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Un Acercamiento a La Historia De La Cirugía De La Mano

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Un Acercamiento a La Historia De La Cirugía De La Mano Un acercamiento a la historia de la Cirugía de la Mano J. CANTERO MARTÍNEZ ANTIGUO MÉDICO-JEFE DE LA PERmaNENCE CHIRURGICALE DE LONGERAIE DE LAUSANNE (SUIZA) MIEMBRO DE HONOR DE LA SECMA Correspondencia: Dr. José Cantero Martínez e-mail: [email protected] Palabras clave: Historia de la Cirugía de la Key words: History of Hand Surgery. Mano. Rev. Iberam. Cir. Mano – Vol. 37 • Núm. 1 • Mayo 2009 (8-16) digo un acercamiento, porque sería pre- Además de ser un elemento primordial de la tencioso por mi parte el intentar abarcar prensión, gracias a la oposición del pulgar, tie- toda la historia de la Cirugía de la Mano ne en el sentido del tacto una tal precisión que Yen el espacio de un artículo. Así pues, me limi- sirve de lectura al ciego, es capaz de hacer mú- taré hacer un amplio resumen de lo que ha sido, sica y sirve de lenguaje al sordomudo. Por ello a través de los tiempos, esta materia. Aristóteles (354-322 a.C.) la calificó de «ins- Podríamos preguntarnos desde cuándo la trumento de los instrumentos» y Galeno (129- Cirugía de la Mano existe como entidad inde- 200) decía que «el hombre piensa y gobierna a pendiente de las otras ramas de la cirugía. La las demás criaturas precisamente porque tiene mayoría de los nombres a ella asociados, co- manos». rresponden en realidad a personajes cuya prin- Cuando Amenhotep IV, más conocido co- cipal actividad quirúrgica era otra que la que nos mo Ajenaton o Akenaton, décimo faraón de la ocupa. Por ello es interesante examinar, de qué XVIII dinastía de Egipto, que reinó entre el 1353 forma la patología de la mano ha interesado a y 1336 a.C., establece una nueva religión, hace nuestros antepasados a través del tiempo. grabar en las tumbas y templos del Alto Egipto Desde que el hombre practica la cirugía, el un cierto número de emblemas religiosos, entre tratamiento de la mano herida ha estado siem- los cuales se encuentra la adoración del sol. Los pre entre sus preocupaciones, dado que la mano rayos de estos soles se terminan en unas manos siempre ha estado expuesta a numerosos trauma- estilizadas, protectoras de las criaturas. En el tismos. Pero se reducía, generalmente, a simples fondo de la tumba de Ramsés VI, quinto faraón gestos, con frecuencia, rápidos y dolorosos. Has- de la XX dinastía de Egipto, que reinó entre el ta hace muy pocos años —mediados del siglo 1145 y 1137 a.C., se encuentra un símbolo hu- pasado—, la Cirugía de la Mano era considerada mano con los dos brazos levantados por encima por muchos cirujanos como «pequeña cirugía», de la cabeza. dejado su tratamiento en las manos inexpertas del A juzgar por las marcas de manos encontra- último recién llegado al Servicio de Cirugía. das entre las pinturas rupestres de algunas grutas, La mano tiene, por el contrario, unas carac- tales como las de Lescaut y de Pech-Merle en terísticas anatómicas específicas en el hombre. Francia, o las encontradas en Borneo, formando J. CANTERO MARTÍNEZ aquí un grupo de manos en negativo, o las de la de de los médicos de todos los tiempos. Escribió Cueva de las Manos en Patagonia (Argentina), más de 250 libros, entre ellos «El Canon de la realizadas entre 11000 y 7500 a.C., la mano tenía Medicina» y «El Libro de las Curaciones». en la Prehistoria una cierta significación religiosa En «Al-Andalus» florece una época fantástica o esotérica. Algunas muestran dedos amputados, de desarrollo de la Medicina. Hay que destacar que podrían tener un significado de duelo. en primer lugar a Abú al Qasim al-Zahrawi, Según los últimos estudios practicados por conocido bajo el nombre de Abulcasis, nacido Mario Capecchi, nacido en Verona en 1937 y en Zahra (Córdoba) en 936, y allí murió en 1013. premio Nóbel de Medicina en 2007, se presume Escribió un importante tratado de medicina: el que el hombre, tal como es actualmente existiría «Al-Tasrif». En su tercera parte trata de caute- ya hace dos o tres millones de años, y su mano rizaciones, de fracturas, describe la hemiplejía ha evolucionado con él. El descubrimiento del de origen traumático. Imaginó una férula de fuego provocaría sin duda quemaduras y, por lo contención de las fracturas de los metacarpia- tanto infecciones, algunas de las cuales acaba- nos, que fue utilizada hasta el siglo XIX. Enseñó rían en amputaciones. cómo suturar las heridas desde dentro, con el Quizás sea en la antigua Grecia donde pode- fin de dejar cicatrices menos visibles. Practicó mos encontrar las primeras manifestaciones de amputaciones y utilizó el método de reducción una verdadera Cirugía de la Mano. Hipócrates de luxaciones de hombro, semejante al conocido (460-377 a.C.) sabía ya cómo reducir luxacio- de Kocher. nes de los dedos, y cómo reducir e inmovilizar