Microsurgery is a young speciality, being not more than forty or fifty years old. It is the surgery of the structures too small to be seen by the human eye. The magnifying loupe or the operating microscope is the microsurgeon’s constant companion, operating without them is a near impossibility. Microsurgery was born sometime in the 1970s and has grown by leaps and bounds since then. Part of the credit of its success story goes to the increasing realisation of its indispensability and the wonders it can perform in the modern medical world. The uses of microsurgical procedures keep on increasing. It started with trauma reconstruction – repairing vital structures like blood vessels and nerves – and went on to complex wound management with exposed bones, avulsed skin and muscle, torn tendons and damaged vessels and nerves. Microsurgery provided a way out to deal with such devastating injuries, the likes of which were considered unmanageable yesterday. With the increasing complexity of traumatic wounds that surgeons were called upon to manage, the dependence on this new specialty increased.
The use of microsurgical techniques soon extended to not only dealing with complex trauma but also reconstructing body parts which were afflicted by cancer and hence had to be cut out. Cancer reconstruction boomed – anything was possible, reconstructing cheeks, jaws, necks, gullets, oesophaguses, nose, ear…the list grew. Microsurgery was rapidly becoming the proverbial rising sun. Microsurgeons were enthused by the wonderful results their efforts gave in fields of trauma reconstruction and cancer reconstruction, and they extended the scope of microsurgery to include other things. Birth defects, obstetric injuries of the upper limb, facial paralysis, scalp avulsions followed; the list seemed endless.
Then came microsurgical replantation and the world shook with its implications. Severed limbs, digits and other appendages could be re-attached to the body with microsurgical techniques. These included severed fingers, avulsed ears and cut penises (a shameful punishment meted out to cheating husbands by angry wives or jilted lovers). The success stories of such replantations were lapped up by the media and splashed across the country so that soon microsurgical replantation of severed limbs became a household name. Referring physicians from far flung health centres would pack the cut limb nicely and refer the patient to the nearest plastic surgeon with the hope that the limb would be saved; and more often than not, they were.
Plastic surgeons were still basking in the glory of limb replantation when an evolutionary bomb exploded. The first hand transplant was done in a hospital in France. The medical and lay press went crazy. Till now transplantations were heard of only in the viscera – kidney, liver and probably pancreas – but a hand! The hand is a complex structure and the success of the surgery depends as much on the structural integrity of the replanted organ as its functional viability. It was a painstaking surgery, joining each blood vessel, tendon and bone of the hand – but the results were fantastic. Microsurgery became the most rapidly growing specialty in the world. Surgeons started to vie with each other to perform the most difficult surgical feat possible.
Recently when reports emerged from the same country about a successful partial face transplant being accomplished, it set me thinking. Here we are putting back severed body parts, replacing destroyed hands and faces by someone else’s and performing all sorts of surgical feats which only a hundred years ago would have been deemed impossible, or at the very least miraculous. Skip a few more centuries backwards and it would have been unthinkable, a figment of imagination or probably a part of folklore or religious mythology; speaking of which I am reminded of Ganapati.
All of us have heard about the fantastic tale where Lord Shiva cuts off the head of Ganesha in a fight only to learn later from his mourning wife Parvati, that Ganesha is her son. A repentant Shiva promises the furious Parvati to make her son whole again and instructs his followers (or ‘Gana’) to severe the head of the first living being they find and bring it to him. The first living being happens to be a baby elephant and Shiva ends up putting an elephant’s head on his son Ganesha’s torso. The child grows up thus with a pendulous trunk and ivory teeth and is later celebrated as a leader of the ‘Ganas’ of Shiva – Ganapati. A fantastic tale? Religious mumbo-jumbo? Figment of imagination?
So it is but natural that when I started looking for a symbol or a mascot for microsurgeons, or a God they could pray to for the success of their surgical ventures, Lord Ganapati should pop into my mind. He is lovingly referred to as ‘Bappa moriya’ (My father) and, according to me, is the first instance of a successful microsurgical venture performed in the world by Lord Shiva himself.