how Katharina Russe-Wilflingseder, Austria, Dr. Christos Merezas, Cyprus (President of the Symposium), Dr. Giorgos Psaras, we can improve patient care. Cyprus (President of the scientific committee of the symposium), Christos Merezas, Dr. Dana Jianu, Romania, Dr. Sofoclis Nicolaides, Cyprus President of the Cyprus Society for PRAS

54 IPRAS Journal www.ipras.org Issue 7 The First Chinese-European Congress of Plastic, Reconstructive and Aesthetic Surgery Beijing, China, October 27-29, 2011

The first Chinese-European Congress of Plastic, cooperation between Prof. Andreas Yiacoumettis in Greece Reconstructive and Aesthetic Surgery was held in Beijing and Prof. Zunli Shen in China, a comprehensive program from 27 to 29, October, 2011. It was the first Congress that was made with a wide coverage of many important co-organized by the Chinese Society of Plastic Surgeons fields. These were complications in plastic surgery, (CSPS), The European Society of Plastic, Reconstructive breast reconstruction, anti-aging, liposuction, tissue and Aesthetic Surgery (ESPRAS) and the International engineering, breast augmentation, ear reconstruction, facial Confederation for Plastic, Reconstructive and Aesthetic aesthetic surgery, stem cells, genitalia, torso, extremity Surgery (IPRAS). In addition, it was supported by the reconstruction, rhinoplasty, facial rejuvenation, hand, laser,

Opening Ceremony of the 1st Chinese European Congress of Plastic, Reconstructive and Aesthetic Surgery

American Society of Plastic Surgery, the Brazilian Society of Plastic Surgery, the European Society of Preventive, Regenerative and Anti-Aging Medicine (ESAAM), as well as the International Society of Aesthetic Plastic Surgery (ISAPS). It was a big international congress which attended by approximately 300 plastic surgeons outside of China with 48 accompanying persons, while the international faculty number was consisted of approximately 100 prominent plastic surgeons. 146 Chinese plastic surgeons attended the congress, in which 20 Chinese plastic surgeons held keynote speeches. 57 international and Chinese companies had exhibitions and provided financial support for the congress. The Plastic Surgery Hospital, affiliated to Peking Union Medical College and Chinese Academy of From the left: Dr. Pericles Serafim Filho, Brazil (member of the Medidical Sciences, offered a substantial support for the Scientific Advisory Board of IPRAS), Prof. Marita Eisenmann-Klein, congress with translations and entertainment programs Germany (IPRAS President), Dr. Albert de Mey, Belgium (member during the opening ceremony. of the Scientific Advisory Board of IPRAS), Prof. Yilin Cao, China (President of CSPS, IPRAS deputy General Secretary), Dr. Sukwha Due to scientific committees’ hard work, especially close Kim, Korea (IPRAS representative of Asian-Pacific region).

Issue 7 www.ipras.org IPRAS Journal 55 Faculty Dinner of 1st Chinese European Congress of Plastic, Reconstructive and Aesthetic Surgery Anti Aging meeting during the 1st Chinese-European Congress of Plastic, Reconstructive and Aesthetic Surgery for establishing scars, maxillofacial, craniofacial, burns, eyelids and orbit, a Chinese Society of Preventive, Regenerative and Anti-Aging oncology and reconstruction, experiment, fat and so on. Medicine as a chapter of the CSPS. First line from the right: Mrs. The master classes, keynote lectures and oral presentations Katherine Lee Tai, USA, Prof. Yilin Cao, China (President of were well selected with high academic standard. CSPS, IPRAS Deputy General Secretary), Prof. Marita Eisenmann- Klein, Germany (IPRAS President), Prof. Chistos C. Zouboulis, There were also some round tables such as ESPRAS/ Germany (ESAAM President), Prof. Zuoliang Qi, China, President- SHARE round table (Humanitarian), Laser round table, elect of CSPS. Second line from the right: Mr. TT Durai, India, Dr. Michael Klentze, Germany, Dr. Paul Ling Tai, USA, Mr. Zacharias Brazilian round table (facial aesthetic surgery in Brazil), Kaplanidis (IPRAS Executive Director), Prof. Zunli Shen, China ESAAM round table and ASPS round table. These (EXCO member in China) round tables provided a nice chance for Chinese plastic surgeons understood more deeply about the related international societies. During the congress, Marita Eisenmann-Klein, President of IPRAS and Yilin Cao, President of CSPS, Zuoliang Qi, President-elect of CSPS, signed a Memorandum of Understanding. This indicated that CSPS would have full support of IPRAS on establishing a Chinese Society of Preventive, Regenerative and Anti-Aging Medicine as a chapter of the CSPS.

Opening Ceremony of the 1st Chinese European Congress of Plastic, Reconstructive and Aesthetic Surgery

It was also the first time for Zita congress S.A. to organize a Chinese European Congress in China with the help by Shanghai Hongbo company (China). After mutual understanding and close cooperation, we believe that the world congress of IPRAS will be held successfully in Shanghai in 2015. In a word, IPRAS and other international societies became well-known in China after this great congress. And the international societies also learned more about Chinese plastic surgeons and the CSPS. The congress has strengthened our cooperation and friendship.

Prof. Zuoliang Qi, President-elect of CSPS, Prof. Marita Eisenmann- More information available at www.China-europe2011.com Klein, IPRAS President and Prof. Yilin Cao, President of CSPS, Prof. Yilin Cao signing a Memorandum of Understanding, establishing a Chinese Prof. Zunli Shen Society of Preventive, Regenerative and Anti-Aging Medicine as a President of CSPS EXCO member in China chapter of the CSPS Co-President of the Congress

56 IPRAS Journal www.ipras.org Issue 7 The First Dutch “National Day for Plastic and Reconstructive Surgery” successfully showed the importance and wide scope of Plastic Surgery to the general public.

On the 25th of November, the Dutch Society for Plastic and Reconstructive Surgery (NVPC, www.nvpc.nl) organized the National Day for Plastic and Reconstructive Surgery. As in many other countries, Dutch Plastic Surgeons struggle with an image of being solely cosmetic surgeons. Therefore, the goal of that day was to show the wide scope of our profession to the public. Special focus was set on subjects other than cosmetic surgery, such as Hand Surgery, Craniofacial and Reconstructive Surgery, illustrating and underscoring the significance of our field in modern society and the medical institutions. The Netherlands has 17 million inhabitants and approximately 300 Plastic Surgeons. We invited all Plastic Surgery units to participate. Approximately 70% of all clinics did so. The Society supported the units by providing a central website and electronic documents to be used as banners on websites. Press release formats, to be adjusted to specific needs, were also distributed in a ‘tool kit’. Local and national media were used, as well as social media, such as twitter (@nedverplastchir) and Facebook, to spread the word. The day was open for the general public, as well as anyone interested, such as students and local hospital staff and nurses. Programs included lectures and live surgery through in-house TV channels or local stations. Other units organized tours through the various rooms, as well as the quite popular suturing courses on bicycle tires or bananas. The result of the day was measured in many ways. First, the number of visitors varied between 40 and 200 per unit, adding up to approximately 1000 persons in total. Second, the number of articles and interviews in the national and local media and in the social media (twitter/facebook) was quite significant. In conclusion; the day was a tremendous success for the Plastic and Reconstructive Surgery Society, the local organizers and our field. Next year 100% of the participants of this edition will join, as well as a number of units that did not choose to participate this year. In addition, the number of positive news articles put our specialty in an especially positive and respectful perspective, which can only be of help for the future of our Plastic and Reconstructive Surgery. Hinne Rakhorst MD, PhD. General Secretary Dutch Society of Plastic and Reconstructive Surgery (NVPC) www.nvpc.nl twitter: @nedverplastchir 23rd Annual EURAPS Meeting, Munich, Germany, May 24-26, 2012

Dear colleagues and friends, For the first time, all participants will have the opportunity to Having been appointed as the EURAPS local host, it is my attend the best research paper of EURAPS Research Council pleasure and privilege to welcome you to the 23rd Annual Meeting on Thursday afternoon (May 24th, 2011) instead of EURAPS Meeting, which will be held on May 24th – 26th, the Refresher Course. This will be the last session of the 2012 in Munich, Germany. A cosmopolitan and hospitable EURAPS Research Council Meeting that will take place in city with excellent infrastructure, Munich offers its guests Munich from May 23rd – 24th, 2012. With this idea from a unique atmosphere. Munich’s world-class transportation the new General Secretary of EURAPS Manfred Frey, we system allows visitors to easily reach the city by train, plane would like to emphasize the importance of research work or car. In 2010, Monocle ranked Munich as the world’s most and give the younger generation an opportunity to attend the liveable city. EURAPS Meeting. The meeting venue, The Bayerischer Hof, is a leading Apart from the exciting scientific schedule, you will world-class luxury hotel, ideally situated in the old town certainly have the opportunity to sample Munich’s artistic district of Munich, in direct proximity to the most important and cultural richness. This includes splendid and exciting sights and shopping opportunities. The hotel maintains concerts, impressive exhibitions, culinary delights, sporting traditional Bavarian values (http://www.bayerischerhof. events and excellent shopping. There is more to Munich de). In addition, participants will be able to indulge in a than meets the eye! special “Oktoberfest atmosphere” at the bavarian evening. For further information on the 23rd Annual EURAPS Furthermore, a magnificent gala dinner at the BMW Welt Meeting and booking details, please visit us online on will be one of the social highlights of the meeting. WWW.EURAPS.ORG. EURAPS Meetings offer a great opportunity for all of us to I look forward to spending some inspiring days with you. update our knowledge, meet with both old and new friends and colleagues and to enjoy each other’s company. This is the best occasion to prepare the ground for fruitful scientific co-operation in the field of Plastic Surgery. The Scientific Program will focus on new developments in Plastic, Reconstructive and Aesthetic surgery, especially in the multidisciplinary setting of Regenerative Medicine. In particular, the Program will concentrate on approaches from diagnosis to state-of-the-art, less invasive treatments. This Meeting will offer new insights, which will be a platform for Milomir Ninkovic scientific exchange and discussion. MD, PhD, EURAPS Local Host, Munich 2012 German Association of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC) goes Web 2.0 Hans Strömsdörfer Tweets, posts, wikis and friends – the “Web • Facebook: 2.0” calls for everyday interaction. Millions www.facebook.com/dgpraec of users work with Facebook, Twitter and Log in and “like“ us. You will receive all new information about Wikipedia day by day – creating an “internet DGPRÄC (in German). within the internet” on computers, cell • Twitter: phones and pads. The German Association http://twitter.com/dgpraec of Plastic, Reconstructive and Aesthetic Sign in for our Twitter account! Surgeons (DGPRÄC) is now also present • Wikipedia: on these channels and welcomes you to http://de.wikipedia.org/wiki/Deutsche_Gesellschaft_der_ participate: Plastischen,_Rekonstruktiven_und_Ästhetischen_Chirurgen

58 IPRAS Journal www.ipras.org Issue 7 Plastic and Reconstructive Surgery Day 15th July, 2011

Dr. S. Raja Sabapathy, MS, M.Ch, DNB, FRCS(Ed), MAMS Director & Head Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns. Ganga Hospital, INDIA

Increasing the visibility and awareness of the possibilities • APSI members performed free surgeries varying of Plastic Surgery remains the concern of Plastic Surgeons from free flaps to replace a giant hairy nevus on the worldwide. To make it possible, the Association of face and reattachment of a hand in a rural setting, Plastic Surgeons of India, led by its President, Dr. S. Raja to the correction of post burn deformities, repair of Sabapathy, hit upon a novel concept of the creation of a “Plastic and Reconstructive Surgery Day”. The date was fixed as July the 15th. Though it did not commemorate a birth or signal an event in the history of Plastic Surgery, the day was chosen for logistic reasons. It was also felt that more than the date we choose, what we do with the concept will count more. What was done on the Plastic & Reconstructive Surgery Day? A call was given by the President of the Association of Plastic Surgeons of India, Dr. S. Raja Sabapathy, requesting all their members to do at least one free surgery on that day. The day could also be utilized to conduct programs to popularize Plastic Surgery. Plastic Surgeons from all over the country responded with great enthusiasm and the concept was a phenomenal success. Activities done on that day included:

Throughout the country Replant for a poor child done in Nanded, Maharashtra the media responded very well. State on Plastic Surgery Day

Issue 7 www.ipras.org IPRAS Journal 59 • Utilizing the concept of the day, Plastic Surgeons in many places met senior government officials and ministers to describe the local needs for Plastic Surgery services. Extra funds were sanctioned for various schemes and for the creation of Plastic Surgery hospital beds exclusively for patients with Hansen’s diseases who need tendon transfers. Some young surgeons even started their practices on that day. Specialized services in hand injuries were started by some hospitals to coincide with the day. • Taken as a whole, the concept of Plastic and Reconstructive Surgery Day provided the much needed opportunity for Plastic Surgeons to reach all sections of the society, from Government administrators to the public. Perhaps the most gratifying response was that Surgeons conducted meetings in the hospitals to make more from the President of the International Confederation people aware of their department on Plastic Surgery Day. for Plastic, Reconstructive & Aesthetic Surgery, Prof. Marita Eisenman-Klein, who suggested in cleft lip and palate and rhinoplasty. The surgeries her newsletter that July 15th, 2012 be celebrated performed covered almost the whole spectrum of as “World Plastic & Reconstructive Surgery Day”. Plastic Surgery. Neighbouring countries like Sri Lanka have agreed • Press conferences were conducted by many Plastic to this concept. We do hope that this will help us Surgery departments. This gave Plastic Surgeons provide yet another avenue for Plastic Surgeons the opportunity to explain to the media the scope of worldwide to reach the masses. Since the response Plastic Surgery. The media responded very well and was overwhelming, the Association has decided to carried the message to the masses. celebrate this day every year.

Hon’ble Minister for Health, Government of India, Shri. Ghulam Nabi Azad, commented the Association of Plastic Surgeons of India on their innovative idea.