Otros nombres de la medicina hispano-árabe fracturas de los mismos. Caius Plinius Secundus, son Avenzoar (1091-1163) y Averroes (1126- llamado «Plinio el Viejo» (27-29), habla ya de 1198), aunque, sin duda, menos interesados por un amputado aparejado con una mano artificial. los problemas de las manos. Claudio Galeno (129-200), que fue sin duda, Pero es en el siglo XVI, con el flamenco con Hipócrates, la máxima autoridad en Medi- Andrea Vesalio (1514-1564) cuando se inicia cina en la Grecia antigua, describe ya las infec- el periodo de los grandes descubrimientos ana- ciones de la mano y establece la diferencia entre tómicos, gracias a la disección de cadáveres hu- arterias y venas. Pablo de Egina (628-690), de manos y no de animales. «De Humanis Corporis la Escuela de Alejandría, fue seguramente el úl- Fabrica», corrigió errores arrastrados desde Ga- timo de una gran sucesión de médicos que han leno, durante trece siglos. marcado los principales periodos de la medici- Los alumnos de Vesalio continuaron su obra. na griega clásica. Su libro, en siete volúmenes, Eran tanto cirujanos como anatomistas, tales co- «Epitomae Medicae» fue acogido con gran entu- mo Gabriele Falloppio (1523-1562), o William siasmo y traducido rápidamente al árabe. En su Harvey (1578-1657), descubridor de la circula- sexto volumen describe las afecciones quirúrgi- ción sanguínea en el hombre. Estudió en Padova, cas de partes blandas y del hueso, así como las donde enseñó Falloppio y donde fue alumno de quemaduras en las manos. Girolamo Fabrice. Estos descubridores partici- Comienza entonces, la gran época árabe con pan de forma activa en las adquisiciones del Re- Abu Bakú Muhammad ibn Zakariya al-Razi, nacimiento en muchos dominios, mientras que, conocido como Rhazés (865-925), médico per- al mismo tiempo, en Francia, la cirugía queda sa, fundador de un gran hospital en Bagdad, don- fuera de la enseñanza académica. de acuden estudiantes de todo el mundo árabe. En Suiza, Theophrastus Bombastus ab Dio mucha importancia al examen clínico para Hohenheim, llamado Paracelsius (1493- llegar a un diagnóstico y al estudio psicológico 1541), profesor de la universidad de Basilea, del enfermo. Escribió 184 libros científicos, de alquimista y médico, dice que «los humores no los cuales 61 dedicados a la Medicina. Otro gran intervienen en la supuración de las heridas: nombre de la medicina árabe es sin lugar a dudas mantenedlas limpias y preservarlas de los ene- Abú Ali al-Husayn ibn Abd Allah ibn Sina, migos exteriores». más conocido por su nombre latinizado de Avi- A Ambroise Paré (1509-1590), médico fran- cena (980-1037), considerado como el más gran- cés, se le considera como el padre de la cirugía Vol. 37 • Núm. 1 • Mayo 2009 UN ACERCAMIENTO A LA HISTORIA DE LA CIRUGÍA DE LA MANO moderna. De condición humilde, no tuvo acceso que se practicaba el arte de curar. Consiguieron a una formación académica. Ignoraba el griego que únicamente pudieran practicar la Cirugía los y el latín, por lo que sus obras las escribía en que hubiesen adquirido el título de «maître des francés. Empezó su carrera como cirujano-bar- arts». Entre los directores de la Real Academia, bero. A los 17 años consiguió ser admitido en hay que citar a Jean-Louis Petit (1674-1750). el Hôtel-Dieu de Paris. Participa como cirujano Fue inventor de un manguito para comprimir las militar en las campañas de Italia. Aplicó la liga- arterias, describió las anomalías de la mano y del dura de vasos sanguíneos en las amputaciones. carpo, las luxaciones medio-carpianas, así como Describió la utilización de prótesis en miembros un método de amputación digital con dos colga- amputados, así como el uso de férulas para en- jos. En cuanto a De La Peyronie, describió la derezar los dedos, después de la resección de induración fibrosa de los cuerpos cavernosos del cicatrices retráctiles. pene, a la que llamó «strabisme pénin», a causa Felix Wurtz (1518-1575), cirujano pediatra de las desviaciones que provoca, y que hoy se de Basilea, describe en su libro «Practica der asocia en algunos casos con la enfermedad de Wundtartzney» cómo curar las heridas de todo Dupuytren. el cuerpo y pone de manifiesto los ciegos dog- Recorriendo los cinco primeros volúmenes matismos del pasado. de las Memorias de la Academia, encontramos El siglo XVII nos trae contribuciones muy in- varias observaciones de dedos arrancados, des- teresantes. No hay más que recordar como prue- critos por Recolin en 1735 y por Morand en ba evidente de ello «La Lección de Anatomía» 1736. Este último, recuerda una observación de Rembrand (1609-1669). El suizo, también más antigua de Pierre de Marquetis, en 1665, de Basilea, Felix Plater (1536-1614) describe de un pulgar arrancado por mordisco de caballo, en 1614, dos siglos antes que Dupuytren, una con su tendón flexor pollicis longus entero.
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