PLASTIC SURGERY
INNOVATION DEFINES Plastic Surgery
Jerry O’Daniel, MD
P
lastic surgery is a specialty unique
amongst all the surgical specialties.
Plastic surgeons do not treat one
specific area of the body. They
incorporate basic principles that
apply across all specialties. Innovation has
been at the heart of plastic surgery since the
origins of the specialty. This history includes
innovative procedures and products, such
as microvascular surgery, liposuction and tissue expansion. 1
Innovations in plastic surgery are not limited to academic centers;
all plastic surgeons are willing and ready to seek creative solutions
to improve current practice and to solve difficult clinical problems. 2
In the 50 top-cited plastic surgery articles, almost half introduced
a new or modified surgical technique that considerably changed
clinical practice. 3
Innovation is defined as “an introduction of something new,
including a new idea, method or device.” 4 It is an improvement
to something that already exists. It is much more than just new
techniques and technology; a new idea, a new perspective, or even
a new question can be as valuable as a new device. 5 Innovation must
not be confused with invention, which is defined as a “discovery
or finding” that is developed after study and experimentation. 6 An
innovation requires implementation in a way that captures its value
(usefulness and profitability). 7 Examples of innovation include
the use of new devices in existing procedures, the introduction of
new procedures that use new devices, and using existing devices
in new procedures. 8 For example, the invention of the microscope
propelled innovation in the field of microsurgery, which ultimately
led to replantation surgery and free tissue transfer.
Most of the technology in plastic surgery is not rooted in plastic
surgery but is adapted technology from larger market specialties
such as cardiology and orthopedic surgery. Plate-and-screw fixation,
designed initially for orthopedic surgery, was miniaturized and
adopted for craniofacial rigid fixation. Hyaluronic acid, marketed
as Synvisc (Genzyme Corp., Cambridge, Mass.) was developed for
joint injections. Botulinum toxin type A (Botox; Allergan, Inc.,
Irvine, Calif.) was initially developed for the ophthalmology market
to treat blepharospasm. Finally, liposuction consisted of technology
adapted from gynecologists’ dilation and curettage cannulas. It is
certainly common for technology that is developed in one sector
to be adapted into other sectors, and certainly speaks to the keen
eye and creativity of plastic surgeons.
Thirty-five years ago, as a general surgery intern, I was exposed
to two plastic surgical innovators whose individual contributions
created the field of microsurgery and craniofacial surgery. These
chance opportunities set the direction of a most rewarding carrier
as a plastic surgeon. On the first occasion, I had the opportunity to
witness Dr. Robert Acland perform a microvascular jejunal free tissue
transfer to reconstruct the pharynx and upper esophagus to restore
oral lining and deglutition on a patient who had just undergone an
extirpation of an advanced head and neck cancer. Dr. Acland was
a pioneer who utilized the invention of the operating microscope
to propel innovation in the field of microsurgery, which ultimately
led to free tissue transfer. By taking the invention of the operating
microscope, Dr. Acland was able to help innovate a new surgical
specialty, and many of his original basic principles and instrument
designs are utilized today. This innovation has been widely adopted
by other surgical specialties including otolaryngology (head and
neck surgery) and orthopedic surgery and today microsurgical
free tissue transfer is routinely performed by thousands of surgeons
around the world to save lives and restore form and function to
millions of patients since.
In the same year, Dr. Paul Tessier was in Louisville to work with
Dr. Gerald Verdi to perform surgical correction of very rare and
complex craniofacial deformities of pediatric patients who had no
existing treatment options. Dr. Tessier was a French plastic surgeon
who pioneered the entire field of craniomaxillofacial surgery and
at that time was only one of a few doctors in the world capable of
successful correction of craniofacial deformities that resulted from
abnormal growth of the craniofacial skeleton. These deformities
affected the normal appearance of the face and skull and created life-
threatening increased intracranial pressure and airway obstruction.
This visit by Dr. Tessier was transformative as I was allowed to
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JANUARY 2019
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