Filed under: Knowledge
A colleagueÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s husband recently underwent a surgical procedure known as the ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œIndian FlapÃƒÂ¢Ã¢â€šÂ¬? for reconstructing his nose. This was the first time I have heard of this 1000 year old technique, and on digging around the web a little, I finally found an article that sheds light on the history and the details of this wonderful procedure.
The first successful transfers of human tissues to heterotopic sites were done via what are now referred to as “pedicle” flaps. Such transfers are never even transiently deprived of their blood supply (2). The pedicle flap principle was initiated largely by trial and error at the time of its inception. In about 600 B.C., the Indian surgeon Susruta first described many types of facial flaps, including how flaps from the cheek, for example, could be used to repair the nose (3).
He wrote “…. first the leaf of a creeper, long and broad enough to fully cover the whole of the severed or clipped off part, should be gathered; and a patch of living flesh, equal in dimension to the preceding leaf should be sliced off from the region of the cheek.” The “Indian flap,” or forehead reconstructive rhinoplasty, was introduced later and performed near Delhi from 1000 AD until the 20th century by the same family–members of the brickmaker caste.
The technique was a treasured family secret: a daughter-in-law would be allowed to watch and assist, but a daughter, who might subsequently marry and take the secret outside the family, was prohibited from observing the procedure. Throughout the operation, the patient would be sitting upright to minimize blood loss, and prior to cutting the flap, a handkerchief would be briefly tightened as a tourniquet around the neck to visualize the congested veins of the forehead which would be included in the flap.
The contemporary use of the “Indian flap” for nasal reconstruction testifies to the practicality and success of a procedure which was first developed in the pre-Christian era. It appears to have taken centuries for the principle and the procedure to travel from its origin in India to Europe, where use of the technique was first documented in the fifteenth century (2).
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