Indian Journal of Plastic Surgery Medknow Publications on behalf of Indian Journal of Plastic Surgery ISSN: 0970-0358 EISSN: 1998-376x Vol. 36, Num. 2, 2003, pp. 134-137

Indian Journal of Plastic Surgery, Vol. 36, No. 2, Dec, 2003, pp. 134-137

History

History of Nagpur plastic, reconstructive & maxillofacial surgery unit: 1st plastic surgery department in India

Kale SM

Department of Plastis & Maxillofacial Surgery, Govt. Medical College, Nagpur
Correspondence Address:Department of Plastis & Maxillofacial Surgery, Govt. Medical College, Nagpur

Code Number: pl03030

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It gives me great pleasure to kick off the ′History Series′ of the IJPS. Everybody is proud of one′s heritage and I am no exception. I take pride in saying that I belong to the 1st Plastic Surgery Department in India, which was started by Professor C. Balkrishnan. I still remember the 1st conference of A.P.S.I. that I attended so enthusiastically trying to talk to the great masters assembled there, introducing myself and telling them I belonged to Nagpur. I could see the love and affection in their eyes which sparkled with the mention of Nagpur. Most of them told me, ′Sunny I also belong to the same Department′. How proud I was! I am greatly honored to have this golden opportunity to present the history of my Alma Mater, i.e. 1st Department of Plastic and Maxillofacial Surgery in India, at Nagpur. I am thankful to all my teachers and all seniors who were associated with this Department for contributing to this article by remembering good old things, and giving their blessings for this article.

The teaching and art of modern plastic surgery in our country is recent, but the plastic surgery or lq?kVu ′kY; fpfdRlk as it was called in ancient times was mastered and taught here in India. Some 2500 years ago, mention about this surgery can be found in Rigveda and Atharvaveda. Sushruta′s work is well known and he is rightly called the Father of Plastic Surgery.

Modern Plastic Surgery in India is post 2nd world war in origin. There were a few British Maxillofacial Injury units and a special mention must be made of Mr. E.W. Peet. There were a few Indian surgeons from the army in this unit. They later on went to England to receive formal training. Dr. C. Balkrishnan was one of them. In 1947, he went there as a Government of India scholar and worked with Professor T. P. Kilner and Sir Harold Gillies. In June 1949, his training at Stoke Mandiville Hospital, Aylesbury, Buckinghamshire was completed. In 1950, he came back and joined as a Lecturer in Surgery at G.M.C. Nagpur. In 1951, he was promoted as Reader in Surgery after Dr. H. N. Dubey left Nagpur.

As a senior surgeon of the unit he was doing all the work independently, which included General surgery, Thoracic surgery, Closed Mitral Valvotomies, Neurosurgery, Orthopaedics; but about 50% of total work was Reconstructive Plastic Surgery.

He was also working hard at the administrative level for getting a separate Department of Plastic Surgery. In 1953, he wrote to the Government, but neither his request for special grants nor a separate Department, was granted.

In 1955, Dr. B. K. Rank, an Australian Plastic Surgeon came to India and stayed at Nagpur for two weeks. He reported to the Government of India the high quality of work being done at Nagpur, and the need to develop it further by starting a separate Plastic Surgery Department. The Australian Government had offered a very handsome grant and the state Government also needed to contribute towards starting a separate Plastic Surgery Institution, but it could not materialise due to problems at the Government level, and the Australian grant was sent back.

In 1955, there were about five Plastic Surgeons in India and the need to start an Association was felt. B. K. Rank, backed the idea and said, "Even The Australian Association of Plastic Surgeons had only 5 founder members". In December 1956, at Indore, Dr. R. N. Sinha moved the resolution and a committee was formed under chairmanship of Dr. P. V. Menon from Madras with R. N. Sinha as convenor. In December 1957, at Nagpur, during the A.S.I. meeting, Plastic Surgery section of Association of Surgeons of India was established and was inaugurated by none other than father of Modern Plastic Surgery, Sir Harold Gillies, a day written in Golden letters. It had seven members:

Dr. R. N. Cooper 1st President
Dr. C. Balkrishnan 1st Vice President
Dr. R. N. Sinha Founder Secretary
Dr. M. Mukherjee Founder Member
Dr. R. N. Sharma Founder Member
Dr. N. H. Antia Founder Member
Dr. Hivedia (E.N.T. Specialist, Bangalore) Founder Member
Sir Harold Gillies stayed at Nagpur for two weeks and operated cases and taught the trainees.

Though the seeds were sown way back in 1951, the dream of this great visionary materialized in 1958, when the 1st independent Department of Plastic Surgery was established at Nagpur, with Dr. C. Balkrishnan as Professor and Head of the Department. He was to formulate a syllabus not only for M.Ch. Plastic Surgery course, but also for occupational therapy and physiotherapy courses. He created the posts of Occupational Therapist and Physiotherapist, Dental Surgeon, Reader in Anaesthesia, Speech therapist, Photographer, Laboratory Technician, Stenographer and Clerk, to be exclusively working for the Department.

This unit was upgraded by the Government of India as the first and only upgraded Department of Plastic Surgery in the country. In 1959, Sir Harold Gillies again visited Nagpur and soon after Dr. B. K. Rank (Australia) also visited.