60 IPRAS Journal www.ipras.org Issue 7 Legalization of the Nicaraguan Society of Plastic Surgery

Early in 2010, the Nicaraguan Society of Plastic Plastic Surgery as a professional and experiences group Surgery initiated the necessary procedures in order to of scientists committed to the highest levels of service, be legally registered for the first time after almost 20 quality and ethical values in the entire Nicaraguan years of history, according to the prerequisites of the medical field. local laws. The first legal procedure was completed in March of the same year. The legal foundation under constitutional articles, which was then followed by the application of the Nicaraguan Society of Plastic Surgery presented to the National Assembly to possess legal status. The board of directors monitored the process until the 6th of July 2011, when the Nicaraguan National Assembly granted the Nicaraguan Society of Plastic Surgery status of a legal entity. The SNCP celebrated this important accomplishment last July, receiving recognition from the Nicaraguan Medical Association for its organizational growth. Dr. Guillermo Echeverria, President of the Ethics Committee of the FILACP was invited as a special guest and gave a speech on “Ethics and Commerce in plastic surgery” suitable for the occasion, taking into consideration that as members of the Ibero-American Federation of Plastic Surgery we all abide by our Dr. Pablo Mongalo President of the Nicaraguan Medical legislation and code of ethics. A fact that makes us a Association Hans in Recognition Diploma to Dra. Sandra respected and solid Association. Gutierrez President of SNCP, for its Legalization. By being granted the long awaited legal status, our association reached a milestone in its long and successful Nicaragua, election of the new board of the history. We reaffirmed our position in the world of Nicaraguan Association of Plastic Surgery On November 25th the Nicaraguan Association of Plastic Surgery conducted an election for the new Board of Directors which corresponds to the period of January 2012- January 2014. The event resulted in the reelection of Dr. Sandra Gutierrez as President, Dr. Alfonso Pares as Vice President and Dr. Carolina Franchini as Treasurer accompanied by Dr. Edgard Ibarra elected Secretary, Dr. Juan Carlos Arguello responsible for fiscal issues, and Dr. Dolores Brockmann as spokesperson for the Association. On December 15th 2012, the Association will be holding the inaugural ceremony for the new board, as well as the end of the year General Assembly. 2011 ends, and will remain in the Associations history as an important year, when one of the greatest achievements in our history was recorded! We obtained our official legal Founding Board of Directors. status in July 2011. Dr. Alfonso Pares Vice President, Dra. Rossana Trejos, Secretary, Dra. Carolina Franchini Treasurer, Dra. Sandra Dra Sandra Gutierrez. Gutierrez President, Dr. Leandro Perez, Fiscal. President. Nicaraguan Society of Plastic Surgery.

Issue 7 www.ipras.org IPRAS Journal 61 Panamanian Association of Plastic, Aesthetic and Reconstructive Surgery (APCPER)

Here at the Panamanian Association of Plastic, Aesthetic accepting an invitation by dr. Raul de Leon, president of and Reconstructive Surgery (APCPER), having a very APCPER. The purpose of the activity is to strengthen small number of plastic surgeons we are currently academic activities for the APCPER. working on projects relating to academic and social fields. On November 18 and 19 we are holding a small Also, “Operation Smile”, Panama Chapter, will be meeting in Panama with the attendance of three very holding its annual mission at the beginning of next year, important international professors. We named it the totaling 21 years of work in the country, offering surgery “first APCPER Journeys”, where topics in aesthetic for the needed with birth and acquired defects. surgery will be covered with open discussions of diverse Dr. Raul de Leon themes. Professors Celso Bohorquez, Gabriel Alvarado President and Santiago Umaña from Bogota are attending after APCPER

Paraguayan Society of Reconstructive and Aesthetic Plastic Surgery

The Congress of the Paraguayan Society of Reconstructive rejuvenation, rhinoplasty, breast surgery, hair implants, and Aesthetic Plastic Surgery in Asuncion, Paraguay on lip and palate surgery, burns etc. September 8th to 10th, 2011. The event played a significant role to increasing the The proceedings took place in a context of warmth and global knowledge on our specialties and in improving the friendship among all the attending local and by foreign human quality of the plastic surgeon generally. surgeons of different nationalities. We had the joy of It is in our plans to continue conducting scientific events welcoming colleagues from France, Italy, Spain, Mexico, in partnership with countries of the region as well as the Brazil, and Argentina. rest of the world. It was nice to exchange scientific and cultural information We sincerely thank IPRAS for the support and look in parallel to the numerous scientific contributions. forward to all our common future scientific events! Some of the topics we talked about were, facial

62 IPRAS Journal www.ipras.org Issue 7 HISTORICAL ACCOUNTS The history of Plastic and Reconstructive Surgery in Australasia Presented at the RACS AGM Plenary Session “75 Years of Surgical Progress” on the 13th of May, 2002.

Bruce Walton Taylor

History can be said to be the story of man’s advances in In the programme of the Inaugural meeting of our College the world and of the contributions of individuals. Thus, held in Canberra in March, 1928, what stands out is the the history of Plastic Surgery can be said to be based on number of presentations the subject of which was Plastic the achievements of individuals, who have advanced their Surgery. The first clinical paper was entitled “The Plastic discipline, made contributions to science and, through Surgery of the Human Body”. I doubt whether any of us their work, have allowed evolution to occur in this would be so bold as to deliver such a paper today. Henry branch of Surgery. Aristotle, in his work ‘On the Parts Newland (later Sir) gave papers on whole thickness skin of Animals’, said: “Art indeed consists in the conception transplants and pedicle skin grafting. There were others of the result to be produced, before its realisation in the dealing with facial injuries, hand injuries and bums. material”. How true this is of the Art and Science of The Royal Australasian College of Surgeons became a Plastic Surgery, which has its foundations in the concept reality 75 years ago. It took another thirty years before the of repairing and changing human tissues. foundation of the “Section of Plastic and Reconstructive As in art, imaginative and creative new ways of looking Surgeons of the RACS”. Of the 21 Foundation members at surgical problems have pushed Plastic Surgery towards of the section, 6 were from N.S.W.; 6 from Victoria; the ever-advancing frontiers of surgery, resulting in 2 from South Australia; 2 from Western Australia; 1 “spin¬offs” that have affected many other branches of from Tasmania and 4 from New Zealand. Some time medicine. should be spent in reviewing some of these individuals We should be grateful to all those surgeons whose and their contributions. However, before doing this, it innovations have made our speciality what it is today and would be interesting to mention three individuals who, to those whose vigilance has ensured that standards of prior to 1928, were carrying out early Plastic Surgical excellence are maintained. procedures. The origins of Reconstructive Surgery procedures are to John Reissberg Wolfe (1823-1904) was a Hungarian be found in Antiquity and hidden in the mists of time. Ophthalmologist, who worked in Scotland and was the Amazingly, some of the original methods remain in use first to report the repair of lower eyelid defects using full today. Perhaps those surgeons who have missed out on thickness skin grafts. He practiced in Melbourne between the experience of “waltzing” a tube pedicle in multiple 1889 and 1901 before returning to Glasgow. stages into position or the fixation of a cross-leg flap by In 1899, William Moore, a Melbourne surgeon, published the use of plaster and broom sticks -along with the coating “Plastic Surgery”, probably the first book written in of plaster on the nurses and an irate theatre supervisor on English on the subject. He received the first Master of a floor liberally coated with slippery plaster -have been Surgery degree from Melbourne University and worked deprived of some of the joys of the “Early Days”. There at both Melbourne Hospital and St. Vincent’s. were many others, but surgical advances bring changes. And thirdly, Henry P. Pickerill, was a New Zealander from But one thing never changes. To produce a result that Dunedin, with both Medical and Dental degrees, who had provides a reconstruction with the minimal amount of worked in England with Harold Gillies. Following his scarring in both the area of deformity and the donor site return to Wellington, he wrote a book on Facial Surgery is still the ultimate aim of all Plastic Surgeons. in 1924. Later on, in 1934, he began annual visits to the And we can be proud that Surgeons from Australia and Royal North Shore Hospital in Sydney, in the capacity of New Zealand have made significant contributions to Plastic Surgeon, that position said to be the first Plastic Plastic Surgery, especially from the period following the Surgery post in Australia. He is remembered as the first First World War up until today. surgeon to use a tube pedicle to close a palatal defect.

Issue 7 www.ipras.org IPRAS Journal 63 It was, however, not until shortly after World War Two from that University. After a period in general practice that Plastic Surgery was truly recognized as a sub- he obtained the FRACS in 1935. As was the custom, surgical speciality in Australia. At that time working in he trained further in the U.K., working with Harold Australia were Benjamin Rank in Melbourne; David Gillies, Rainsford Mowlem, Archibald McIndoe and Officer Brown, Kenneth Starr and Basil Riley in T. P. Kilner who had joined Gillies in 1919, and on his Sydney; Philip MacIndoe and Llewellyn Swiss Davies in return to Australia he confined his practice to Plastic and Brisbane; Leslie Le Soeuf in Perth and Henry Pickerill, Reconstructive Surgery. When World War Two first broke Bill Manchester, Frank Hutter, Joe Brownlee and Leslie out, he worked in the Maxillofacial and Plastic Unit at Roy in New Zealand. the 2nd AGH, coincidentally with Benjamin Rank. In 1956 Sir Harold Gillies, a New Zealander by birth In 1940 he returned to the U.K. to work with Gillies and then aged 74, attended the AGM in Christchurch until 1942, when he rejoined the Australian Army in and, believing that the time was overdue, gave great Alexandria. On his return to Australia he was appointed impetus for the further recognition of Plastic Surgery to St. Vincent’s and RPA Hospitals in Sydney and there as a Speciality. A letter signed by David Officer Brown, he trained many of the Sydney Plastic Surgeons. Phillip Macindoe and Benjamin Rank had already been The third chairman of the Section, between 1962 and sent to the College in 1950, suggesting the formation of a 1965 was Sir Benjamin. Rank, a graduate of Melbourne Plastic Surgery Section. But it took until 1956 before the University who gained his English Fellowship in 1938 Section was founded and the inaugural meeting was held also came under the influence of Gillies, McIndoe and in Melbourne in 1957. Mowlem (as a matter of interest, all originally New The 21 Foundation members of the section were: Zealanders). Rank, Newing, Snell, Gunter, Hueston and Wakefield When war broke out, Rank joined the Australian Armed from Victoria Forces and saw action in Egypt and EI Kantara, before Riley, Dey, O’Mara, Gibson, Officer Brown and Starr being transferred back to Australia to set up the Plastic from New South Wales and Maxillofacial Unit at Heidelberg Military Hospital in Newland and Robinson from South Australia Victoria. In 1946 he took up the first Plastic Surgery post Le Souef and McComb from Western Australia at the Royal Melbourne Hospital. Stephenson from Tasmania Undoubtedly, Sir Benjamin helped to put Australian Hutter, Manchester, Brownlee and Roy from New surgeons on the international map, being honoured in Zealand Great Britain, India, the United States and Canada. He has Some of these surgeons had worked at Sidcup, England, been a Carnegie Fellow, a Sims Professor and Moynehan at the Queen Mary’s Hospital, later named St. Mary’s. Lecturer, as well as presenting the Gillies Memorial By 1917, this was a 600-bed hospital devoted to Lecture in 1973 and the Syme Oration in 1976. Maxillofacial and Plastic Surgery and was divided into In 1965 he was the President of the British Association British, Canadian, New Zealand and Australian sections, of Plastic Surgeons and Chairman of the British Surgical while later on American casualties were treated as well. Colleges in 1967. From 1966 until 1968 he was the Sir Henry Newland, later to become the inaugural President of the Royal Australasian College of Surgeons, Chairman of the newly formed Section of Plastic Surgery, while in 1971 he was President of the International was in charge of the Australian section. Born in Adelaide, Confederation of Plastic and Reconstructive Surgeons at be obtained his English fellowship in 1899, after which the 5th International Congress held in Melbourne, after returned to practice in Adelaide. During World War One which he was knighted. Sir Benjamin retired just a few he served in the Middle East, Gallipoli and France, before years ago, as the President of Interplast Australia. He was his transfer to Sidcup. For his service he was awarded the author of several books and a distinguished painter the DSO. He returned to Adelaide after the war, was in oils. awarded a CBE, followed by a Knighthood in 1928 and, William Manchester, the fourth Chairman of the amazingly, continued to work until the age of 78. Division, was a graduate of Otago University in 1938. He was the President of the Section of Surgery of the During his service in the New Zealand Army he was sent British Medical Association in Australia and of many other to England for training in Plastic Surgery under Gillies, organisations. From 1929 to 1935 he was the President McIndoe and Mowlem, after which he set up the Plastic of the Royal Australasian College of Surgeons and, even and Maxillofacial Unit near Cairo. He was recalled to more importantly for us, he was the first Chairman of the Christchurch in 1944 and after his discharge in 1945 he Section from 1957 to 1960. established the first Plastic Surgery Unit at Burwood. The second Chairman of the Section was David Officer More training followed in the UK, after which he returned Brown, from 1960 to 1962. A graduate of Melbourne to Middlemore Hospital in Auckland. University, he also obtained his MD and MS degrees Amongst many honours he received a knighthood and

