Review Article International Ayurvedic Medical Journal ISSN:2320 5091

PLASTIC AND RECONSTRUCTIVE SURGERY IN AYURVED

Ahuja Deepak Kumar1 Mishra Vandana2
1
Dept of Shalakya Tantra, S. R. M. State Ayurvedic College, Bareilly, Uttar Pradesh, India
2
Practioner, Bareilly, UP, India

ABSTRACT
Sandhan karma as described by Acharya Sushruta is a very old science which can be
compared with the plastic surgery or reconstructive surgery in recent times. It is however very
difficult to say when the first reconstructive operation on mankind was performed. Sushruta
Samhita, which describes the ancient tradition of surgery in India, contains detailed descriptions
of teachings and practice of the great ancient surgeon Acharya Sushruta. He has written about
all the surgical diseases, their causes, types, prognosis and treatment, especially about the
wounds. There are several Siddhanta or basic principles of Sushruta which are at the root of
today’s surgery. Shashti-Upakrama is one among these principles. Shashti-Upakrama is the
sixty types of treatment described for wound. Sandhan-Upakrama is one of them. Dalhana
described the term Sandhana as unions of organs which are separated due to injury or trauma in
his commentary. Today Sandhan is at its advanced position in the form of plastic and
reconstructive surgery. But originally it was initiated with the Rhinoplasty operation performed
by Sushruta called as Nasasandhan. Besides this, Sushruta has also performed KarnaSandhan
(lobuloplasty) and Oshtha Sandhan. The aim of the study is to review the Sandhan-Upakram in
historical (vedic) and ayurvedic texts and compare it with the present era’s plastic and
reconstructive surgery.
Keywords: Sandhana karma, Plastic surgery, Reconstructive surgery, Nasasandhan, Ostha-
sandhan

