1.
Introduction
Modern
plastic surgery practice contributes in management of huge health problems
either throughout providing surgical interventions or medical treatment. First
Known description of plastic surgery procedure was more than 5000 years ago,
when medical text from Ancient Egyptian Papyrus mentioned plastic surgery
reduction of broken nose and post-operative fixation by the linen rods, almost
in the same technique used today[1].800 years BC
Indian surgeon, Sushruta, first one who highlighted the nasal reconstruction [2].
Charak
and Sushruta work were originally in Sanskritthen translated 50 years later
into the Arabic language during the age ofAbbasid Caliphate and then
transmitted to Italy in Europe via intermediaries[4].
1stcentury BC, the Romans added their contribution in plastic surgery[3]. After World War 1 Gillies' McIndoe and Tommy
Kilner inspired the new plastic surgery modern techniques. Gillies were sent
near Basingstoke, to Rooks, down House, which became the official army plastic
surgery unit. McIndo founded a center named; Queen Victoria Hospital, for
management of Jew and facial disfigurements in East Grinstead, Sussex. Tommy
Kilner who innovated the cheek retractor and worked with Gillies in world war
first, went to Roehampton, and worked at Queen Mary's Hospital. All basics of
modern plastic surgery practice and concepts are attributed to their
generation, coming students after them, they were provided innovative ideas and
techniques.
The
scope of plastic surgery has been extended to include all human body, from hair
to nail interventions and all body layers management starting from the skin,
subcutaneous, muscle and bones reconstruction[5].
Now there is great diversity in the plastic surgery subspecialties including;
aesthetic, burn management, hand surgery, general reconstructive, microsurgery,
skin cancer, congenital anomalies, Cranio-maxillofacial, Oncoplastic and
non-surgical procedures for treatment of ulcers, bed sores and burns and for
aesthetic restoration. Plastic surgery principles are based on minute anatomy
and functional and aesthetic units' concepts. Each principle and concept is
serving for all sub subspecialty development and for getting better outcome
regarding the surgery and the skilled well-trained plastic surgeon. Surgical
applied anatomy, pathology, physiology, basic sciences, skills in surgery
design of flaps, grafts, microsurgery, replantation, tissue transfer, aesthetic
units, facial proportion, spirit of renaissance are fundamental to plastic
surgery specialty.
2.
Patient and Methods
We
designed questionnaire to ascertain the knowledge of three community sectors,
each one is 100 persons, about the scope of plastic surgery. The three sectors
are junior fresh graduated doctors, specialized - non-plastic surgery- doctors
and random 100 hundred populations' sample.
The
questionnaire designed in English and in Arabic languages, giving the targeted
study samples, the mostly practiced surgical and reconstructive procedures
list, and giving them 15 specialties list to choose from them. We targeted the
minds of three community sectors in two different countries cultures; in Egypt
and UK. So we did the same questionnaire with the numbers, 100, for each sector
in each country.
The
study groups answered the following question; who is the specialist from the
given specialties list, you will advise to treat each case of the given
procedures list.
We
requested from candidates of each study group, to choose first and second
choice.For the 1stchoice we requested from her/him to select the given number
of the specialty in A, and for second choice we requested from her/him to
select the given number of the specialty in B. Given specialties were:
Neurosurgeon, Maxillofacial surgeon, Plastic surgeon, Ophthalmologist,
Pediatric Surgeon, Orthopedic surgeon, ENT surgeon, General surgeon,
Dermatologist, Onco-surgeon, Urologist, Thoracic surgeon, GIT surgeon,
Gynecologist and Andrology Surgeon.
Questionnaire
was included detailed surgical procedures and interventions to ascertain the
knowledge of the surveyed sectors. Given procedures were about; burns
treatment, surgery for burns, hand problems congenital, hand surgery for cut
tendon, hand surgery for tendon transfer, hand surgery for swellings/tumors ,
hand surgery for arteries and veins, hand surgery for nerve, hand surgery for
bone, brachial plexuses congenital, nerve graft in extremities, congenital
anomalies of the cranium, congenital ear deformities, nasal fractures,
rhinoplasty, cleft lip/ palate/hypospadias, oropharyngeal reconstruction,
breast oncoplastic surgery, scalp lacerations, facial fractures, face lift,
thoracic wall reconstruction, abdominal wall reconstruction, trunk
reconstruction, surgery for bed sores, liposuction, aesthetic breast surgery,
tummy tuck, skin cancers, microsurgery, grafts, flaps surgery, perineum
reconstruction, penile surgery, vaginal agenesis, lower limb reconstruction,
laser facial rejuvenation, hair transplantation, tissue expansion, Botox,
filler and thread rejuvenations and vacuum/leech therapy for wounds. Questionnaire
was signed with mention of each person's profession and date of graduation, if
any, with statistical analysis for the survey data. Study was carried out
through questionnaire survey at Al-Azhar University and Ministry of Health,
Cairo, Egypt and Liverpool, UK.