64 IPRAS Journal www.ipras.org Issue 7 was, importantly, the first Professor of Plastic Surgery Philip Hudson McIndoe graduated from Sydney in the Antipodes. In addition, he served as General University in 1935 and, after having obtained his Secretary of the Asian Pacific Section of the ICPRS and fellowship in Edinburgh two years later, was appointed on the Committee of the International Confederation. He to Prince Henry Hospital in Sydney. During the war he was Chairman of the Section from 1964 to 1966. served at Gaza Ridge in Palestine and later in Egypt, Apart from the distinguished Chairmen we have just Greece, Crete and finally in New Guinea. In 1945 he was profiled, there were other surgeons who deserve mention appointed Officer in Charge of the Plastic Surgery Unit because of their efforts in establishing Plastic Surgery as at Greenslopes, later working at Brisbane General as a a speciality in Australia and New Zealand. It is so easy to Plastic Surgeon, before changing direction to become take the present status of the speciality for granted, but we Medical Superintendent at Goulbourn Base Hospital in owe an expression of gratitude to those who can really be NSW. termed pioneers and who worked hard to establish Plastic Llewellyn Swiss Davies was a Melbourne graduate who Surgery as a separate entity. did his residency at Brisbane General Hospital. During the war he was posted to the Concord Military Hospital Kenneth Starr, an honours graduate from Sydney, worked Plastic and Maxillofacial Unit, under Colonel K. W. Starr. at RPA. He too had worked with Gillies and McIndoe Later he served in Moratai and Greenslopes in Brisbane. in England before returning to Sydney in 1942 to set He remained in charge of the Greenslopes unit until after up a Maxillofacial Unit at the 13th General Hospital in the war, when he became Senior Visiting Plastic Surgeon Concord. Starr was President of the RACS from 1964 -66 at the Royal Brisbane and Repatriation Hospitals, as well and awarded many honours, although he did not confine as the Mater and Children’s Hospitals. his work to Plastic Surgery. He was knighted in 1971. Basil William Birkenhead Riley was born in Sydney in We must not forget Thomas Graham Humby, a colourful 1885 and served in the First World War as a Lieutenant. and controversial character who was an English 1935 He graduated in Medicine from Sydney University in graduate. Whilst still a student at Guy’s Hospital, he 1923 and trained at Royal North Shore Hospital before modified the skin graft knife then in use, introducing his moving to London to work with Mowlem and Gillies. moveable roller, which allowed more precise skin grafts. Back in Australia his return to North Shore was followed His residency at Guys was anything but dull. He was in 1937 by 18 months in Europe and the United States, an understudy to Fred Astaire in “Funny Face”; gained studying Plastic Surgery. The Second World War saw him the first gliding certificate in England and represented working in the Plastic Surgery Unit at Concord Hospital, England in international yachting. He joined the British while at the end of the war he was appointed Surgeon-in- Navy in World War II and trained as a Fleet Air Arm pilot charge at the Royal North Shore Hospital and periphery in Florida. The war over, he trained in Plastic Surgery hospitals. He is remembered with affection by all who and was appointed to Stoke Mandeville Hospital. Again, knew him. he did not restrict his life to surgery but started a freight Frank Leo Hutter graduated from Otago University carrier,”London Aeromotive Service”, using old RAF in 1935. He worked in Palmerston North for a while bombers. before moving to London, where he spent time in several A bout of TB, farming in Dorset and a Plastic Surgery hospitals, including Great Ormond Street Children’s practice in the West Indies occurred before he finally Hospital, in 1938. In 1940 he joined the New Zealand came to Sydney in 1956. He went into practice as a Army Corps, serving in Plastic Surgery and General Plastic Surgeon in Rose Bay, concentrating on Cosmetic Surgery Units. After his discharge in 1945 he worked Surgery, one of the early surgeons to do so. There are with Gillies, McIndoe and Mowlem at East Grinstead. many tales about his eccentricities but these must remain On his return to New Zealand, he was appointed Plastic untold as it is impossible to confirm their authenticity. Surgeon to Wellington and Palmerston North Hospitals. Ian Ross Wakefield,known to all as “TheVicar” -what else In 1952 the unit was moved to Hutt Hospital, from which -graduated in 1941 from Melbourne University, gaining a he retired in 1973 to a farming career. Masters degree in 1946. During the war he was in the A1F Leslie John Roy was also a graduate of Otago University Medical Corps. He obtained his Australian and English in 1936. Having worked in Christchurch, he travelled to fellowships, then carried out Plastic Surgery training in the U.K. and, like Hutter, he did a stint at East Grinstead, England. Back in Melbourne he worked at The Royal after which he was appointed as a Plastic Surgeon in the Melbourne, The Royal Women’s and Royal Children’s West of Scotland. When war broke out, he joined the Hospitals. With B.K. Rank he published a noted textbook New Zealand Army Corps, serving in Egypt and Italy. on Hand Surgery. He was the first secretary of the Section Following his discharge he returned to New Zealand to and later its Chairman (1966-1967) an appointment at Burwood Hospital in Christchurch. Arthur Stephenson graduated from Sydney University

Issue 7 www.ipras.org IPRAS Journal 65 in 1941, gaining a Masters Degree in 1949. During the trainees who were selected on a state-by-state basis. war he served as a Captain in New Guinea and Tarakan. Since 1990, the continuation and approval by the Board He settled in Tasmania, where he was Senior Plastic in Plastic Surgery is required for each trainee. Regular Surgeon at the Royal Hobart, as well as consultant to the inspections of hospital training posts are carried out by Repatriation Hospital. board members to ensure they fulfil the requirements Leslie Ernest Le Soeuf was a Melbourne graduate, 1922, for the teaching programmes. On completion of their obtaining a Doctorate two years later, before travelling training and the RACS exam, many go overseas for to England to obtain his Fellowship. During the Second further experience in centres of excellence, chiefly in World War he served with the A1F in Libya, Greece and North America, the UK or other European destinations. Crete, being mentioned in despatches, and was awarded In 1979 David David suggested annual week-long courses the OBE as well as French decorations. He was also a for trainees and these have been held in different centres prisoner of war in Germany. He held many official posts since 1980. in Western Australia and served the Royal Perth and The late sixties and early seventies saw the beginning of Princess Margaret Hospitals for many years. many changes in the delivery of health care in Australia. There were other dedicated surgeons who impacted on Because the College of Surgeons is responsible only for the recognition of Plastic Surgery as a separate entity. training and standards and does not deal in the political Men like Richard Newing, John Snell, George Gunter, and financial aspect of practice, the Australian Society of John Heuston, David Dey, Ted Gibson, Max O’Mara, Plastic Surgeons was incorporated in 1971 to deal with David Robinson, Harold McComb and Joe Brownlee such matters, in an environment of constantly changing were all Foundation members of the Section who served ground rules. A similar Society was founded in New the speciality with dedication and enthusiasm and whose Zealand. ASPS is open only to Fellows who fulfil the contribution is not forgotten. Plastic Surgery training and examination standards laid In 1956, following the inception of the Section of Plastic down by the College. Surgery, the first College Plastic Surgery examination was An application was made in 1974 for establishing held and by 1960 a Sub-Committee on Surgical Training Armorial Bearings for the Society. In 1976 a Grant of was founded. Due to the increase in trainee numbers in Arms was made by the College of Heralds in London. 1970, a Committee on Surgical Training was elected, The Kings of Arms noted that “the elements of the grant the chairman being David Robinson of South Australia, symbolise the essence of Plastic Surgery in the most Harold McComb of Western Australia and Don Marshall pleasing and truly heraldic manner”. of Victoria. In order that there be regional representation, In 1998 the decision was made to dissolve the Division. the Committee was enlarged to include John Williams of However, while ASPS is now the sole body covering New Zealand, Noel Sweeney of NSW, Trevor Harris of the day to day matters of the Specialty, all training and Queensland and Arthur Stephenson of Tasmania. Later standards remain, as it always had, under the auspices of on there were two additions, Ted Gibson of Sydney and the College via the Board in Plastic Surgery. William Manchester of New Zealand. As specialisation in individual aspects of Plastic Surgery In 1977 the College determined that each speciality should became more widely spread, the Aesthetic Society of have a board, in order to determine their own destiny, Plastic Surgery was formed and Plastic surgeons also under directions of the College. The first Chairman was joined various hand, head and neck and burn societies, David Robinson, who served until 1980. He was followed while small study groups continued to meet. by John Hanrahan, (1980-84), who later was elected As we have seen from the very early days of the speciality, President of the College and Tony Rieger (1984-1987). Australasian surgeons have trained and made their Originally, most of our Plastic Surgeons received their mark overseas. Internationally, following the Second training overseas. When Plastic Surgery residency posts World War, Plastic Surgery as a speciality was gaining first became available in our public hospitals, trainees were momentum. In 1955 the first Congress of the International selected by the hospital and normally remained in one place Confederation of Plastic and Reconstructive Surgery throughout their training. However, in 1987, it became was held in London, coincidentally the year after two obvious to the Board that this restriction to one hospital Americans from Boston, Joe Murray, a Plastic Surgeon, offered a limitation of experience. To ensure exposure to and Hartwell Harrison, performed the first human kidney all facets of Plastic Surgery, a hospital rotation system was transplant in the world. introduced, with the selection of the trainees being made by Since that time, the Congress of the International a sub-committee of Plastic Surgeons in each state on behalf Confederation of Plastic and Reconstructive Surgery has of the Board, instead of the hospital administration. been held every four years. In 1971 the Meeting was held Regional sub-committees were set up, reporting to the in Melbourne, under the chairmanship of B.K. Rank, while Board. These sub-committees kept close contact with next year the Congress will again come to Australia, to

66 IPRAS Journal www.ipras.org Issue 7 Sydney. Australian Surgeons have played an active role Replantation of a completely avulsed ear (D.G. in the International Confederation with representatives on Pennington, M.F. Lai and AD. Pelly: 1980) the central Committee and the Asia Pacific section. “Wrap around” toe to thumb transfer for Over the years since the inception of the College, great reconstruction(W. Morrison, B. O’Brien and A advances have been made in Plastic Surgery. In Paediatric MacLeod: 1984) Surgery, for example, craniofacial procedures, genitalia correction, velopharyngeal procedures and improvements Since 1974 the B. K. Rank Travelling Professorship in cleft lip and palate offer new hope for children born has been awarded annually, to a distinguished Plastic with congenital abnormalities. Surgeon from an overseas centre of excellence. The list Victims of trauma can receive replacement of severed reads like the Who is Who of the speciality. But it has body parts such as fingers, hands, scalps and ears, while not always been one sided. Australian Plastic Surgeons the treatment of burns sees an ongoing quest for ever have been awarded Overseas Visiting Professorships better methods of skin culture and grafting and post burn and, particularly in the Asia Pacific region, have served scar relief. to benefit the hospitals in their host nations. Breast reconstruction, as well as reduction and In addition, overseas visits by groups of Plastic Surgeons augmentation, the treatment of male and female genital from our area have been well organised and visits to abnormalities and of facial palsy are only some of the centres in the United States, China, India and Russia areas in which plastic surgery advances provide a better have led to great interchange of ideas. and more normal life to patients. Until recent times, there were no professorial With the use of the surgical microscope, osseointegration, appointments in Australia, however Wayne Morrison plate fixation,tissueandboneexpansion,musculocutaneous was the first such appointee and is now Professor of flaps, free flap transfers, muscle and nerve transposition Surgery at St. Vincent’s Hospital, Melbourne. The first and transplantation, vascularised bone grafts and bone academic Chair in Plastic and Reconstructive Surgery is substitutions, we have reached results in reconstruction held by Michael Poole in Sydney at St. George Hospital. undreamed of 75 years ago. The University of Auckland New Zealand appointed Sir The elixir of eternal youth or a magic wand have not yet William Manchester Professor of Plastic Surgery in 1977, been developed but the subperiostal face lift, brow lift, the first such appointment in our area. hair micrografting, liposuction, laser surgery, implants, It should also be noted that a federally funded Craniofacial collagen, abdominoplasty and so on offer ways of defying Unit exists in Adelaide, under the Chairmanship of David the physical signs of ageing or creating a new image for David. However, there are other Craniofacial units in other the patient. Plastic Surgery departments. These all draw patients, not Many surgeons from the Antipodes have made significant only from Australia, but from countries near and far. contributions on the International scene. Moore, Pickerill, Here we must make mention of Interplast Australia, which Rank, Wakefield, Hueston, Thompson, David, O’Brien is a medical relief organisation initiated in 1983, which and Morrison have written well known textbooks, while sends Australian Plastic Surgery teams to some twenty they and others have contributed chapters to Plastic different areas throughout the South Pacific. These teams Surgery literature worldwide. B. K. Rank, Ian Taylor, consist of two Plastic Surgeons, an Anaesthetist and nurse, Wayne Morrison, Bernard O’Brien, to name just a few, all volunteers. Procedures are carried out in the field but have been major presenters at International Meetings. there have been some forty five patients who have been Some of the World’s first microsurgery procedures were brought to centres in Australia, while approximately carried out and reported in Australia. Let’s look with forty eight doctors and nurses from eleven different areas pride at these examples. have secured valuable experience here, which they take Replacement of completely severed digit (P.G. back to their country of origin. Since 1983, 286 teams Lendvay and E.R Owen:1970) have examined over twenty thousand patients and carried out over twelve thousand operations, assisted by local The first Free Transfer of tissue by vascular medical and nursing staff. anastomosis (G.I.Taylor and RK. Daniel: 1973) As previously mentioned, Sir Benjamin Rank was the The free vascularangeal bone graft (G.I.Taylor, first President of Interplast, followed by Don Marshall. G.D.H. Miller and F.1. Ham: 1975) When Plastic Surgery was first officially recognised as a Replantation of an avulsed scalp by microvascular Surgical Speciality by the College in 1956, there were just anastonosis (G.K.H. Miller, E.1. Anstee and J.A 21 qualified Surgeons. Last year, 2001, there were 257. Snell: 1976) Like all other surgical groups, Plastic and Reconstructive *The iliac crest free flap (G.I. Taylor, P. Towns and R Surgery has had its problems; a lack of realistic level of Corlett: 1979) visiting medical officers, shortage of Hospital beds and

Issue 7 www.ipras.org IPRAS Journal 67 lack of funding and facilities for research and training or via meetings, such as the one being held this week. posts. There is no doubt that the advances in all branches of this As we look back into the history of Plastic Surgery in Surgical Speciality have been rapid and the future is very Australasia, we see that it is indeed an example of the encouraging. participation of individuals in advancing a field of The progress that Plastic Surgery has made throughout medical science. Time does not allow me to name all the the world and especially in our area during the past few many Fine Plastic Surgeons who have contributed to and decades has been remarkable. Plastic and Reconstructive received recognition for their part in the development Surgery is truly at the forefront of the advancing frontiers of their speciality. Not all innovations have made their of Surgery. Just as truly, it has played an important part way into textbooks but many have been shared with in the history of the development of medical care in students and fellow Surgeons in the operating room Australasia. SELECTION OF FOUNDATION MEMBERS OF THE PLASTIC SURGERY SECTION OF RACS

I-r: J.A. Snell, B.K. Rank, G. Gunter, J.T. Hueston, A.R. Wakefield, B.W.B. Riley, D.L. Dey, M.L. O’Mara, E.W. Gibson, D. Officer Brown, K.W. Starr, H. Newland, D.N. Robinson, H.K. McComb, A. Stephenson, W. Manchester, LJ. Roy. Not appearing: F.L. Hutter, L.E. Le Souef, R. Newing, J. Brownlee. PLASTIC SURGEONS WHO HAVE BEEN RACS PRESIDENTS

Sir Henry Newland Mr Kenneth Starr Sir Benjamin Rank Mr John Hanrahan 1929-1935 1991-1993 1964-1966 1966-1968 OTHER MEMORABLE PLASTIC SURGEONS

H.P. Pickerill, L.S. Davies, P.H. MacIndoe, T.G. Humby, J.R. Wolfe

68 IPRAS Journal www.ipras.org Issue 7 A combined historical account of Plastic Surgery in India and the Association of Plastic Surgeons of India