INTRODUCTION Sangraha mainly deals with medicine

Plastic surgery is a medical specialty deals knowledge while Sushruta Samhita deals
with the repair, reconstruction or replace- mainly with surgical knowledge. Compli-
ment of physical defects of form or function cated surgeries like Caesareans, Cataract,
involving the face or other parts of body. artificial limbs, fractures, urinary stones,
The term plastic derived from Greek word plastic surgery (Sandhana Karma) proce-
Plastikos, meaning to mould. There are so dures including pre-operative and post-oper-
many Samhitas and Granthas those are ative treatment along with complications are
dealing with Ayurveda. Among them Cha- written in Sushruta Samhita , which are sur-
raka Samhita, Sushruta Samhita and As- prisingly applicable even in present time.
tanga Sangraha are the three main pillars of The plastic operation of ear (Otoplasty) and
Ayurveda. Charaka Samhita and Astanga plastic operation of nose (Rhinoplasty) are
 Ahuja Deepak & Mishra Vandana: Plastic and reconstructive surgery in Ayurved
described in Sutra sthana 16th chapter. Re- ras show them interest in learning Madhu
constructive plastic surgery is oldest type of Vidya. So they cut head of Dadyyancha and
surgery of the world. In older time, for giv- kept separate. Then they transplant the head
ing punishment to the prisoners of wars and of horse to the body of Dadhyancha and
making marks for unfaithful wives amputa- learn Madhu Vidya from them. After learn
tion of nose and cutting of ear lobule, was Madhu Vidya, they transplant his own head4.
done by kings. Surgeons were doing recon- Dakshya cut head and trunk of Chyavan.
structive surgeries for giving correction Ashwini kumaras performed the first plastic
them. The procedure of Rhinoplasty was operation to join them.5 According to Upani-
written in Sushruta Samhita which is almost shad, Ashwini kumaras also operated and
800 B.C. old literature. repaired the excised head of Yagyana by
References of Plastic and Reconstructive Rudra. Ashwini kumaras were doing both
Surgery in Vedas homo and hetero transplantations at that
Oldest references of Sandhan karma found time.
today even before Aacharya Sushruta, are of Concept of Plastic and Reconstructive
Vedic times. In Vedik era, science of Sand- Surgery in Ayurveda
han karma was also well developed. Ash- The origin of Ayurveda occurs from Vedas.
wini kumaras were the chief surgeons of It is also called fifth Veda. Ashwini kumaras
vedic period. There are so many examples of are knows as Dev Vaidya in Ayurveda. They
their work in the field of plastic surgery, have done excellent surgical work in Ayur-
surgery, Ophthalmology and orthopedic. veda. Rigveda is full of examples of their
Lord Shiva cuts the head of Ganesha in an- works. They operated the eyes of Reejashva.
ger and after knowing the truth and on re- They also implanted the teeth of Phushna in
quest they join the head of elephant to the his edentulous mouth. This knowledge of
Ganesha. This is oldest example of trans- Ayurveda descends to the earth by Ashwini
plantation which is well known to us since kumaras. Sushruta, people of Lord Dhan-
childhood as told by our mothers and vantari, has written Sandhan Karma (Plastic
grandmother in stories. Bispala, wife of king Surgery) in Sutra sthana 16th chapter. He
Khela, lost her leg in war. Ashwini kumaras elaborated Rhinoplasty for deformed nose,
transplant her leg by an iron leg 1. The lost plastic surgery operation for deformed and
part of body of Rishi Atri was re-joined by cut ear lobules, corrective surgical procedure
Ashwini kumaras. The body of Acharya for cleft lip, injured lips and cleft palate. In
Shyaba was cut into three parts. Ashwini the starting of 16th chapter, Acharya Su-
kumars rejoin the all parts and give him life shruta first describe the method of piercing
immediately 2. Beside the Rigved, Padampu- of ear lobule in infants for the purpose of
ran also have written examples of recon- decoration and giving protection from the
structive plastic surgery 3. Bhairav cut the graham badha.6 This method is also used in
head of Brhama and Dadhichi. Ashwini ku- children in present era. Often these ear lo-
maras rejoined their head. They also trans- bules, due to the use of heavy ornaments, get
plant the head of Yahnya. Dadhyancha was considerably expanded and ultimately split.
the master of Madhu Vidya. Ashwini kuma- Sushruta has described fifteen methods of

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 Ahuja Deepak & Mishra Vandana: Plastic and reconstructive surgery in Ayurved
joining these separated ear lobules.7If a per- 2. Utpala bhedyaka: Utpala bhedyaka type
son without ear lobule come to a surgeon, of Otoplasty is indicated when cut ear lobule
then surgeon should reconstruct the ear lo- is equal in size and shape and both are large
bule by taking a flap of skin from the cheek around.
region; with a pedicle attached to the donor 3. Vallooraka: When cut fragment of ear
side. 8The aim of keeping the skin flap at- lobules are small, round, equal in shape and
tached to the donor site with a pedicle to size, Valloorka type of Otoplasty should be
maintain the sufficient blood supply. By done.
doing such process, three purpose will be 4. Aasangima: Aasangima type of Otoplasty
solved. First there occur no complication, is indicated when proximal part of cut ear
secondly the organ will vitalize with sensa- lobule is larger.
tion and third, healing will be very soon. 5. Gandakarna: Simillarly when distal part
Same techniques with same manner are used of cut ear lobule is larger; this type of
in the present time. Otoplasty should be done.
Techniques for Sandhana Karma of Ear 6. Aaharya: This type of Otoplasty is suita-
lobes-Otoplasty ble when both the fragment of cut ear lo-
There are fifteen operative methods to rejoin bules are absent.
injured ear lobule-9 7. Nirvedhima: Nirvedhima type of Otop-
Nemi Sandhank lasty is indicated when both the fragment of
Utpala bhedyaka cut ear lobules are absent from the root. In
Vallooraka this type remaining part of Putrika (Tragus)
Aasangima is making base for surgery.
Gandakarna 8. Vyayojima: Vyayojima type of Otoplasty
Aaharya is indicated when one part of cut fragment is
Nirvedhima larger than other i.e. both are dissimilar.
Vyayojima 9. Kapata Sandhika : This type of Otoplasty
Kapata Sandhika is suitable when one fragment of cut ear lo-
Ardha Kappata Sandhika bule is longer from proximal side and
Sankhshipta second part is smaller.
Heen Karna 10. Ardha Kappata Sandhika : Simillarly
Valli Karna Ardha Kappata Sandhika type of Otoplasty
Kakaushthka is indicated when outer fragment of cut ear
Yasti Karna lobules is larger in dimensions
Among them 10 techniques are successful, Sandhana Karma of Nose (Reconstructive
last 5 methods are unsuccessful. Rhinoplasty)
Indications for different methods of After explaining the Otoplasty, Su-
Karna Sandhana10 (Otoplasty)- shruta elaborate the reconstructive Rhinop-
1. Nemi Sandhanka: This type of Otoplsty lasty in same chapter. He given indication
should be done when the both fragments of for nose either lost by disease or by
ear lobules are heavy and large in surface trauma/accident. The portion of the nose to
and also both are equal in shape and size. be covered should be first measured with a