3.
Results
The scope of
plastic surgery specialty in minds of general population, junior graduated
doctors and senior specialized non-plastic surgeons samples, was only 32%, 42%
and 62-79% orientation, in minds of the three studied sectors respectivelyFigure 1.
General
populations were aware only about aesthetic procedures and burn management
mainly. Of 100 persons in this group, 20% of this group was aware about
Onco-plastic breast surgery and the word of graft as it is plastic surgery
procedure.
Junior
graduated doctors were more aware than general populations by 10%. This 10 %
comes from their awareness by flaps and bed sores management. Where both
sectors were well oriented about aesthetic procedures more than hand,maxillofacial,
microsurgery, reconstructive or skin cancer. Table 1.
Senior
specialized non-plastic surgeons, was only oriented by 62-79% of plastic
surgery procedures. They were 30% and 20 % more ascertaining procedures of
plastic surgery, then general populations and junior graduated doctors.
The
surprising result was that: there is no difference between questionnaire
analysis of the two groups, junior fresh graduated doctors, and populations'
sample in both countries, Egypt and UK. While specialized non-plastic surgery-
doctors in UK were more oriented about the scope of plastic surgery by 17%, as
it was 79% of plastic surgery procedures.
4.
Discussion
This
study results show the limitation of plastic surgery procedures scope in minds
of general population, junior doctors and specialized non-plastic surgeon as
well.
The
scope of plastic surgery specialty in minds of general population sample,
junior graduated doctors and senior specialized non-plastic surgeons is under
expected. It was only 32%, 42% and 62-79% orientation in Egypt and UK, about
the scope of plastic surgery specialty in minds of the three studied sectors
respectively. This means less expectation of different specialties interaction
with plastic surgery specialty, and then may results in less optimum outcome in
health providing diverse services.
The
study shows different sectors orientations when, senior specialized non-plastic
surgeons, was oriented by 62-79% of plastic surgery procedures. 32% and 42% of
plastic surgery procedures were actual ascertained by general populations and
junior graduated doctors.
In
study conducted by Alan David in 2013, in South Africa, surveyed, the knowledge
of 33 house officers, about the scope of plastic surgery, showed
underestimation and limitation of their orientation about the diversity of
plastic surgery procedures to be only 36.4% in cutaneous malignancies, maxillofacial
trauma, and hand surgery [6].
This
study shows the 32% orientation, of junior doctors, but it carried on wider
scale, 100 personnel of junior freshly graduated doctors in Egypt and UK, and
also our study surveyed the general populations and specialized non-plastic surgery
senior doctors.
This
result raises a question about training of the undergraduate doctors in plastic
surgery specialty and the teaching of the curriculum of surgery which mainly
carried out by dominant role of general surgery department. This internship
training and curriculum teaching, might be in need for revisions as junior
doctors are the pivot point in providing primary health care and mainly exposed
for the decision of referrals for higher levels of care.
This
study also shows the general population underestimation for the specialty and
this comes with Gills et al
one in Australia [7].We believe in that; the
non-controlled media marketing has helping in formation of false specialty
practice image which is only limited for aesthetic surgery.
This
relative increase in orientation of non-plastic surgeon specialized doctors,
than junior doctors or general population groups, might be attributed to their
experience getting through practice and interaction within work environment.
The
more orientation of non-plastic surgeon specialized doctors in UK, about 79%,
than the Egyptian non-plastic surgeon specialized doctors, 62%, also raise a
question about the multidisciplinary team management of health problems and how
senior doctors think about interdepartmental co-operations.
This
study agrees with many other studies which have demonstrated under estimation
of the scope of plastic surgery specialty in minds of medical and non-medical
personals [8-10], but this study was carried out
on wider scale of 300 persons in each country, divided into three groups;
junior fresh graduated doctors, specialized non-plastic surgery- doctors and
random populations' sample.
Plastic
surgery deals with human body from hair to nails either for reconstruction or
aesthetic restorations. It interacts with Dermatology in treatment of facial
aging, laser therapy, and treatment of vitiligo by ultrathin grafting, and skin
treatments for rejuvenation and skin surgery.