Just as the Sun rises in the East, the science of Plastic Kangra (Himachal Pradesh) and some families in Nepal Surgery first dawned in the ancient Indian civilization. In were practicing ancient Indian surgical skills; most India, from the beginning of recorded history, offenders notable amongst them being midline forehead rhinoplasty. or sinners were punished with mutilation or severance In Kangra, forehead rhinoplasty had been practiced for of the nose, ears or parts of limbs. Indian mythology centuries by a family of Hakim nose surgeons called and history are replete with stories of Surpanakha and ‘Kanghiaras’. They had been operating in Kangra since Nakatapore i.e. ‘City without Nose’. Moreover, in India the time of Raja Sansar Chand (1440 A.D.) and had also the nose is considered to be the organ of respect and obtained certification from Mughal kings. Hakim Dina reputation, hence plastic surgical procedures to correct Nath Kanghiara was the last surviving descendent of these deformities were a necessity. the family, known to have performed such an operation. The first detailed description of plastic surgical procedures Details of their surgical skill appeared in Punjab Medical is found in the clinical text on Indian Surgery, the ‘Sushruta Journal in 1967. Later still, Dr. Tribhovandas Motichand Samhita’ (circa 600 B.C.). Atharva Veda, the root of Shah, the then CMO of Junagadh is said to have performed Ayurveda, the classical text of Indian medical knowledge, 400 rhinoplasties by forehead flap. includes two seminal texts, Charaka Samhita, on medicinal In fact, India and Egypt are considered as the fountain- aspects and Sushruta Samhita, which incorporates details heads from which the stream of knowledge flowed to of surgical tools and operative techniques. Sushruta wrote the Middle East, eventually to reach the Mediterranean this treatise based on the lectures of his teacher, the famous civilizations; the Greeks and the Romans. The ancient surgeon king, Devadas (‘incarnation of Dhanwantari, the Indian medical knowledge was carried into Greece and Divine Physician). In the fourth century A.D. Vagbhat, an Arabia by Buddhist Missionaries. Further still, avenues Indian Physician, recounted the plastic surgical procedures of trade were set up between Greece and India following with more details than provided in Sushruta Samhita. In the conquests of Alexander ‘The Great’. Arabs played his book, ‘Astanga Hridyans Samhita’ he credits the an important role in transmitting the surgical knowledge techniques to Maharishi Atreya. It is interesting to find to the West. The Persian hospital at Gandi-Sapor (6th mention of plastic surgical procedures such as rhinoplasty, – 10th century A.D.) was a great learning centre of that otoplasty, tissue grafting, organ transplants, transfer of era, permitting the amalgamation of Hindu, Greek and embryo, cross-grafting of head and reattachment of limbs Arab schools of thought. Here, the Sushruta Samhita was etc. in these ancient Indian Medical Treatise and Puranic translated into Arabic and later into Latin. Arab physicians Literature. of that time, Rhazes and Aviceruna, often referred to the The gradual decline of this golden era of Hindu Surgery teachings of Sushruta and Paulus Aegina. Paulus Aegina began at the time of Buddha (562- 472 B.C.). Buddhist was a 7th century physician who was responsible for the scripture Mahavagga Jataka enforced strict prohibition integration of Indian and Western surgical knowledge on Surgeons and Manusmriti prescribed special rituals and summarized it in a seven-volume compendium. for their purification. Contemporary teachings, based Further down the timeline, Aulus Cornelius Celsus (25 on Ayurveda, basically supported medicinal treatments. B.C.) propagated this science to Rome in his book ‘De Ayurveda forbade surgery, as contact with blood and Re Medica’. During 525 A.D. the Christian Orthodox pus was considered polluting. Hence, during this period, Church started rising and the enthusiasm towards surgery these great surgical skills were delegated to lower castes declined. Surgical skills were now reared in the hands like ‘Koomars’ or potters, who were known for their of people of lower status like barbers, a situation similar manual dexterity. They kept this valuable knowledge to what had happened in India centuries ago. Sushruta alive and passed it from father to son, as a family secret. Samhita was translated into English by Kariraj Atrideo Some of these families were identified in the latter half Gupta Vidyalankar Bishangar (1950) and Kaviraj of eighteenth century. Marathas of Pune, Kangharias of Kunjalal Bhishagranta (1963).

Issue 7 www.ipras.org IPRAS Journal 69 Despite these hurdles, reconstructive operations of is a “jack of all trades and master of none”. It required the nose and face received an impetus in the European all the tenacity and dedication of a handful of pioneer countries during the 19th century. The German, French Indian Plastic Surgeons, who made Plastic Surgery their and English Surgeons were introduced to the older Indian career, to overcomethe initial difficulties. For almost 8 method. During that period, certain German scholars who to 10 years, these pioneers at Nagpur, Patna, and later at studied the original text in Sanskrit, British surgeons and Lucknow, Bombay and Calcutta, struggled hard for their French travelers, who saw for themselves the rhinoplasty existence and worked as sections in the departments of operations performed in India, revealed the wonders and General Surgery. practical possibilities of this specialty to the Western Dr. N.H. Antia, after his post-graduate training in Plastic world. Surgery in the U.K., started working in a private hospital It was, however, the discovery of anaesthesia (Morton, in Pune and was also engaged in Rehabilitative Surgery Long and Wells) and anti-sepsis (Lord Lister) which at the ‘Kandhwa Leprosy Centre’ outside the city. He revolutionized the practice of surgery and made it carried drums with sterilized linen and instruments from painless and infection-free. Modern Plastic Surgery in Pune to the leprosy centre. Dr. Antia worked here in a India started after World War II. During the war, there makeshift O.T. on absolutely voluntary and honorary were a couple of British Maxillofacial Surgery Units basis in spite of considerable hardship. His pioneering and a special mention was made about them by Mr. work on leprosy was rewarded by an invitation from Tom Gibson (Canniesburn Hospital) at Bangalore and England to deliver the Hunterian Lecture at the Royal by Mr. E.W. Peet at Pune, during their visits to India. College of Surgeons, London in 1955. This kindled the interest in Plastic Surgery among a few Sir B.K. Rank visited India from Australia, on a goodwill young Indian surgeons working then with the armed mission under the Colombo Plan to advise the Government forces as “temporary commissioned officers”. After the of India and his own Government about the possibilities war, two of them, Dr. C. Balakrishnan and Dr. R.N.Sinha, of developing Plastic Surgery in India. He spent two specialized in Plastic Surgery, while Major Sukh pursued weeks in India and recommended the development of his interest in the specialty as a pioneer in the field of a Centre of Excellence at Nagpur, under the dynamic Plastic Surgery at the Armed Forces Medical College and leadership of Dr. Balakrishnan. This was to be aided up Hospital, Pune. to 50% under the Colombo Plan and the rest to be granted Plastic Surgery did not exist as a recognized specialty by Central and State Governments. Unfortunately, the in the country. While in training at Stoke Mandeville plan never materialized. However, the first independent Hospital, U.K., Dr. C. Balakrishnan sent a memorandum Department of Plastic Surgery in the country was finally to the Director General of Health Services, New Delhi, created at the M.C. Hospital, Nagpur, in 1958. proposing the development of a Department of Plastic By 1955, there were about four to five Plastic Surgeons, & Maxillofacial Surgery, because there was a crying devoting their full time to this specialty and there was need for at least one such department in the country. a desire to form an Association. Thus, in the Annual After great persuasion, he was offered the post of General Body Meeting of A.S.I. (Association of Surgeons Lecturer and Surgeon at Medical College and Hospital, of India) held in December, 1956 at Indore, Dr. R.N.Sinha Nagpur (at that time known as the Central Provinces required a resolution to this effect. A sub-committee was of Madhya Pradesh and Bihar State). He accepted the formed with Dr. C.P.V. Menon of Madras as its Chairman offer and started to develop a Department of Plastic and and Dr. R.N. Sinha as the Convener to frame By-laws Maxillofacial Surgery. Dr. R.N. Sinha, who was trained and Regulations for an Association of Plastic Surgeons under Prof. Kilner, on his return to Medical College, of India - as a Section of Association of Surgeons of Patna (Bihar State) made pioneering efforts to educate India. However, it was only in December 1987 that APSI surgical colleagues, State and Central Government and became a Registered Society with the government. the Medical Council of India about the need to develop In the year 1957, considerable interest was created in Plastic Surgery as a specialty. He wrote numerous Maharashtra, following the visit of Sir Harold Gillies. He articles in scientific journals and lay press to drive home was pleasantly surprised to see deformities being treated the point. This indeed was a great task, since there were by tube pedicles and other modern techniques of Plastic no books or literature available to read, learn from and Surgery. He applauded the excellent work that Major receive guidance about the new specialty. During those Sukh was doing in the field of Rehabilitative Plastic days, even minor progress was very difficult, because the Surgery at the Armed Forces Medical College, Pune. It development of specialties was generally frowned upon was not only an eye-opener for all, but a surprise to Dr. and frankly discouraged by General Surgeons. Slowly, Gillies himself. Many war casualties needed extensive even the patients started realizing that a person who stay in his unit for such procedures of rehabilitation. Sir concentrates in one field, does much better than one who Harold Gillies also demonstrated various operations and

70 IPRAS Journal www.ipras.org Issue 7 techniques at Kandhwa Leprosy Centre, where Dr.N.H. A Burns and Plastic Surgery Unit was established in 1961 Antia was working. Dr. Gillies, as the founder of modern at K.E.M. Hospital, Bombay, by Dr. Charles Pinto. Mr. Plastic Surgery, was keen to propagate knowledge in this E.W. Peet of Oxford was a regular visitor to this unit. specialty in one of the most populous countries of the The first summer conference of the Association was world. He visited and lectured at several centers in the held at Nagpur in 1964. The most outstanding feature country including Nagpur, Calcutta, Delhi, Patna and of the conference was the brilliant presentation on Jaipur. At Nagpur, in December 1957, he inaugurated the the classification of cleft lip and palate by Prof. C. Association of Plastic Surgeons in India - as a section Balakrishnan; now known throughout the country as The of A.S.I. The Association elected the following office Nagpur Classification. The first batch of post-graduate bearers: students trained in our country appeared for their Dr.R.N.Cooper President examination from Nagpur and Patna Universities in 1962 and 1963 respectively. Dr.C.Balakrishnan First Vice-President In 1963, the Government decided to start a Department Dr.R.N.Sinha Founder Secretary of Burns, Plastic and Maxillofacial Surgery at Safdarjung Hospital in Delhi. Dr. J.L. Gupta had the honour of starting Dr.R.N.Sharma Founder Members and developing this unit which, by sheer hard work and Dr.N.H.Antia Founder Member dedication, became a major unit of Plastic Surgery in India in a very short time. Dr.Hirdeis Founder Member In 1964, during the first Post-graduate Medical Education (ENT Specialist from Bangalore) Conference, convened by the Medical Council of India, This was indeed a great historic moment and Dr. Gillies under the Chairmanship of the then Union Minister of was made the first Honorary Member. Dr. Gillies stayed Health Dr. Sushila Nayyar at Delhi, the first curriculum in India for about three months and, before leaving for and physical standards for MCh postdoctoral training in England, he insisted on a token payment of Rs.100/- Plastic Surgery was drafted. to Dr. Antia, as an inspiration to continue his efforts In 1967, Dr. R. N. Sharma represented our Association at in establishing a Department of Plastic Surgery at the the International Meeting held in Rome, and thus, APSI Government Medical College in Bombay. This proved joined the International Confederation of Plastic Surgeons. to be a great morale booster and the first unit of Plastic By December 1967, the Association had grown to about Surgery started at J.J. Hospital, Bombay in December 66 members (including 37 full members). By 1968, we 1958 with Dr. Antia as its Head. had 11 plastic surgery centers in the country at Nagpur,

Inaugural ceremony of IPRAS 2009 at Siri Fort Auditorium on 29th Nov 2009. (L-R Dr. G. Balakrishnan, President APSI, Dr. Suresh Gupta, President IPRAS 2009, Dr Marita Eisenmann-Klein, Secretary General IPRAS, Dr. Kiran Walia, Chief Guest and Minister of Health in Government of Delhi, Dr. Rajeev B. Ahuja, Chairman IPRAS 2009, Dr. Rakesh Khazanchi, Secretary General IPRAS 2009).

Issue 7 www.ipras.org IPRAS Journal 71 Patna, Lucknow, Bombay, Pune, Delhi, Chandigarh, India had the privilege of hosting the IXth and the Patiala, Madras, Madurai and Calcutta. XVth Congresses of IPRAS in Delhi, in 1987 and 2009, In the last four decades there has been a tremendous respectively. Dr Suresh Gupta and Dr Rajeev B. Ahuja, growth of Plastic Surgery. The number of teaching respectively, were principally responsible for the organization centers has increased in the country and today hardly of the events. Both the events were a huge success, with any student is going abroad for basic Plastic Surgery the delegates who enjoying the Indian hospitality. APSI training. The Association has established several also has the privilege of giving two Secretary Generals to traveling fellowships for training within and outside the the Asia Pacific Section of IPRAS; Dr B.M. Daver (1997- country (appendix I), as well as several Professorships 2001) and Dr Rajeev B. Ahuja (2009-2013). (appendix II). A few specialized centers of excellence APSI has recently established a Humanitarian activity for management of burns, Hand and Micro-vascular corpus and the interest from this will be available to any Surgery, Craniofacial Surgery and Aesthetic Surgery APSI member to use for a humanitarian project in the also developed, in different parts of the country, by country. APSI has also leaded in proposing and observing dint of hard work and special interests. The Indian July 15th as the Plastic Surgery Day, when all Plastic Journal of Plastic Surgery started in 1981, in order to Surgeons are urged to contribute free services to the needy bring together all the professionals involved and to in their Region. IPRAS has promised to propagate this disseminate and advance their knowledge. Very proudly, concept. APSI has also started professional development IJPS (India Journal of Plastic Surgery) is now a popular courses, which are topic-based and held three times a journal, indexed with Medline and publishing papers year, rotating across the country. They are delivered at no from across the world. cost to students and APSI members, through sponsorship There are about 800 Full members and 150 Associate from Ethicon. These courses are extremely popular and members of APSI today. have been a huge success.