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 Ahuja Deepak & Mishra Vandana: Plastic and reconstructive surgery in Ayurved
leaf. Then a piece of skin of the required surgery like planning, procedure and perfec-
size should be dissected from the living skin tion has its roots in Sushruta Samhita. So it
of the forehead or cheek, and turned back to can be concluded that the source of plastic
cover the nose, keeping a small pedicle at- surgery is Sushruta Samhita, the great In-
tached to the cheek. dian Ayurvedic surgical literature, from here
The part of the nose to which the it spread worldwide.
skin is to be attached should be made raw by REFERENCES
cutting the nasal stump with a knife. The 1. Rig Veda 1-116.95
physician then should place the skin on the 2. Rig Veda 1-117.14
nose and stitch the two parts swiftly, keep- 3. Padma Purana 2-66/212-215
ing the skin properly elevated by inserting 4. Rig Veda 1-116.13/9-117.17
two tubes of Eranda (the castor-oil plant) in 5. Rig Veda 1-158,4-6
the position of the nostrils, so that the new 6. Sushruta Samhita , Sutra Sthana 16/3 ,
nose gets proper shape. Kaviraj Ambika dutt Shastri (Hindi transla-
After this a powder of Pterocampus tion), vol.1, Published by Chahkhambha
santalenus (Lal Chandan), Glycerrhiza gla- Sanskrit Sansthan Varanasi.
bra (Mulethi) and Rasot (extract of Barberis 7. Ibidem 16/3
aristata) should be sprinkled over the oper- 8. Ibidem 16/9
ated area. Then the operated part should be 9. Ibidem16/10
covered with cotton pad or gauze pieces and 10. Ibidem 16/11
irrigated with sesame oil frequently11. 11. Ibidem 16/49-53
Ostha Sandhana Karma (Reconstructive 12. Ibidem 16/54
Surgery of Cleft Palate) CORRESPONDING AUTHOR
Injured lip or congenital cleft palate is also Dr. Deepak Kumar Ahuja
reconstructed by same method as discussed Dept. of Shalakya Tantra
above for Rhinoplasty in same chapter. The S.R.M. State Ayurvedic College
only difference is that in lip surgery there is Bareilly-243001 Uttar Pradesh, India
no use of stem of Ricinus communis Email: drdeepakahuja@yahoo.co.in
(Eranda naala). The Vaidya who get skilled
in these reconstructive surgery, become Raj- Source of support: Nil
vaidya i.e. who can treat the king12. Conflict of interest: None Declared
CONCLUSION
It is very difficult to say that when
exactly the first plastic operation was done
on man. Aacharya Sushruta has described
various reconstructive methods and different
types of procedures like taking a flap of skin
from the cheek region, with a pedicle at-
tached to the donor side.
If we observe carefully, then it is
found that, all the basic principles of plastic

85 www.iamj.in IAMJ: Volume 2; Issue 1; Jan – Feb 2014