NEW DELHI (Sputnik) — An Indian doctor has revived a 500-year-old surgical procedure, opening up new possibilities in the field of plastic surgery. Dr. Nitin Mokal, a Mumbai-based plastic surgeon was faced with a tough challenge having to create a nose for a girl born without one.
Doctors had already tried twice to construct a functioning nose on the face of Komal using the forehead flap technique before the desperate 18-year-old approached Dr Nitin. After realizing that the technique would not work in the case of Komal, Dr. Nitin decided to refer old scientific literature to dig out a possible remedy. He subsequently decided to adopt a technique that had been abandoned centuries ago. The technique, namely the Tagliacozzi procedure of nasal reconstruction or the Italian method, was pioneered by Shushruta, also known as the father of surgery and later mastered by Italian surgeon Gaspare Tagliacozzi.
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After Komal and her family gave their consent, Dr Nitin partially severed a flap of skin from Komal's arm and attached it to her face near the place where the nose was to be constructed. In this procedure, the flap of skin is not completely severed so that it does not start to decay. The patient could not move from the position unless the skin graft was successful. When the skin graft was successful after a month, the arm was detached from the face and the grafted skin was given the shape of a nose. He then inserted two reeds or tubes, to ensure the nostrils didn't heal closed, rubbed the new nose with an abrasive powder and dressed it in a clean cloth, which irritated it and caused it to start healing.
"This particular patient had congenital absent nose with loss of bone and skin architecture. She was operated at the district level by local surgeons without any result. This also caused damage to the locally available skin. This was the reason I thought of using a medial arm tube pedicle flap, which has relatively better color skin match, " Dr Nitin Mokul told Sputnik.
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Dr Nitin said he carried out the surgery for free, but convincing Komal and her family for the time taking surgery was a challenge.
"The family members had already exhausted their financial resources on the two previous surgeries. Ours is a government set up where I am the unit in charge and work for free. I managed to convince the patient and motivated her for the staged surgeries," he said.
Dr Nitin is of the opinion that ancient surgical practices are a treasure trove of knowledge and are still relevant. They just need to be supported by modern equipment like quality suture material, quality antibiotics and medicines that improve blood circulation.
