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Lord learned it from the Ashwini brothers and Letters to Editor passed it to many sages including Sage Bharadwaj (Guru of Atreya) and the King Divodasa Kasi Raja (Lord Dhanwantari). Sushruta, approached Dhanwantari to accept him as his disciple. Under him Sushruta learned Life and times of Sushruta: Fact the basis of with special emphasis on Salya and fiction (surgery) and this is supposed to have happened in the Upanishadic age. After this, he started writing the Dear Sir, Sushruta Samhita while teaching in the Benaras [2] Sushruta, the father of Indian surgery is generally believed University, situated by the river Ganges in north India. to have lived around 600 BC [Figure 1]. However he has puzzled scholars regarding the period when he lived and Nagarjuna’s Upayahrdaya (500 BC) refers to Sushruta and practiced, with opinions ranging from 1000 BC to 1000 this takes him to a period before him which was around AD. According to Indian mythology he was the son of 2000 yrs ago. Further he is mentioned in both sage Viswamitra and a disciple of , Divodasa Mahabhasya of Patanjali and the Varttikka of Katyayana. Kasi Raja.[1] No other Sushruta is known except the medical writer who was the propagator of salyantantra. Hoernle places The ancient Indian epic, tell us about the Sage Sushruta at about 600 BC as he counts only 300 bones in Viswamitra and his relationship with Ram and his the body and on this ground, Hoernle believes him to brothers. The chronology of the epic is placed have lived before Atreya and Yajnavalkya and thus taking [3] somewhere in 1800 BC, so if Sushruta was actually the him to somewhere around 600 BC. son of the sage then he lived far earlier to the times he is commonly associated with. Another misleading aspect Also Johnston–Saint opined that the linguistic style of [4] comes from his own treatise, the Sushruta Samhita, in Sushruta belonged to the period of Buddha in 600 BC. which he mentions Lord who is described vividly However, Wise contended that the ancient form of in the , another Indian epic which is dated Sanskrit used in the Sushruta Samhita was prevalent in [5] somewhere in the 1300 BC. So it is possible that Sushruta the ninth century. The Bower manuscript, which was was of the race of Viswamitra as represented in the unearthed in the 1890 is probably the most authentic Mahabharata – Anushasan Parva chapter 4. document of ancient India was studied carefully by Hoernle and placed its origin to around 500 BC.[3] The Mythology takes us through the history of medicine in fact that Sushrutha’s name is mentioned in it puts him India. Brahma, the creator of the universe knew the basis in a period of between 600 and 800 BC. of Avurveda through meditation and passed it to Daksha Prajapati, who in turn taught it to the Ashwini brothers. In summary the figure 600 BC often mentioned in western literature as the life and times of Sushrutha is more empirical than historical. It is quite possible that his actual time predates it by many centuries.

V. K. Baskaradoss, R. M. Jose* Department of ENT, West Wales General Hospital, Carmarthen; *Department of Plastic Surgery, George Eliot Hospital, Nuneaton, UK

Address for correspondence: V. K. Baskaradoss, Department of ENT, West Wales General Hospital, Carmarthen, Wales, United Kingdom, SA31 2AF. E-mail: [email protected]

REFERENCES

1. Tewari M. Sushruta-The father of Indian Surgery. Indian J Surg Figure 1: Sushruta: a surgical genius of the ancient India 2005;67:229-30.

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2. McDowell F. The Source book of Plastic Surgery. Williams and following massive burns.[4] At present, reconstruction Wilkins Co: Baltimore; 1977. p. 65-85. often require surgery to take tissue from another 3. Hoernle AF. Studies in the Medicine of Ancient India. Part 1. Osteology or the Bones of the Human Body. Clarendon Press: location of a patient’s body. The stem-cell approach might Oxford; 1907. p. 109. eliminate the need for the additional surgery 4. Johnson-Saint P. An Outline of the History of Medicine in India. Indian Med Rec 1929;49:289. 5. Wise TA. Commentary on the Hindu System of Medicine. The advantage of a stem cell-based method in aesthetic Thacker: Calcutta; 1845. p. 1. surgery is that the implant from stem cells have the potential to provide a safer alternative to allogenic implants, and when used for wrinkle removal and breast augmentation, the implants will retain their size and Role of stem cells in Plastic shape better and longer than any other allogenic implant.[1] Surgery We still have a long way to go and more, longer term studies will be needed as many questions remain Dear Sir, unanswered. However, the present approach represents Stem cells have created a lot of interest and attention a giant leap in tissue engineering technology and it over the past few years, mostly for their potential in seems that the time is not far when the stem cell-derived treating variety of medical and surgical conditions. tissue would offer a better way forward for both reconstructive and aesthetic surgery. Recently, stem cell research has started exploring the potential use of a patient’s own stem cells for tissue Sanjay Saraf replacement and rejuvenation in plastic surgery. Department of Plastic Surgery, NMC Specialty Hospital, Dubai, UAE. E-mail:[email protected] Presently, there is a lot of concern about the currently available breast implants, which are marred by the REFERENCES tendency to form contracture, propensity to rupture, leak and possible interference with breast cancer 1. Alhadlaq A, Tang M, Mao JJ. Engineered adipose tissue from detection. The materials being used in facial plastic human mesenchymal stem cells maintains predefined shape surgery too, are less than ideal. The various allogenic and dimension: Implications in soft tissue tissue augmentation and reconstruction. Tissue Eng 2005;11:556-66. materials used in facial cosmetic surgery tends to lose 2. Patrick Jr CW. Adipose tissue engineering: The future of breast its size and shape over time. Even conventional soft and soft tissue reconstruction following tumor resection. Semin tissue reconstruction following cancer or trauma Surg Oncol 2000;19:302-11. 3. Casabona, Martin I, Muraglia A, Berrino P, Santi P, Cancedda R, surgeries can lose 40-60 percent of their volume over et al. Prefabricated Engineered Bone Flaps: An Experimental time. Model of Tissue Reconstruction in Plastic Surgery. Plast Reconstr Surg 1998;101:577-81. 4. Pellegrini G, Ranno R, Stracuzzi G, Bondanza S, Guerra L, The new technique of tissue engineering is expected to Zambruno, et al. The control of epidermal stem cells (holoclones) revolutionize various aspects in reconstructive and in the treatment of massive full-thickness burns with autologous aesthetic surgery. Reconstructive surgery could greatly keratinocytes cultured on fibrin1. Transplantation 1999;68:868- benefit from stem-cell generated natural tissue that 79. does not shrink or lose its shape.[1] Whereever large areas need reconstruction, like in head and neck cancers or breast cancers; it will be possible with stem cell Response to “Anatomy of an technique to take stem cells from the patient, grow them internet consultation” in vitro, and subsequently use this autogenous tissue for reconstruction.[2] Stem cells also offer the possibility Dear Sir, of prefabrication of flaps,[3] reconstruction of auricular My heartfelt gratitude to the association and to you for framework, articular condyle, vascularized bone keeping me on your mailing list. Though I retired 10 flaps,cranial bone defects and renewable source of years ago, I try to keep up with the new innovations replacement cells and tissues to cover raw areas and ideas by reading journals. I specially enjoy the Indian

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