It
shares orthopedic surgery in treatment of hand fractures, tendon transfer,
lower extremity complications, bone exposure, osteomyelitis and management of
trauma by reconstruction by local and free flaps.
Plastic
surgery contributes with Onco-surgery in flap reconstruction and microsurgery
for head and neck cancer, skin cancer, sarcoma and onco-plastic breast surgery.
Plastic
surgeon works and collaborates with orthognathic and Orthodontic for management
of primary and secondary cleft lip and nasal deformities and facial
disproportion of the bony skeleton of the face.
Plastic
surgery specialty has very wide contribution in Maxillofacial fractures,
tumors, facial palsy management and facial bones advancement, distraction and
setting back of lower Jaw.
Scalp
lacerations, scalp expansion and craniosynostosis and other congenital skull
deformities are managed by teamwork consists of plastic surgery, neurosurgery
and Craniofacial surgery.
Neurosurgeon,
Orthopedic are sharing plastic surgeon in management of carpal tunnel syndrome
and ulnar nerve entrapment in the hand.
Most
of reconstructive procedures for pediatric congenital anomalies as brachial
plexus, skull, ear, lip/ palate, velo-pharyngeal valve, hypospadias,
epispadias, congenital hand, chest wall and abdominoperineal deformities are
given hand by plastic surgeon either as primary operator, secondary operator or
within multidisciplinary team management. Nasal aesthetic and reconstructive
nasal surgery and remodeling are one of the famous procedures for plastic
surgery specialty with great collaboration with ENT specialty in its management
and also both specialties are sharing experiences in management of
velo-pharyngeal incompetence, pharyngeal, laryngeal and external ear
reconstruction.
General
surgery is also a primary training for all plastic surgeons to provide them
strong surgical bases for generalized principles and lifesaving procedures,
burn management in general and abdominal wall structure reconstruction.
Urologists
are always interested in experience exchange with plastic surgeons for the
reconstruction for the external urinary tract problems, as well as male genital
system reconstruction, as regard Phaloplast ,furniar gangrene and penile
augmentation. Genital reconstruction also makes plastic surgery reconstruction
interact with anthologists for penile augmentation, and with gynecologists for
vaginal reconstruction in cases of vaginal hypoplasia or agenesis.
It
is really difficult to find any surgical specialty doesn’t share plastic
surgery specialty in some procedures as first hand or second hand giving
support, e.g. Many medical and non-medical career specialized persons may not
imagine the relation between cardiac surgery specialty and plastic surgery
specialty, but in fact there is a great collaboration and interaction between
both, in cases of treatment of chest wall congenital deformities, wounds
management by reconstruction or treatment after chest wound dehiscence, or
graft donor sites complications.
Aesthetic
surgery also interacts with many other specialties as dermatological surgery,
ENT and ophthalmology. For example, one of the commonest aesthetic procedures
is blepharoplasty and it is practiced by both plastic surgeon and
Ophthalmologist.
Aesthetic
surgery training deals with undesirable aberrant qualities of normal body
structures, including liposuction, hair transplantation, facial aesthetics,
rhinoplasty, aesthetic breast surgery, tummy tuck, thigh lifting, arm lifting,
and all over facial and body reshaping by surgery or non-surgical
interventions. Plastic surgery has very wide diversity and modern techniques,
getting every day update challenge and development, so the learning curve is
relatively slow. Some surgeon is confined to certain subspecialty practice and
some is practicing the entire specialty.
Plastic
surgery specialist is able to help patients in very diverse and unique ways,
and at the same time he has the ability to focus his practice either on cold
aesthetic and reconstructive cases, on traumatic excited unpredicted trauma, or
to practice academic research and has the option to have his own private career
practice5. At the end of the day plastic surgery specialty provides surgeon
flexibility in life style not allowed in other surgical specialties.
5.
Conclusion
Human
medical and surgical health problems aren't one man show management. Mandatory
collaboration between all specialties with each other is the key of success in
health problems to get better outcome. Plastic surgery specialty is neither
only aesthetic practice nor burn management as it is in the minds of random
population, junior doctors and even specialized non-plastic doctors. But its
scope extends to include hand surgery, general reconstructive, microsurgery,
skin cancer, congenital anomalies, cranio-maxillo-facial, oncoplastic and
non-surgical procedures for treatment of ulcers, bed sores and burns and for
aesthetic restoration.
research article 