Past Presidents of APSI during APSICON at Goa in 2010. (L-R Dr K.S. Sekhar, Dr N. Pandya, Dr V. Bhattacharya, Dr Suresh Gupta, Dr Mukund Thatte, Lt Gen L.P. Sadhotra, Dr Rajeev B. Ahuja, Dr K. Sridhar, Dr. Rajasabapathy)

72 IPRAS Journal www.ipras.org Issue 7 The upcoming events of the APSI are: Appendix II. 1. Plastic Surgeon of the Year award – from DR KS 20-22nd Jan 2012 ISAPS Course, Goa Shekar endowment 19-20th Feb 2012, APSI-Ethicon accredited course on Reconstruction in Abdominal & Trunk. 2. Honorary Membership Award 27-29th April 2012, APSI-Ethicon accredited course on 3. Ethicon Visiting Professorship in Plastic Surgery Basics in plastic surgery. 4. Ethicon Visiting Professorship in Microsurgery 2-3rd Nov 2012-Preconference APSI-Ethicon accredited 5. Ethicon Visiting Professorship in Cosmetic Surgery course in cleft surgery. Lucknow 6. Gen. N.C Sanyal - Armed Forces Professorship 6-8th Nov 2012 Main APSICON Conference, Lucknow 7. Peet Prize for best presentation during Annual 4-8th March 2013, World Congress of IFSSH Congress in Award category The current Executive members 8. Kilner Essay Award representing APSI: 9. APSI Junior Best Paper Award at Annual congress. President: Dr A.K. Singh 10. McNeil audio-visual award for best presentation by a President Elect: Dr Ashok Gupta junior plastic surgeon at Annual congress. Immediate Past President: Dr Raja Sabapathy 11. Kammath Memorial prize for best poster during Secretary: Dr Atul Shah Annual congress. Treasurer: Dr Sailesh Ranade 12. N H Antia award for best publication from India. Editor: Dr Surajit Bhattacharya 13. Army Endowment for best report. Council Members: Dr.B.G. Tilak, 14. R. N. Sinha award for best paper Published in IJPS. Dr Amresh S. Baliarsingh, Dr Nitin Mokal, Contact for APSI Dr Ravi Mahajan, Dr. Atul Shah, Secretary APSI Dr Subramanian Iyer, 20, Om Park, Near Andhra Bank, Stadium Road, Akota, Dr Hari Venkataramani Baroda. Gujrat 390 020, India Trustees: Dr K.S. Sekhar, Ph: +919825033832 ; +912652321769 Dr J.K. Sinha, E-mail: [email protected]; [email protected] Dr K. Sridhar, Website; http://apsi.org.in Dr Suresh Gupta, Dr Rajeev B. Ahuja Appendix I. 1. Ethicon Plastic Surgery Traveling Fellowship 2. Ethicon traveling fellowship in Microsurgery 3. Ethicon cosmetic surgery traveling fellowship 4. R.G. Saraiya international fellowship – 5. Brig. Kathpalia fellowship in hand surgery 6. Myovatec fellowship for training in Plastic surgery 7. Vasudhan Arjin Fellowship in Laser Surgery 8. APSI sponsorship to attend APSICON 9. IX IPRAS Congress fund international traveling Fellowship. 10. IX IPRAS Congress fund national traveling Fellowship. Dr Rajeev B. Ahuja 11. K.E.M. Microsurgery fellowship Trustee and Past President of APSI

Issue 7 www.ipras.org IPRAS Journal 73 History and present situation of Turkish Plastic Surgery 50th Anniversary of the Turkish Society of Plastic Surgeons Prof. Ibrahim Yıldırım MD Plastic, Reconstructive and Aesthetic Surgery Department, TPCD Cerrahpaşa Medical Faculty, İstanbul University, İstanbul Turkey

It is an interesting coincidence for me that this article At the beginning of the 13th century, the first Turkish is written just on the 50th Anniversary of the Turkish Medical Book “Tuhfe-I Mübarizi” was written in Turkish Society of Plastic Surgeons. The society was founded in by Hekim Bereket8. 1961. As it is known, the first University was founded in Istanbul The history of Turkish Plastic Surgery goes back to in 1453, just after the conquest of the city by the Ottoman the 8th century. German scientists found 64 Turkish Turkish Empire. Şerefeddin Efendi of Amasya 3,4,5,6 was manuscripts, dated 1902 – 1914 years ago, in the a pioneer in Turkish Plastic Surgery and he published a Sincan region of “East Turkistan” (in present-day north- superb and beautifully illustrated surgical book, named western China, where Uygur Turks live). These are “Cerrahiyyetü-l Haniyye3 in 1465, written in the Turkish the oldest documents in Turkish and Turkish Plastic language. He described many different techniques and Surgery 1,2,written in three different alphabets: the Uygur he demonstrated these techniques with 140 diagrams version of the Sogd alphabet, the Brahmi alphabet in his two-volume book. Most of the cases were related of Indian root and the Nestori/Suryani alphabet 1,2. to congenital problems and trauma. Additionally, They are kept in the Brandenburg Academy of Science gynecomastia, hermaphrodism, mandibular subluxation, in Berlin and consist of mostly traditional medical and carcinoma of the lip, etc. were also described. documents, dealing with subjects including nasal tumors, In the 15th century, Mümin bin Mukbil16 from Sinop, fascial palsy, head and neck tumors, skin lesions, wound described techniques for the treatment of diseases and healing and other plastic surgical problems. coloured lesions on the eyelids and orbital region; in

All documents were read by Ord. Prof. Reşid Rahmeti addition, blepharoplasty and special surgical instruments Arat (Gabdul Raşid Rachmati Arat) in Berlin. for these procedures as well. Most of the Turkish physicians often used to work on more After the “decline of the Ottoman Empire”, new than one subject and the languages of the scientific arena understandings and modern establishments brought new at that time were Arabic and Persian 4. One of them was horizons to medicine. The first modern school of medicine7 AviCenna 4 (Ibn-i Sina) (980 – 1037) from Harmaysan, was established in 1827 in Istanbul by Sultan Mahmud. near the Buhara; in his well-known book “Tıp Kanunu” The Second one was a military medical school 9,10. In order (Law of the Medicine) he gave details about “Ectropion to be able to relate to the Western World, the teaching and Entropion” and the muscles of the eyelids. language was converted to French, starting in1839 and,

74 IPRAS Journal www.ipras.org Issue 7 accordingly, the methodology of teaching was mostly The second Plastic Surgery center was founded in the French. This school was re-organized in 1866 – 1867, and Military Medical Academy11in Ankara, in 1943, as “Jaw the linguafranca was converted to the native language; the Surgery Center”, by Dr. Necdet Albay, but later, in 1958, school was re-established with a civil section11. This was a it was changed to the “Maxillofacial and Plastic Surgery very satisfactory situation; at the end of the 19th Century, Department” by Dr.Cihat Borçbakan19. As it has been there were many very well-trained phyicians. mentioned previously, the Turkish Society of Plastic It is possible to see some plastic surgical articles17 in Surgeons7 was founded in 1961 in Ankara. The founders the of “Tıb Cemiyeti Mecmuası” journal (the Medical were eight Plastic Surgeons, two general surgeons, and Journal) between 1856 and 1906, such as “Tagliocozzi two ENT Surgeons. The first president was Dr. Konuralp Procedure for the Repair of the Nose”, “Cleft Lip and from Istanbul. Palate repair”, “Eyelid operations”,“Indian Flap for The first National Meeting18,19 of this society was held in Nasal Reconstruction (1858)”, “Partial resection of jaws Ankara and Tord Skoog from Sweden was the honorary guest (1868)”,“Epidermo-dermal Graft Application (1872), and speaker. Afterwards, the first Skoog fellow was sent “Ollier-Thiersch Graft (1885) etc. to Upsala. The International Association of Maxillofacial The first modern literature in Plastic Surgery apperared Surgeons was founded in Leipzig and Dr.Konuralp was during this period. Dr.Cemil Topuzlu12 presented 120 founder and elected vice-president in 1970. plastic surgical cases, among his series of 758 surgical Turkish Plastic Surgery Society has organized National cases, between 1893 and 1897. He was the first surgeon Meetings every two years, and, in 1983, a Symposium in the world to recommend “Z-Plasty” for contractures of was added to the program. Since 1988, a National the Achilles tendon12 and to use sutures to repair arteries. Meeting and Symposium have taken place each year. The period between the two World Wars was an excellent Some combined meetings and courses were arranged time for Plastic and Reconstructive Surgery, both at home together with other countries, such as the Turkish – French and abroad. It is important to mention Dr. Cafer Tayyar (Istanbul 1980), Turkish – Greek (Athens1988) and Kankat, Dr. Şerif Korkut and especially Dr. Halit Ziya several Aesthetic Surgery courses of ISAPS, as well as Hand Konuralp, who were the pioneers of modern Plastic Surgery Surgery courses held in different cities of the country. in the country at that time. Dr. Kankat13,14 performed many The Sixth European and the Fifth Asian – Pacific reconstructive and aesthetic operations; the first Turkish Congresses were organized by the Turkish Society in Journal of Plastic Surgery was published by him under the Istanbul in 1989. name of “Modern Cerrahi ve Nöroşirürji (Modern Surgery Dr. Güler Gürsu from Turkey was the President and Neurosurgery)” in three sections: General, Neuro- and of ISAPS between 2000 and 2002 and she was Plastic Surgery, between 1936 and 1947. also the President of the World Congress of Dr. Kankat14 published “The First Penile Reconstruction”, ISAPS, which was held in Istanbul in 2002. “Cartilage Grafts for Impotence”, and aesthetic operations Over the past twenty years, new establishments like the such as “Face Lifting”, “Rhinoplasty” and “Abdominoplasty” Turkish Society of Aesthetic Plastic Surgeons, the Society etc., in this journal. Later on, in 1953, he started publishing of Interplast Türkiye, the Society of Hand Surgeons, the first journal purely for Plastic Surgery under the title the Society of Maxillo facial Surgeons, the Society of “Plastik, Reparatris ve Estetik Şirürjisi”. Aesthetic Face and Nasal Surgeons and the Society of Dr. Konuralp15,18 performed many reconstructive surgical Reconstructive Microsurgeons have become closely techniques, which he had learned from the book by affiliated with the Turkish Society of Plastic Surgeons. Kirschner and Nordmann (1927) and published several Interplast Türkiye has, so far, offered its services to papers in surgical journals between 1930 and 1935. Dr. nearly 40 countries. Konuralp founded the first Plastic Surgical Ward in Turkey There is a two-step national examination twice a year to enter in 1938. It had 49 beds and was under the Department the specialty training. The first step is a foreign language of General Surgery in Istanbul University Hospital. exam, the second part a professional exam, similar to the The first teaching program in Plastic Surgery was started at USMLE in the USA. This is a fairly competitive exam. that time. Many very well-known Plastic Surgeons visited After passing the exam, medical doctors earn the right this clinic. They included Maliniac (USA), Rose Tilley to enter to the specialty programme. In Turkey, the total (Canada), John Conley (USA), Heuser (Germany), Milton training time in Plastic Surgery is five years, including Freeman (USA), Griffith (USA), Polzer (USA), McDowell rotational programs in General Surgery, Pediatric Surgery, (USA), Schimitzu (Japan), Organe (UK), Broadbent (USA), ENT, Orthopedics and traumatology, Neurosurgery, Kilner (UK), Matthews (UK), Longacre (USA) , Skoog Anaesthesiology, Emergency Medicine and Anatomy. (Sweden), Bardach (Polonya) and others. These individuals At the end of the five years residents, must have prepared visited at various times. In one occasion, Dr. Kilner invited a thesis, which is an experimental or a clinical research Dr. Konuralp to England, where he spent time with Gillies, study, conducted under the instruction of a tutor. The McIndoe, Kilner, Mowlem, Matthews, Barron, Osborne, candidate must take an examination to earn the specialty Peet, Reidy, Dennis Brown and Sedden. His first book diploma, which consists of three steps: was published in 1952, entitled “Main Priciples in Plastic 1. Thesis must be accepted by jury members Surgery”2. He was also one of the eminent Plastic Sur 2. An oral examination organized by jury members. geons of the fırst IPRS Congress in Stockholm, in 1955. 3. A practical examination in the operating room with a

