Millard and Gillies’ 8th Commandment of Plastic Surgery: “Thou Shalt Not Do Today What Thou Canst Put Off Until Tomorrow”

by Or Friedman, MD
Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical, affiliated with the Sackler Faculty of Medicine
Tel-Aviv University, Tel-Aviv, Israel


Millard reported on his mentor Sir Harold Gillies’ “ten commandments of plastic surgery” in 1950, codifying a set of principles encompassing practical, technical, and ethical axioms to guide the reconstructive efforts of plastic surgeons [1] (Table 1).

Rohrich et al., revisited those commandments and described their practical application during our daily practice [2]. We would like to highlight each principle with a resource from PRS Global Open that demonstrates its use.


8. Thou shalt not do today what thou canst put off until tomorrow.

This is a favorite of mine. Encapsulating the concept of timely definitive treatment following reflection and setting up the best possible conditions for success. Since most cases in plastic surgery are not immediately life-threatening events, this commandment should be one of the first things to pop to the reconstructive surgeon’s mind. 

Microsurgical Lower Extremity Reconstruction in the Subacute Period: A Safe Alternative” by Dr. Margaret Starnes-Roubaud, et al. could be used to demonstrate this idea while tackling the commonly cited approach to lower limb salvage set by Dr. Gudina’s work.

The authors review 51 consecutive lower limb salvage cases form a single center and compare several endpoints based on time of definitive reconstruction. The idea behind the study is that by proper damage control, wound management, and recipient site preparation, definitive reconstruction can be achieved even in the subacute period. This is an exciting concept that stands in contrast to the classic 72-hour timeframe Dr. Gudina advocated. I would encourage you to critically read the paper both papers as a critical thinking exercise as well as a clinical reference.  

PRS Global Open case reports are a great source for challenging plastic surgery cases and breaking them down to the “ten commandments” may help consolidate our “plastic” approach and reasoning.

References:

  1. Millard DR Jr. Plastic peregrinations. Plast Reconstr Surg (1946) 1950;5:26–53.
  2. Rohrich RJ, Timberlake AT, Afrooz PN. Revisiting the Fundamental Operative Principles of Plastic Surgery. Plast Reconstr Surg. 2017 Dec;140(6):1315-1318.3.
  3. Starnes-Roubaud MJ, Peric M, Chowdry F, et al. Microsurgical Lower Extremity Reconstruction in the Subacute Period: A Safe Alternative. Plastic and Reconstructive Surgery Global Open. 2015 July;3(7).

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