Month: January 2016

Recently one of our surgeons had the opportunity to visit the Hunterian Museum in the Royal College of Surgeons in London, UK. This two-part blog piece describes three of the wide range of exhibits that our readers should find very interesting.

Historical Perspective on Surgery

The Hunterian Museum began as the personal collection of John Hunter, an 18th century London surgeon and anatomist. Hunter and his brother, William, advanced the practice of surgery by stressing the teaching of anatomy based on observation as opposed to accepted tradition. John Hunter’s collection included body parts donated by some of his patients at their death so he could study the results of the operations he had performed on them. A number of these specimens exhibit tied off syphilitic aneurysms (weakened ballooned-out arterial walls caused by the sexually transmitted disease which was rampant in 18th century Europe).

Prominently displayed near the museum entrance is the skeleton of the “Irish Giant”. Charles Byrne, who stood 7 feet 7 inches tall, earned his living by charging people to gawk at him at a time when the average British man was only 5 feet 5 inches tall. Word reached Byrne that John Hunter desired to display his skeleton in his museum after the “Giant” passed away. Wanting to foil Hunter’s plans, Byrne got his friends to agree to bury him at sea in a lead coffin. The collector learned of Byrne’s efforts, bribed the “Giant’s” friends, and obtained the body when Byrne died at the age of 22. And so his skeleton shares a display case in the Hunterian museum with a short stature skeleton that suffered from abnormal bone fusion.

Recent Medical Study with the “Irish Giant”

Physicians now know that the “Irish Giant” suffered from a pituitary tumor that caused the over–production of Human Growth Hormone. In 2008 Charles Byrne’s skeleton was used in a medical study when DNA was extracted from two of his teeth. He was found to have a mutation of the AIP gene that causes a condition called Familial Isolated Pituitary Adenoma. Only 200-300 people carry the mutation and most of them live in the same Irish county where Byrne was born. A number of them were found to be his relatives.

The Royal College of Surgeons Today

Medical ethics have changed since the day of John Hunter and no doctor today would advocate grave robbing (although archeologists still dig up pyramids and ancient burial grounds). There have been recent calls to honor Charles Byrne’s wishes and bury his skeleton at sea. The Royal College of Surgeons has rejected these demands as they feel that as science and medicine advances, the “Irish Giant” may still have more to teach. So the man who earned his living letting people stare at him continues to be the center of attention after his death.

The October 7, 1794 issue of the Gentleman’s Magazine published a letter to the editor from one reader identified only as B.L. reporting on a nasal reconstruction operation performed in India, then a British colony. This letter, written by a non-physician and published in the non-medical GQ Magazine of the day, revolutionized the practice of rhinoplasty.

European Nasal Reconstruction

Until that time, nasal reconstruction in Europe was performed with an operation introduced in 1597 by an Italian professor of medicine from Bologna, Gaspar Tagliaccozzi. Using Dr. Tagliaccozzi’s method of rhinoplasty, a doctor would make two parallel incisions in the upper arm to partially cut away the skin. In this procedure that we now call “delay,” the doctor would then insert linen gauze under the skin flap. Then the rhinoplasty patient was kept on bed rest for 14 days.

Once the skin flap adjusted to its reduced blood supply, the next stage of surgery was performed. In this second phase of rhinoplasty, the part of the skin flap closer to the face was cut free leaving the base attached near the elbow. The free edge was attached to the patient’s face, and the patient’s arm and shoulder then had to be immobilized in a leather vest with multiple straps.

After another three weeks, the skin at the arm was cut free and the new nose trimmed and shaped. By this point the patient had a new reconstructed nose, but at the cost of a now frozen shoulder.

Indian Rhinoplasty

The case report from India described a “bullock-driver with the English army in the war of 1792” who had his nose and arm chopped off while he was a prisoner of war. After a year without a nose, the former prisoner, named Cowasjee, went to a brickmaker who recreated his nose using skin from his forehead.

Initially, a wax nose pattern was made, then reversed, flattened and traced on patient’s forehead. The cuts were made along the traced line and the forehead skin flap was rotated 180 degrees and attached to the nose leaving a narrow bridge of skin intact between Cowasjee’s eyebrows.

After 25 days, the skin bridge was divided and the patient was kept on bed rest for four to five days. The donor site on the forehead was allowed to heal on its own, leaving a mirror image of a nose on the forehead.

What became known as the Indian rhinoplasty very quickly became the operation of choice for nasal reconstruction in Europe and America, in spite of the usual chauvinistic attitudes of European doctors. Patient down time was minimal and the shoulder complications were avoided.

Interestingly, whereas most Europeans seeking rhinoplasty had lost their noses in duels or battles, the Indian operation had been developed more than 2000 years earlier when the punishment for adultery was cutting off the offender’s nose. As we rarely see duelers seeking restoration of a lost nose, removal of skin cancers is now the most common reason people seek nasal reconstruction.

Modern Nasal Reconstruction Surgery

Today at the Plastic Surgery Group we perform nasal reconstruction using a modernized version of the Indian operation. Some of the technical aspects of the early rhinoplasty operation do help plastic surgeons today, while modern aesthetic techniques help us to achieve today’s beautiful results in nasal reconstruction. However, please note that we don’t advise patients to seek medical advice from brickmakers, even though nasal reconstruction apparently originated with some in their profession two millennia ago.

Rapid weight gain and rapid enlargement of the abdomen or breasts during pregnancy or puberty can result in stretch marks. Stretch marks, also called striae, are areas of damaged skin where the deeper skin layer, the dermis, has been thinned. We do not claim that we can completely eliminate stretch marks, but we have seen a 50% decrease in the appearance of stretch marks through the treatments we offer.

Here at the Plastic Surgery Group of Memphis, our aestheticians offer two types of skin care treatments to reduce the appearance of stretch marks. Both techniques are nonsurgical and are aimed at stimulating collagen production in the dermis to fill in the stretch marks. These treatments can work on both new and mature stretch marks.

How does ResurFX reduce stretch marks?

One stretch mark treatment we provide uses a non-ablative laser called ResurFX to stimulate collagen and elastin production in the dermis. If the stretch marks are pink or brown, the abnormal color can be removed with IPL (Intense Pulsed Light). ResurFX stretch mark treatments take 15-30 minutes and are very tolerable with the use of a topical numbing cream.

The area will be mildly swollen for a few hours and will appear pink for about a day, but the patient can return to normal activities and work immediately. Maximum stretch mark reduction requires 3-5 sessions spaced 3-4 weeks apart. For additional information, please visit our stretch mark treatment supplier’s website.

What is the Rejuvapen Microneedling System?

Another option to reduce stretch marks is the Rejuvapen Microneedling System. Microneedling is a therapy growing in popularity for treatment of stretch marks, fine wrinkles and mild skin looseness. The 9 micro needles make precise invisible micro perforations through the epidermis into the upper dermis to stimulate collagen production. Again, topical numbing cream helps to minimize discomfort during this treatment of stretch marks.

After a session, most patients will feel as if they have a moderate sunburn for 2-24 hours. Maximum stretch mark reduction requires 3-6 treatments every 4 weeks. For additional information from this stretch mark treatment supplier, please visit the Rejuvapen website.

Begin Stretch Mark Treatment Today

Although the weather in Memphis is at its coldest right now, swimsuit season will be here before you know it, so now is the time to start reducing stretch marks. Make an appointment with our laser and skin care nurse, Carla Mask, to find out which stretch mark treatment can make you more confident in the appearance of your skin this year.