Issue 7 www.ipras.org IPRAS Journal 75 random choice of cases, watched by the jury members. References: The jury members are three lecturers from Plastic Surgery and two lecturers from any other of the close specialties 1. Arat, Reşid Rahmeti, Ord. Prof. Dr., Berlin Brandenburg like ENT, Paediatric Surgery, etc. Academy of Science, Hand- written Collection,“Zur Heilkunde der Uiguren” (SPAW, Phil. Hist. Klasse, 1930 XXIV, Berlin 1930, The first specialty exam for Plastic, Reconstructive page(451-473) and Aesthetic Surgery took place in 1965. 2. Sertkaya Osman Fikri, “Kurzer Überlick Über Die Uigurischen Training centers are allowed to conduct this exam on Medizinischen Texte” Kitap: Festschrift für Arslan Terzioğlu, Prof. behalf of the Ministry of Health. Diplomas are awarded Dr. Ing. Dr. med. habil., zum sechzigsten Geburtstag /sahife: s. s. after successful examination. Any specialist with this 125-138 diploma is entitled to have a practice, either in one of the 3. Uzel İlter; “Şerefeddin Sabuncuoğlu; Cerrahiyetü-l Haniyye” official institutions or in the private sector. The public Türk Tarih Kurumu Yayınları, III.Dizi-Sa.15,I. cilt, 495 sahife, still looks at Plastic Surgery as Aesthetic Surgery. That is II. cilt 98+36 fasıl, 140 minyatür, Ankara 1992 why this field is highly popular. 4. Ağırakça. Ahmet; Prof. Dr., “İslam Tıp Tarihi; Başlangıçtan VII./ Nowadays, we have 53 training centers all over the country, XIII. Yüzyıla Kadar, 399 sahife; FesanBasımevi, Derya Ciltevi, in University and State Hospitals. There are around 900 İstanbul, 2004 Plastic Surgeons and nearly 300 residents for a 75-million 5. McDowell, Frank, MD., Sc.D., “The Source Book of Plastic population. Unfortunately, some Plastic Surgeons are not Surgery”, Williams and Wilkins Company,Baltimore,1977; 509 members of the Society. There are “Hand Miocrosurgery pages Centers” in the large cities, mostly in the private sector and 6. Horton, Charles E. MD. “Plastic and Reconstructive Surgery in University Hospitals.There are “Burn Units” in different of the Genital Area”, 695 sahife; Little Brown and Company; centers, but not enough for the country. Boston, 1973 We owe thanks to Cemil Topuzlu, Cafer Tayyar Kankat, 7. Yıldırım İbrahim; “Plastic Surgical Training in Turkey, History, Halit Ziya Konuralp and Cihat Borçbakan who were present situation and future”, EuropeanJournal of Plastic Surgery the leading Surgeons in the development of the Modern (Springer-Verlag), 16:115-117, 1993 Turkish Plastic Surgery. 8. Erdağı Binnur; “Anadolu’da Yazılmış İlk Türkçe Tıp Kitabı”, Türkbilig-Türkoloji Araştırmaları, 2001-2002, sahife: 46-55, TDV Matbaası, Ankara, Temmuz 2001 9. Terzioğlu Arslan Prof. Dr.; “İstanbul Tıp Fakültesi Tarihçesi 1”, Türk Dünyası Tarih Kültür Dergisi, İstanbul, Ekim 2010, s: 286, sahife 24-32 10. Terzioğlu Arslan Prof. Dr.; “İstanbul Tıp Fakültesi Tarihçesi 2”, Türk Dünyası Tarih Kültür Dergisi, İstanbul, Kasım 2010, s: 287, sahife 43-5 11. Terzioğlu Arslan, Prof. Dr., “Gülhane’nin Kuruluşunun 110. Yıld.nümü Anısına, Son Araştırmalar Işığında Gülhane ve Türk Tıbbının Gelişmesine Katkıları”, Türk Dünyası Tarih Kültür Dergisi, Ocak 2009, sayı 265, sahife 13-22, İstanbul 12. Topuzlu, Cemil; “80 Yıllık Hatıralarım, (İstibdat-Meşrutiyet- Cemil Topuzlu Cafer Tayyar Kankat Cumhuriyet Devirlerinde) ‘Cemil Paşa’nınCerrahî Yayınları’ sahife 248-257, D.rdüncü Baskıya hazırlayan Dr. Cemalettin 1866 – 1958 1895 – 1955 Topuzlu, Topuzlu Yayınları, Üniform Matbaacılık, İstanbul 2002 13. Kankat, Cafer Tayyar; “Modern Cerrahî ve N.roşirürji Mecmuası”, Ekspres Basımevi, Kader Basımevi,İstanbul 1936-1947 yılları arasında 36 sayı çıkmıştır. 14. Kankat, Cafer Tayyar; “Plâstik, Reperatris ve Estetik Şirürjisi Kitabı, 33 sahife, Kader Basımevi, İstanbul, 1946 15. Konuralp, Halit Ziya; “Plâstik Cerrahide Esas Prensipler”, 148 sahife, İsmail Akgün Matbaası, İstanbul, 1952 16. Kâhya, Esin; “Onbeşinci Yüzyılda Yaşamış Bir Bilim Adamımız, Mümin B. Mukbil”, X. Türk Tarih Kongresi, Ankara 22-26 Eylül 1986, Türk Tarih Kurumu Yayınları, IX. Dizi-Sa.10d, V. Cilt, sahife 2253- 2260, Türk Tarih Kurumu Basımevi, Ankara 1994 17. Sezer, Baha; “Plâstik Cerrahî”, Tıp Dallarındaki İlerlemelerin Halit Ziya Konuralp Cihat Borçbakan Tarihi (Dünyada ve Türkiye’de 1850 yılından sonra), Cerrahpaşa 1903 –2005 1912 – 1991 Tıp Fakültesi Vakfı Yayınları:4, Editör: Prof. Dr. Ekrem Kadri Unat, sahife:362-372, Gürtaş Matbaası, İstanbul 1988 The distribution of Plastic Surgeons is, unfortunately, not 18. Konuralp, Halit Ziya; Anıları “Personal Communication”, 1990- ideal in the country; they mostly try to stay in big cities. 2005, İstanbul In our field, the number of the Plastic Surgeons in Turkey 19. Cihat Borçbakan’nın kendi sesinden Anıları, “Personal will be another problem in the near future. Communication”, 1986 – 1990, Ankara

76 IPRAS Journal www.ipras.org Issue 7 A history of the British Association of Plastic, Reconstructive and Aesthetic Surgeons Previously: The British Association of Plastic Surgeons The First Meeting (Stoke-on-Trent, Manchester and Birmingham) had been overwhelmed, and that even in November 1946 “the most The inaugural meeting of the British Association of Plastic recently established centre at Sheffield, with 40 beds, had Surgeons was held at the Royal College of Surgeons of only been open for five months, but already had a waiting England on 20 November 1946. It was chaired by Sir list of 70 cases and is compelled to refuse admission to Alfred Webb-Johnson (later Lord Webb-Johnson), who deserving cases from surrounding towns”. was then the President of the Royal College of Surgeons The Committee was of the opinion that Plastic Surgery of England. units should be based in general teaching hospitals and The next day, the Association’s first President, Sir Harold that they would function best in association with other Gillies, wrote the very first letter in the name of the departments, but retain their own individuality, with British Association of Plastic Surgeons, to Sir Alfred dedicated wards, operating theatres and offices, and Webb-Johnson: wherever possible they should also support research. Dear Alfred The First Presidents I cannot let this opportunity go without putting on paper the very deep appreciation of your mostly The inaugural committee had faced a difficulty as to kindly and helpful intervention last night. Your who to put forward as the first President of the British handling of the inaugural meeting, your help to me Association. The two main contenders were Sir Harold and to others in the later discussions were superb, Gillies, and Professor Kilner, (who was the holder of the and I can assure you and the Council of the College only chair in Plastic Surgery in the United Kingdom). The that our little association was happily started. We initial committee vote split, half for Professor Kilner and now also feel that the Royal College is our home half for Sir Harold. A compromise solution of having two and that the President and his team are our friends. presidents was rejected by both, and Archibald McIndoe We trust that we shall be worthy members of this was definite in his advice that Sir Harold Gillies should surgical family. be put forward, and this prevailed. Sir Harold was President from 1946-47, Professor Kilner HDG followed in 1947-48 (and was elected President again in BAPS had the objectives of relieving sickness and 1955), and they were succeeded in 1949 by Archibald protecting and preserving public health by the promotion McIndoe. and development of Plastic Surgery. The Association also undertook to advance education in all aspects of Harold Delf Gillies Plastic Surgery. Harold Gillies was born in New Zealand in 1882, the The need for Plastic Surgery youngest of eight children. His father died when he was 4 and he was sent to boarding school in England at the A Plastic Surgery Planning Committee chaired by age of 8. Four years later he returned to school in New Professor T Pomfret Kilner, and whose other members Zealand, and in 1901 came back to Gonville and Caius were Sir Harold Gillies, Mr Wilfred Hynes, Mr Archibald College, Cambridge. He played the violin, developed H McIndoe and Mr Rainsford Mowlem, had in fact met a love of fly-fishing, he rode and played golf (reaching on five previous occasions before the inaugural meeting. the semi-finals of the amateur golf championship at St They had found that the specialised war time units, Andrews). which were especially equipped for treating injuries of He graduated from St Bartholomew’s Hospital, London, the face and jaw, burns and soft tissues losses, had given becoming a Fellow of the Royal College of Surgeons in facilities for treatment and research greatly in advance 1910 and he became assistant to Sir Milsom Rees, the of those available in peace time. They also identified senior ENT surgeon at St Bartholomew’s. When war civilian needs, such as some 700 cases of cleft lip and broke out in 1914, Gillies, then 32, volunteered to serve palate each year, industrial injuries and many patients for with the Red Cross and was sent to France as a General reconstruction and repair after surgery for cancer. Surgeon in 1915. He was closely associated with Charles They noted that facilities in London and in the provinces Auguste Valadier and Varaztad H Kazanjian, who

Issue 7 www.ipras.org IPRAS Journal 77 stimulated his interested in maxillofacial injuries. He The Second World War and afterwards visited Hippolyte Morestin at the Val-de-Grâce military On December 7, 1941 the Japanese bombed Pearl Harbour hospital in Paris and after watching him operate he wrote and the next year large numbers of American forces began “this was the one job in the world I wanted to do”. to appear in Britain, together with their surgical hospitals Gillies transferred to the Royal Army Medical Corps and field units. They brought with them specialised and with the backing of Sir William Arbuthnot-Lane, set Maxillofacial and Plastic Surgery teams, including pioneers up a special unit at the Cambridge Military Hospital in such as Aufricht, Converse, Ivy, Kazanjian and Webster. Aldershot, in 1916. From the Battle of the Somme (July The friendly co-operation during that time led to strong 1916) 2000 casualties were referred. There were only trans-Atlantic friendships, including the collaboration of 200 beds and the facilities were overwhelmed. Ralph Millard of Miami with Sir Harold Gillies, with whom The Queen’s Hospital in Sidcup was established, with he became co-author of “The Principles and Art of Plastic an additional 200 beds and when the old hospital was Surgery” (1957) being awarded an honorary FRCS(Ed). eventually knocked down many years later, a plaque was After the end of the war, Loenneken (Oslo), Olsen placed in the entrance of the new Queen Mary’s Hospital, (Copenhagen), Ragnell (Stockholm), and Schjelderup Sidcup, to commemorate “Harold Delf Gillies, CBE, (Bergen) were amongst those who came to Britain to FRCS 1882-1960, whose work at this hospital attracted train in the new specialty of Plastic Surgery, encouraged worldwide recognition and led to the foundation of Plastic by the inauguration of the Association in 1946 and of the Surgery in Great Britain”. British Journal of Plastic Surgery in 1948. BAPS Between the wars Distinguished Visitors to Britain After peace was declared in November 1918, American, Many pioneers of Plastic Surgery in Europe came to train Canadian, Australian and New Zealand surgeons returned in Britain, including: to their home countries to develop Plastic Surgery and to establish new units. Holland: C Koch, C Honig Most of England was covered by four Plastic Surgeons Belgium: J Polus, A de Coninck in the 1930’s – Gillies, Kilner, McIndoe and Mowlem. In 1936, Richard Battle was told “there are four Plastic France: D Morel-Fatio, C Dufourmentel, Surgeons in the country and there is no room for any R Tubiana more”, but fortunately he was not put off. The only Spain: B Vilar-Sancho, J Planas, L Mir y Mir, other surgeon in formal Plastic Surgery training at that P Gabarro time was David Matthews, later joined by Eric Peet and J P Reidy. Portugal: J Conde, A M Fernandes The Royal Air Force was to recognise the importance Italy: S Rosselli, S Teich-Alasia, G Dogo of the new specialty of Plastic Surgery, setting up Austria: R Trauner, P Wilflingseder Plastic, Maxillofacial and Burns centres, including East Grinstead and Halton. At the Queen Victoria Hospital, Switzerland: H U Buff, H L Obwegeser East Grinstead, the Guinea Pig club was founded by Yugoslavia: V Arneri, I Cupar, H Klemencic, surviving burnt RAF crew members. The Royal Navy M Derganc, F Zdravic and the Army also developed Plastic Surgery facilities. From 1939, the period of the “phoney war” mass casualties Czechoslovakia: F Burian, S Demjen that had initially been expected did not materialise, but Poland: J Szlazak the specialty developed by accepting civilian casualties resulting from the blackouts, which increased the road Denmark: P Fogh-Andersen and domestic accident rate, and from those injured in Sweden: T Skoog, B Johanson factories, which were depending on unskilled labour to develop munitions (for example, women whose long hair International Meetings in Plastic Surgery was caught in conveyor belts causing scalping injuries). Surgeons from France, American and Britain, who had The British Association of Plastic Surgeons stimulated been engaged in treating the wounded of the First World the development of the specialty in many countries War, attended a meeting held in Paris in June 1925. around the world. At the outbreak of the Second World Meetings were then held in Brussels in 1936 (“Le Premier War, medical officers from Australia, Canada, India, Congrès de Chirurgie Structive”) and this was followed Ireland, New Zealand and South Africa were allocated by the “Second European Congress of Structive Surgery” to the four newly established Plastic Surgery units in the in London, in October 1937. An international meeting United Kingdom for training.

78 IPRAS Journal www.ipras.org Issue 7 was planned under the presidency of Professor Sanvenero is always looking to promote innovation within the Rosselli in Milan, in September 1938 and this had to be speciality of Plastic Surgery. abandoned midway, because of the Munich crisis. Dr Tord The President in 2011, Tim Goodacre, set out ways in Skoog was the Organising Secretary of the Scandinavian which the Association looks to develop: enhancing its Association of Plastic Surgeons International Congress, research profile; increasing its presence in the regions which was held in Stockholm in August 1955, under the in support of its members; and collating accurate data presidency of Professor Erik Aschan of Finland, with Sir relating to the numbers of Plastic Surgeons, the focus of Harold Gillies as its Honorary President. their work and the impact created. The London International Congress was held at the Royal College of Surgeons of England, on July 13th, Members and Plastic Surgery Units 1959, under Mr Rainsford Mowlem, President of the There are currently Plastic Surgery units in 56 centres British Association of Plastic Surgeons and Professor in the United Kingdom and 6 units in the Republic of T P Kilner, Vice-President of the Association and of the Ireland. Plastic Surgery clinics, however, are held in Congress. Appointed delegates of 29 national societies many other hospitals throughout the country, each one of Plastic Surgery attended, each seated below their linked to a regional unit. There are 892 members of national flag and receiving an address from His Royal the Association including honorary members, senior Highness, Prince Philip, Duke of Edinburgh, who had members, full members, trainee and junior members, and consented to being the Patron of the Congress (and who other categories of associated and overseas members. in November 1964 agreed to become the first patron of the British Association of Plastic Surgeons), a role which Current Meetings, Courses, and Research he continues to the present day. The Association, together with the Royal Colleges, BAPS Becomes BAPRAS has appointed Plastic Surgery and Cosmetic Surgery tutors. Each year, BAPRAS holds two 3- day Scientific In 2004 the majority of the members of the British Meetings, and two 2-day Advanced Courses, covering the Association of Plastic Surgeons (BAPS) voted to change spectrum of Plastic Surgery, which are open to colleagues the name of the Association to the British Association from the UK and abroad. In addition, there are two 1- of Plastic, Reconstructive and Aesthetic Surgeons day meetings for medical students interested in Plastic (BAPRAS), in line with many European associations of Surgery, and a 1-day breast care nurses’ course. There is Plastic Surgery. http://www.bapras.org.uk an active Education and Research subcommittee. The Association’s new look and name came into being in The Next BAPRAS instructional Course will be held July 2006. This was associated with a change of brand- in Manchester on 18th and 19th April, 2012. Delivered identity, moving from the previous heraldic crest to a by renowned international experts, this course is aimed new, contemporary logo, retaining one of the key motifs, at specialist trainees and established surgeons in Plastic the salamander. Surgery, breast oncology, and applied disciplines from The salamander possesses natural powers of regeneration the UK and the wider international community and will and is able to restore lost or damaged tissue or limbs. In cover the latest innovations and techniques. mythology, the salamander was believed to be capable of withstanding fire and was often depicted walking Examinations and Assessment unharmed through flames. Thus, this simple amphibian Members of BAPRAS have also been heavily involved is an enduring symbol of reconstruction, protection and in mainstream teaching, training, and examinations. The repair. Over the years, the salamander has also been Intercollegiate Board in Plastic Surgery brings together the valuable in scientific research and this new emblem four Royal Colleges and the examination structure, which provided a vital link with history as, moving forward started with the FRCS (Plastic Surgery) in 1986 at the BAPS became BAPRAS and a new era began. instigation of Mr Ian McGregor, which includes written, oral The British Association of Plastic, Reconstructive and clinical examinations. The FRCS (Plast) examination and Aesthetic Surgeons is now “the voice of Plastic is held in different centres throughout the UK. Surgery” in the UK, advancing education in all aspects The evolving structure of the Intercollegiate Examination of the specialty and promoting contemporary practice. has helped to shape the course of other examinations BAPRAS sees its role as increasing understanding of the abroad, including those of the European Board, first held scope of the specialty of Plastic Surgery. It aims to raise in Brussels in 1994 under the encouragement of Mr Magdy the profile of Plastic Surgeons, who are a crucial element Saad, then President-Elect of BAPS, and Professor John of surgical care teams which provide specialist care to Ioannovich of Athens. The EBOPRAS European Board patients over a wide range of conditions. Continuing Examination in Plastic Surgery currently has a British the core objective of advancing education, BAPRAS Chairman, Mr John Boorman FRCS.