In 1960 the Department was working as a large unit of excellence and all the posts were filled up. There were 47 beds (27 - female and children and 20 - male). The M.Ch. course started on 15th December 1960. In the 1st batch, 4 trainees were selected from all over the country. They were 1) Dr. C. R. Sunderrajan (Madras) 2) Dr. Mrs. Usha Luthra (Delhi) 3) Dr. R. P. Mishra (Lucknow) 4) Dr. C. S. Vaidya (Nagpur). One additional trainee, Dr. M. S. Pathak, joined soon.

In 1961, Dr. J. L. Gupta joined the Department as a Reader after coming back from U. K. There used to be Monday and Thursday O.P.D. and six days in a week O.T. Work was going on in full swing. In the opinion of Dr. J. L. Gupta at that time the unit′s work was ′Excellent, one of the best′. In 1963, Dr. J. L. Gupta left to start a Department of Plastic Surgery at Safdarjang Hospital in New Delhi.

During the 1960 - 66 period, about a dozen trainees were trained who started different centers all over the country. Prominent among them were Dr. Sam C. Bose, Dr. L. K. Sharma, Dr. A. S. Gupta, Dr. Lucas, Dr. Venkatswami, Dr. S. N. Sharma, Dr. Ranganathan, Dr. S. R. Sivramkrishna. Dr. C. Balkrishnan was also offered Colombo aid for development but due to administrative problems it could not come through.

Dr. C. Balkrishnan innovated many operative techniques though he did not publish them;
1) He gave a classification of cleft lip and Palate, which is recognized, as the Nagpur Classification.
2) Triple wedge technique for cleft lip repair.
3) Two types of vomer flaps for complete unilateral and bilateral cleft lip and Palate.
4) Toe joint transfer for T. M. joint ankylosis.
5) Pull out shoelace knot and vertical mattress suture for anterior urethra formation.
6) Cheek skin buccinator mucosa flap for upper eyelid reconstruction.
7) Acromioscapular sandwich flap for reconstruction of facial defects.
8) Fascia lata sling pharyngoplasty for cleft Palate.

Recently, there has been some interest in the Nagpur Classification of CL-CP, hence, I am putting it on record to avoid further confusion:

Group I : Cleft of Lip
Group I(A) : Cleft of Lip with Cleft of Alveolus
Group II : Cleft of Palate Alone
Group II(S) : Submucous Cleft of Palate
Group III : Cleft of Lip and Palate
The side of cleft was mentioned as (R) for right, (L) for Left and (RL) for bilateral.

Great Units are remembered not only for their great academic or clinical achievements but also, or more so, for their organizational feats. These may lay bare some of the unusual characteristics of the great men behind these feats. I remember ward 8 of GMCH, where all our cleft lip palate patients would be admitted. No relatives were allowed inside the ward. On admission, the relatives would be dispatched home with the assurance that they will be informed by post at discharge or if required. There was absolute cleanliness and discipline in the ward. All beds and side tables were equipped with materials for that individual patient. Now, it so happened once that Dr. C Balkrishnan′s own child suffered appendicitis. Dr. C. Balkrishnan insisted on admitting the child to ward 8 and got the surgery done. During postop period, as was the rule, the poor child′s mother Dr. P. K. Devi, who was Professor in Gynecology and Obstetrics at the same institute, was not allowed to enter the ward. The rules were so strictly followed that Dr. P. K. Devi eventually took Discharge Against Medical Advice only to be able to meet her child!

In 1966, when work was in full swing, Dr. C. Balkrishnan got an opportunity to organize another unit at P.G.I. Chandigarh. On 16th May 1966, Dr. C. Balkrishnan and his wife Dr. Devi left Nagpur after a happy and fruitful stay of 16 years.

Dr. L. K. Sharma, who was trained here and was pool officer then, was appointed as Reader and Head of the Department. He continued the same pattern of work with 2 units, the other being managed by Dr. C. S. Vaidya. About 15 students were trained under him.

The clock clicked as usual, the years flew by and again there was time for change. On 1st September 1989, Dr. C. S. Vaidya retired and Dr. S. M. Kale, i.e. the author, took over the second unit. On 1st June 1991, Dr. L. K. Sharma also retired leaving all the burden of a huge amount of clinical work and postgraduate teaching on my humble shoulders. I was overwhelmed with the sheer quantum of work and the legacy of this 1st monument of modern Plastic Surgery in India, with no help what so ever.

I was alone, without a Professor to help me in difficulty and without a Lecturer to give any assistance, with just 2 postgraduate students and occasionally appointed residents. I knew that I must do everything myself. I braced myself up to the best of my capabilities and started work practically doing surgery five days a week and O.P.D. twice a week. The number of surgeries per year remained just a shade below when three of us were there. About 14 students have been trained by me. The sheer hard work took its toll without my realizing it. I had to undergo a coronary artery bypass in 1997, but fortunately was soon back on my feet and started all the work again after just 2 months. In 2002, my first breather came with Dr. Surendra Patil joining as Lecturer to share my burden, and since then things are a little better.

The unit still lacks full facilities for craniofacial work and formal Microsurgery, which we have started to do very modestly now. But things need to be improved. Basic facilities and working conditions need to be improved, which is not happening because of apathy. Are we going back to the days of C. Balkrishnan, when he was battling to start a Department? We are still battling to keep it alive and well. I have great faith in God. I hope the night will end and soon there will be dawn. Winter will give way to spring, so that flowers will again bloom in the Department and it will reach the height that it should, being the first and the best at that time. It will again become one of the best Department of Plastic Surgery in India.

Copyright 2003 - Indian Journal of Plastic Surgery

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