PLASTIC SURGERY: PAST, PRESENT, FUTURE

Background Plastic surgery has been an independent branch of surgery for a relatively short period of time. And yet its beginnings stretch back as far as 600 BC. The history of plastic surgery can be best reviewed through the development of flaps, which have always been a very useful tool in the hands of plastic surgeons. They started as local flaps with random blood supply. The first breakthrough came after the First World War, with the development of the tubed pedicle flap by Sir Gilles. Later on, the accumulation of knowledge about blood circulation, resulted in the development of axial (deltopectoral, inguinal) flaps, which enabled the transposition of large amounts of tissue. Conclusions The next important (perhaps most important) turning point was the development of free flaps. The "Ljubljana school" was an active contributor in this segment. Nowadays much care is taken to minimise the morbidity of the donor site for free flaps. Perforator and chimeric flaps are being used. There have also been advances in preoperative diagnostics and postoperative monitoring of flaps. The future of plastic surgery is probably a tissue engineering, that is transplantation by microsurgical technique of patient's own tissues developed in vitro. This will probably mean the use of different multipotent cells. There is also an intense research of the effect of a host of tissue factors and mediators on the circulation and survival of flaps. Most surgical procedures will become minimally invasive.