Issue 7 www.ipras.org IPRAS Journal 79 BAPRAS and the Developing World THE McINDOE LECTURE British Plastic Surgery has a long tradition of links with In 1962, the Royal College of Surgeons of England the developing world. Through its Overseas Service and received a donation from the Royal Air Forces Association Training Committee, BAPRAS continues to offer support which was to cover a Lectureship, awarded by the Council to developing countries, recognising the importance of of the College, on the recommendation of the President of Reconstructive Plastic Surgery in the treatment of injury the College and the President and Honorary Secretary of and disease and helping to develop Plastic Surgery skills the BAPRAS, devoted to Plastic Surgery or another allied in these environments. subject, in the name of Sir Archibald McIndoe, the Third President of the British Association of Plastic Surgeons. BAPRAS is keen to provide sustained and effective help to colleagues abroad. Some UK Plastic Surgery units already have twinning arrangements with overseas hospitals and HUNTERIAN LECTURES departments and more links can be set up through the Many Plastic Surgeons, and members of the Association, BAPRAS Overseas Service and Training Subcommittee. have been awarded Hunterian Professorships by the Royal BAPRAS also has links with non-governmental College of Surgeons, at the invitation of the Council. The organisations, as well as the UK government, to provide most recent Hunterian lecture was given at the BAPRAS acute help, for example following natural disasters abroad, Winter Scientific Meeting in December 2011 by Mr M such as earthquakes. Overseas activities include: Schaverien whose ground-breaking work in the UK, Australia and the USA was the basis of his lecture on “The • Funding short visits for Surgeons to learn new use of three-dimensional imaging for the investigation techniques in the UK of the microvascular arterial and venous anatomies and • Supporting Surgeons in countries as diverse as perfusion of surgical flaps and the integument”. Bangladesh, Ghana, India, Nepal, Pakistan, Sri Lanka and Uganda The Organisation of BAPRAS • Enabling BAPRAS members to visit many of these The Officers of BAPRAS are its President, Vice- countries to participate in meetings and to work in President, Honorary Secretary and Honorary Treasurer. collaboration with overseas colleagues The other elected members of Council and the officers • Conducting teaching and training and workshops in are the Trustees of the Association and there has been a countries with limited plastic surgical infrastructure. strong move recently towards regional representation on the Council. The Journal of Plastic, Reconstructive A number of other colleagues are invited to attend and Aesthetic Surgery BAPRAS Council meetings, including the President of the Irish Association of Plastic Surgeons, a patient An early proposal, after the foundation of the Association liaison representative, the editor of JPRAS, the Chairman in 1946, was to start a regular scientific communication on of the Overseas Service and Training Committee, the Plastic Surgery and the British Journal of Plastic Surgery Chairman of the Professional Standards Committee, the was launched in March 1948, under the editorship of Mr Communications Officer, the chairman of the Specialist A B Wallace. Advisory Committee in Plastic Surgery, the President of the British Association of Aesthetic Plastic Surgeons, and Lectures the Chairman of the Education and Research Committee. From 2012 the presidency will be extended to a two year THE GILLIES LECTURE term of office. Recent Presidents: In 1961 the Council of the British Association of Plastic • Mr Timothy Goodacre (Oxford) 2011 Surgeons instituted the Gillies Lecture as a memorial • Mr Richard Milner (Newcastle) 2012 to Sir Harold Gillies. Distinguished Plastic Surgeons • Mr Graeme Perks (Nottingham) 2013/2014 from within the UK and abroad, are invited to lecture to the Association and receive the Medal. The most European and International recent Gillies Lecture was given at the BAPRAS Representation Winter Scientific Meeting in December 2011 by Dr Sam BAPRAS is proud to be represented on the European Noordhoff, a world leader in the field of cleft lip and Board of Plastic, Reconstructive and Aesthetic Surgery, palate and Craniofacial Surgery, who practised for over and the Union Européenne des Médecins Spécialistes. 40 years in Taiwan and was instrumental in establishing BAPRAS is represented on the International Confederation several hospitals and Plastic Surgery Departments in for Plastic, Reconstructive and Aesthetic Surgery by its Taipei, which have an international reputation. President.

80 IPRAS Journal www.ipras.org Issue 7 ESPRAS, Edinburgh, 2014 (from “The History of the British Association of Plastic Surgeons THE FIRST FORTY YEARS” Churchill Livingstone 1987, and BAPRAS is pleased to be able to host the 12th Quadrennial other sources) meeting of ESPRAS in Edinburgh, in 2014. Earlier this year, Mr Tim Goodacre, President of BAPRAS in 2011, Chris Khoo issued a warm invitation to colleagues throughout the Previous President, BAPRAS world to join their BAPRAS colleagues in Scotland in the Member, Executive Committee of the European Board, summer of 2014. IPRAS Regional Representative

A.B. Wallace, M.C. Oldfield, W. Hynes, J.S. Tough R.Mowlem, J.N. Barron, Prof. T.P. Kilner, R.P. Osbourne, Sir Harold Gillies Given by I.A. McGregor

Sir Harold Gillies in uniform and when kligthed Given by Lady Gillies

Issue 7 www.ipras.org IPRAS Journal 81 82 IPRAS Journal www.ipras.org Issue 7 Çistory of Plastic Surgery in the Republic of Armenia

The history of Plastic Surgery in the Republic of Armenia The Armenian Association of Plastic Reconstructive and begins in 1982. Since 1982, the “Initiative Group”, a Aesthetic Surgeons (AAPRAS) was founded in 2005 by team of young surgeons, started experimental operations. the main Committee (The First RPesident was Armen They derived from the ranks of a microsurgery fellowship Hovhannisyan). The greatest part of the Armenian Plastic in Moscow. They worked in the Armenian branch of Surgeons have decided to create this Society, giving the All-Union Scientific Center of Surgery. The first priority to issues like: successful clinical operation, was the replantation of - coordination of the surgeons’ practical thumb in 1984. and scientific work, In 1984 a division of microsurgery in the Armenian branch of the All-Union Scientific Center of Surgery - promotion of postgraduate education, was created by the initiative group. The first operations - unification of educational programs, were muscle, tendon, vessel and nerve reconstructions of extremities. - organization of International Congresses. In 1985 the first department of Microsurgery was During the last period the Association organized four created and headed by Artavazd Sahakyan. Later in International Congresses, the last of which took place 1992, a second department, the Center of Plastic and under the endorsement of IPRAS and ESPRAS. Our Reconstructive Surgery was organized and headed Association is in close relationship with the Russian and by Gagik Stamboltsyan. All surgeons of the second Georgian Societies. Our relationship with IPRAS and department completed their specialization period in Yale ESPRAS is very productive and highly influential to our University. young Plastic Surgeons’ education and training in famous Since 1990 many aesthetic operations take place in the European clinics. Republic of Armenia. Nowadays, many Member Surgeons of our Association In 1996 in Yerevan State Medical University and work in aesthetic and reconstructive Surgery Units National Health Institute, two new departments of worldwide. Plastic Surgery were organized. They also manage a In 2013 we are planning an International Multidisciplinary postgraduate education program. After graduating from Congress on Antiaging Medicine and we invite all our a 4 year residency in one of these departments you can colleagues to participate in it. get a Plastic Surgeon’s diploma. Dr. Armen Hovhannisyan President of AAPRAS

Armenian Association of Plastic Reconstructive and Aesthetic Surgeons (ÁÁPRAS)

Issue 7 www.ipras.org IPRAS Journal 83 World Health Organization

Dear colleagues, WHO Patient Safety is pleased to share with you the results of the Latin American Study of Adverse Events (IBEAS): on a given day, 1 in 10 patients admitted to the participating hospitals were suffering from, or undergoing treatment for, a health care -related adverse event. The risk of suffering adverse events doubled if the entire hospital stay was considered. This evidence is a reflection of the reality of many other hospitals in transitional countries across the globe and it highlights the importance of addressing patient safety globally. The result of a collaborative effort between the governments of Argentina, Colombia, Costa Rica, Mexico and Peru, as well as the Spanish Agency for Quality of the Ministry of Health, Social Policy and Equality, the Pan-American Health Organization and WHO Patient Safety, the IBEAS study is the first large scale study of this kind in Latin America.

For more information, click here http://www.who.int/patientsafety/research/country_studies/en/index.html

To download the study results in English, click here http://www.who.int/patientsafety/research/ibeas_report_en.pdf

To download the study results in Spanish, click here http://www.who.int/patientsafety/research/ibeas_report_es.pdf

The WHO Patient Safety team

84 IPRAS Journal www.ipras.org Issue 7 Issue 7 www.ipras.org IPRAS Journal 85 86 IPRAS Journal www.ipras.org Issue 7 Issue 7 www.ipras.org IPRAS Journal 87 88 IPRAS Journal www.ipras.org Issue 7 Issue 7 www.ipras.org IPRAS Journal 89

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Dear colleagues, The IPRAS International Committee for Quality Assurance and Medical Devices in Plastic Surgery (IQUAM) celebrates the 20-year anniversary from its foundation, in 1992. This celebration will take place during the 10th Congress and Consensus Conference to be held in Athens on Nov 1st – 4th, 2012. The organization was founded as EQUAM by a group of Plastic Surgeons from various European, Central and South American, African, Southeast Asian and Middle-Eastern countries. Representatives participating in meetings are Plastic Surgeons, scientists, manufacturers and delegates from governmental bodies involved in the development and surveillance of advanced technologies, devices and techniques in the field of Plastic Surgery. Consensus Conferences are held biennially. At the close of meetings, a Position Statement is drawn up, summarizing the conclusions of the meeting. This statement is presented to the health ministry and Plastic Surgery society of each member country, the industry and any other interested party. Over the years, these statements acquired an important significance in the practice of the Specialty and proved helpful for all. No doubt, this type of meeting is unique in its purpose and, besides clinical practice, it also focuses on evaluating technology and methodology. Among others, topics like Fat Grafting, Stem cells and Growth Factors will be addressed, as well as results from recent and older procedures like breast augmentation and ALCL, quality of silicone implants, injectable fillers, Botulinum toxin A, suturing materials, wound dressings, medical equipment, instruments, LASER apparatuses and so many others. The recent issue regarding PIP, which alarmed Plastic Surgeons and the public worldwide, will be particularly discussed in detail. Besides science, a rich social program is planned, including a guided evening tour at the illuminated Acropolis. Most of all please be assured that the organizing committee shall spare no effort in putting together a successful congress. A cordial invitation to all, C. Neuhann-Lorenz IQUAM President Jan Poëll Congress President Daniel Marchac Chair Organizing Co. Andreas Yiacoumettis Chair Scientific Co.

108 IPRAS Journal www.ipras.org Issue 7 For the FIRST time…

The 1st IPRAS INTERNATIONAL TRAINEES’ MEETING will take place in Athens on November 1st, 2012. This meeting will make history as the first of its kind in the world. It is expected that Trainees from many countries will participate, as well as representatives from Trainees’ organizations. The program will include the following: 1. Scientific Presentations 2. Training and accreditation 3. International co-operation 4. Official participation of trainees in IPRAS The Faculty of this meeting will include respected and well known teachers, Heads of training programs, Trainees and members from the IPRAS leadership. More information will soon be uploaded on the IPRAS website www.ipras.org

Issue 7 www.ipras.org IPRAS Journal 109 SUPPORT LETTER FROM BOARD OF TRUSTEES MEMBER

Dear colleagues and friends of IPRAS, I have always been certain that the only way forward is to have our eyes looking to the future, confident that plastic surgery will carry on thriving, absorbing new technologies and techniques. I have accompanied our society since its first steps, and I am glad to see visions transformed to reality! It has been my hope that IPRAS and its national societies will continue to be the forums where innovation will be presented, where the inquisitive mind will find others equally curious, so that plastic surgery may evolve within the framework of two principal objectives: to generously pass on knowledge to the next generation, and to assure safety to our patients. I am particularly happy that the upcoming IPRAS World Congress is to be held in beautiful Chile, in our continent of South America, where plastic surgery has made giant steps of development. I invite you all to add this important event to your plans for 2013 and to take advantage of the opportunity to attend one of the most important scientific gatherings for plastic surgery.

Ivo PITANGUY Head-Professor of the Plastic Surgery Departments of the Pontifical Catholic University of Rio de Janeiro and the Carlos Chagas Institute of Post-Graduate Medical Studies Member (and patron) of the Brazilian Society of Plastic Surgery, the National Academy of Medicine, and the Brazilian Academy of Letters Visiting Professor, I.S.A.P.S. FICS, FACS

110 IPRAS Journal www.ipras.org Issue 7

NATIONAL & CO-OPTED SOCIETIES’ FUTURE EVENTS

17 - 19 February 2012 17th Annual Pakistan Association Of Plastic Surgeon Meeting Location: Bahawalpur, Pakistan - Venue: Quaid-e-Azam Medical College - Contact: Dr M. Mughese Amin E-mail: [email protected] - URL: http://www.papscon2012.com

06 - 11 March 2012 XLIII National Congress of Plastic, Aesthetic and Reconstructive Surgery Location: Merida, Yucatan, Mexico - Venue: Convention Center Merida URL: http://www.cirugiaplastuca.org.mx

09 - 11 March 2012 1st Congress of the International Society of Plastic Regenerative Surgery (ISPRES) Location: Rome, Italy - Venue: Hotel Columbus - Contact: Chrysa Kontololi Telephone: +30 2111001783 - Fax: +30 2106642116 E-mail: [email protected] - URL: http://www.ispresrome2012.com

11 - 14 March 2012 16th ASEAN Congress of Plastic Surgery Location: Boracay Island, Aklan, Philippines - Venue: Boracay Regency Beach Resort & Convention Center URL: http://www.papras.org/

17- 20 April 2012 42º Argentine Congress of Plastic Surgery Location: Buenos Aires, Argentina - Venue: Sheraton Hotel - Telephone: (54) 114811-9103 E-mail: [email protected] - URL: http://www.42congresoargentino.com

03 - 05 May 2012 3rd Central Asian Plastic Surgery Conference Location: Tashkent, Uzbekistan - Contact: George Koliopoulos E-mail: [email protected] - URL: http://www.caps2012.com/

15 - 18 May 2012 11th SRBPRAS Congress Location: Belgrade, Serbia - Venue: HYATT Regency Belgrade E-mail: [email protected] - URL: http://www.srbpras2012.org

18 – 20 May 2012 Controversies, Art and Technology in Breast and Bodycontouring Aesthetic Surgery, CATBBAS I Location: Ghen, Belgium - URL: www.coupureseminars.com - E-mail: [email protected]

22 - 26 May 2012 XIX International Meeting of FILACP Location: Medellín (Colombia) - URL: http://www.filacp2012.com 29 - 31 May 2012 3rd European Congress on preventive, Regenerative & Aesthetic Medicine (ECOPRAM) Location: Istanbul, Turkey - Venue: Harbyie Military Museum - Contact: Chrysa Kontololi Telephone: +302111001783 - Fax: +302106642116 E-mail: [email protected] - URL: http://www.ecopram2012.com/ NATIONAL & CO-OPTED SOCIETIES’ FUTURE EVENTS

05 - 07 June 2012 17th Meeting of the Euro-Mediterranean Council for Burns and Fire Disasters (MBC) & 25th Anniversary Commemorative Meeting Location: Palermo, Italy - Contact: Prof. Bishara Athiyeh - E-mail: [email protected] 16 - 17 June 2012 1st Seoul Rhinoplasty Forum Location: Seoul, Korea - Venue: Seoul St. Mary’s Hospital E-mail: [email protected] - URL: http://www.srf2012.or.kr/conference/1st_html/ 11-12 September 2012 The XIIth Congress of the Romanian Association of Plastic Surgeons with Participation of Hungarian Association of Plastic, Reconstructive and Aesthetic Surgery Location: Sinaia, Romania - Contact: Lefteris Aivaliotis - E-mail: [email protected] 12 – 15 September 2012 LaserInnsbruck 2012 Location: Innsbruck, Austria - Venue: Faculty of Catholic Theology of the University of Innsbruck Contact: Chrysa Kontololi E-mail: [email protected] - URL: http://laserinnsbruck.com/ 13 - 15 September 2012 43. Jahrestagung der DGPRÄC / 17. Jahrestagung der VDÄPC Location: Bremen, Germany - URL: http://www.dgpraec2012.de 10 - 13 October 2012 2nd World Congress of Plastic Surgeons of Lebanese Descent Location: Cancun, Mexico - Venue: Convention Center Cancun URL: http://www.congressmexico.com/LSPRAS2012 26 – 30 October 2012 Plastic Surgery THE MEETING Location: New Orleans, USA - E-mail: [email protected] URL: http://www.plasticsurgerythemeeting.com/ 1st November 2012 The 1st IPRAS International Trainees’ Meeting Location: Athens, Greece - Venue: Royal Olympic Hotel Contact: Mr Nikos Antonopoulos - E-mail: [email protected] 01 - 04 November 2012 10th IQUAM CONSENSUS CONFERENCE Location: Athens, Greece - Venue: Royal Olympic Hotel - Contact: Nikos Antonopoulos Telephone: +302111001782 - Fax: +302106642116 E-mail: [email protected] - URL: www.iquam2012.com 14 – 18 November 2013 49th Brazilian Congress of Plastic Surgery Location: Porto Alegre - URL: http://www.cirurgiaplastica.org.br/ IPRAS WEBSITE JOIN YOUR COLLEAGUES The first website that gives you the opportunity to upload your scientific profile for free!!

Now it is very simple to upload your scientific be sent at the Association of the country that you profile and gain the benefits of being under the have declared, ensuring that only IPRAS members IPRAS umbrella. of good standing and high ethical principles are Try it…!! able to upload their personal details. Sign up on www.ipras.org and follow the following As soon as your Association verifies you as steps: a member, your profile will automatically be 1. Create an account by clicking “Member’s uploaded at the website’s, “Find a doctor” option login” on the top right-hand corner and then in the “Members”section. select the “Create new account” tab. It is also up to you to decide whether your profile 2. Fill out your “Username”, “Email” and will be classified as “private” or visible to all “Password”, as required. visitors of the IPRAS webpage. Our aim, besides 3. Select the option “Doctor” and your country, facilitating communication among colleagues, under the section “If you are a doctor, complete expands to allowing patients to verify the good the following”. standing and high ethical principles of the doctors’ profiles hosted, allowing them to choose qualified 4. Once all account details have been added, click IPRAS members for needed procedures. on “Create new account” button. In conclusion, I want to emphasize the usefulness Then you click on “EDIT” and then on “DOCTOR of the IPRAS website FORUM. A section you PROFILE”. will gain access to, as soon as your profile has This is the section where all the information of been accepted and uploaded. Only verified your scientific profile can be uploaded. plastic surgeons can use it and read its contents. You may complete the fields with the information Therefore, you will have the opportunity to that you prefer such us: Personal Picture, Hospital exchange ideas, news regarding plastic surgery Position, Affiliation, Special Field of Interest, techniques, news from your National Association, Contact Details, Memberships, Topics of Special alerts and all other information you would like to Interest, Publications etc. share with your peers. At the “EDIT” section you may proceed to the Don’t miss the opportunity to make the IPRAS appropriate corrections at your account such us website twice as useful to you! to change your password or to update personal If you face any difficulties please do not hesitate information.

www.ipras.org to contact me at: maria.petsa@iprasmanagement. When you complete the aforementioned steps com . there will be one last step remaining for your Always at your disposal! details to be uploaded on the IPRAS website. The application must be approved by the National Maria Petsa Association you are a member. The application will IPRAS Assistant Executive Director

116 IPRAS Journal www.ipras.org Issue 7 INDUSTRY NEWS Crisalix 3D simulations are now used in more than 70 countries “Special offer for all IPRAS members and readers. See end of the article for more details.” e-Stetix 3D 2011 has been the result of several important achievements, among them: - e-Stetix 3D progressed through versions 1 to 5, with a long list of improvements and new functionalities. All updates answering the most common question from patients. were provided for free to registered users, and the service Dr. Serge Lê Huu (LaClinic, Montreux) has been using e-Stetix was continuously updated with the latest technology since its first commercial release and recently announced that following users’ feedback. in only 18 months, e-Stetix had contributed to increasing his - e-Stetix was selected by IBM for its “Smarter Planet” conversion rate from 57% to over 92%. Aside from generating these impressive results, Dr Lê Huu also noted that e-Stetix has been invaluable in optimizing the relationship with patients, through educating them about their bodies, helping them to select the desired implants, and helping to understand and manage the patients’ expectations and aspirations.

Some new developments available in version 5.2: complete set of linear and surface measurements, 3D planning for implant positioning and nipple orientation, and much more. program due to its innovative cloud computing approach. - A 24/7 support desk was implemented, to train and support every e-Stetix user whenever necessary. - A second research & development project was commissioned by the Swiss National Fund of Research - CTI (Commission of Innovation and Technology) in Switzerland, due to the value e-Stetix unique technology brings to the field of plastic surgery. - e-Stetix reached the milestone of more than 1,500 active users in more than 70 countries (see map below). - The launch of its consumer website www.sublimma.com, SHOWCASE – Serge Lê Huu – Switzerland which today is already generating more than 30 enquiries per day in 10 different languages from people interested in “e-Stetix for Patient Education“ Dr Lê Huu specifically refers to using e-Stetix in order to highlight asymmetries and distance between the breasts, as well as to show how implant shapes and volumes can produce varying results on different patients’ bodies. He maintains that having this discussion prior to surgery has significantly minimized potential disappointment, and even surgery revisions, to the extent that he has not encountered a single unsatisfied patient during these 18 months. IPRAS members and readers have a special 10% discount on e-Stetix annual subscriptions until March 15th 2011. To benefit from this offer, please visit http://www.crisalix.com/en/ pricing and proceed to “sign up”. Use the following code in the “Promotional Code” field: 41f282e1d8 plastic surgery with certified surgeons. - Endorsements by the International confederation of Plastic Crisalix Reconstructive Aesthetic Surgery (IPRAS) and the Sociedad PSE-A Española de Cirugía Plástica Reconstructiva y Estética 1015 Lausanne (SECPRE). Both organizations support and share the same Switzerland objective as Crisalix; increasing patient satisfaction by [email protected]

Issue 7 www.ipras.org IPRAS Journal 117 IPRAS PAST GENERAL SECRETARIES

Tord Skoog David N. Matthews Thomas Ray Broadbent William M. Manchester (Sweden) (U.K.) (USA) (N. Zealand) 1955 - 1959 1959 - 1963 1963 - 1967 1967 - 1971

John Watson Roger Mouly Jean-Paul Bossé" Ulrich T. Hinderer (U.K.) (France) (Canada) (Spain) 1971 - 1975 1975 - 1983 1983 - 1992 1992 - 1999

James G. Hoehn Marita Eisemann-Klein (USA) (Germany) 1999 - 2006 2006 - 2011

118 IPRAS Journal www.ipras.org Issue 7 International Confederation International Confederation for Plastic Reconstuctive for Plastic Reconstuctive and Aesthetic Surgery and Aesthetic Surgery

IPRAS BENEFITS IPRAS BENEFITS FOR INDIVIDUAL MEMBERS FOR NATIONAL ASSOCIATIONS • Immediate information about safety • Association support for educational and warnings on devices, drugs and procedures research purposes • Information regarding the proper use of • Association legal & ethical advice all materials, substances and techniques according to international law and related to Plastic, Reconstructive and practices and assistance with crisis Aesthetic Surgery through IQUAM management (the International Committee of Quality • Promotion of local or regional events Assurance and Medical Devices in Plastic through the official IPRAS management Surgery) General Consensus statement, office with an update every 2 years • Promotion of local or regional news and • Free electronic receipt of the IPRAS a Historical Account for the Association JOURNAL through the IPRAS Journal • Information regarding harmonization of • Free shipment of copies and electronic training receipt of the IPRAS Journal • Information regarding accreditation of • Immediate information and advice about Plastic Surgery Units safety warnings on devices, drugs and • Promotion of Patient Safety and Quality procedures Management (in cooperation with WHO) • Information regarding the proper use of • Protection of the Specialty and Promotion all materials, substances and techniques of its image world-wide related to Plastic, Reconstructive and • Promotion of Individual Members of Aesthetic Surgery through IQUAM National Associations by uploading their (the International Committee of Quality scientific profile on the IPRAS website Assurance and Medical Devices in Plastic • Exchange of ideas, views, thoughts and Surgery) General Consensus statement, proposals though the IPRAS website and with an update every 2 years its FORUM section • Promotion of Patient Safety and Quality • Certificate for Individual Members to Management (in cooperation with the display their IPRAS Membership World Health Organization - WHO) • Regular updates on necessary information • Information regarding harmonization of and the right to participate in all events training organized by National Societies and • Information regarding accreditation of IPRAS Plastic Surgery Units • Strengthening ties of professional • Protection of the Specialty and Promotion cooperation and friendship with colleagues of its image world-wide beyond national borders all over the world • Information and reports about events • Information regarding the developments of organized by other National Societies and plastic surgery worldwide IPRAS 7th Issue January 2012

IPRAS Journal Management Editor: IPRAS Editor-in-Chief: Thomas Biggs, MD Editorial Board: Marita Eisenmann - Klein, MD Andreas Yiacoumettis, MD Christian Echinard, MD Constance Neuhann-Lorenz, MD Zacharias Kaplanidis, Economist Page Layout: Ioannis Karanasis E-mail: [email protected] Post Editing: Athena Spanou, MD Photographer: Julian Klein

IPRAS Management Office DISCLAIMER: ZITA CONGRESS SA IPRAS journal is published by IPRAS. IPRAS and IPRAS 1st km Peanias Markopoulou Ave Management Office, its staff, editors authors and contributors do P.O BOX 155, 190 02 not recommend, endorse or make any representation about the Peania Attica, Greece efficacy, appropriateness or suitability of any specific tests, products, Tel: (+30) 211 100 1770-1, Fax: (+30) 210 664 2216 procedures, treatments, services, opinions, health care providers or other information that may be contained on or available through this URL: www.ipras.org • E-mail: [email protected] journal. The information provided on the IPRAS JOURNAL is not intended or implied to be a substitute for professional medical advice, Executive Director: Zacharias Kaplanidis diagnosis or treatment. All content, including text, graphics, images E-mail: [email protected] and information, contained on this journal is for general information purposes only. IPRAS, IPRAS Management Office and its staff, editors, contributors and authors ARE NOT RESPONSIBLE NOR Assistant Executive Director: Maria Petsa LIABLE FOR ANY ADVICE, COURSE OF TREATMENT, E-mail: [email protected] DIAGNOSIS OR ANY OTHER INFORMATION, SERVICES OR PRODUCTS THAT YOU OBTAIN THROUGH THIS JOURNAL. Accounting Director: George Panagiotou NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE OR DELAY SEEKING MEDICAL TREATMENT BECAUSE E-mail: [email protected] OF SOMETHING YOU HAVE READ ON OR ACCESSED THROUGH THIS JOURNAL. Associations Management Director: Dimitris Synodinos While every effort has been made to ensure accuracy, neither the E-mail: [email protected] publisher, IPRAS, IPRAS Management Office and its staff, editors, authors and or contributors shall have any liability for errors and/or Commercial Director: Gerasimos Kouloumpis omissions. Readers should always consult with their doctors before any course of treatment. E-mail: [email protected] ©Copywright 2010 by the International Confederation of Plastic, Reconstructive and Aesthetic Surgery. All rights reserved. Contents may not be reproduced in whole or in part without written permission of IPRAS. Next issue: April 2012 Not for sale. Distributed for free.