2687 2687 2688 2688 Skin is the largest end organ, covering the body's entire exter- 2689 2689 nal surface. Together with its derivatives, including hair, nails 2690 2690 and sweat glands, it forms the integumentary system. The skin 2691 2691 serves a number of functions that are critical for survival. It 2692 2692 provides a protective barrier against mechanical, thermal and 2693 2693 irradiation (ultraviolet) injury and infection. It also plays a role 2694 2694 in homeostasis by preventing fluid loss and regulating tempera- 2695 2695 ture. As the primary interface with the external environment, 2696 2696 it acts as a sensory organ and also produces vitamin D. Hence 2697 2697 restoration of the skin is essential even if the underlying struc- 2698 2698 tures await delayed reconstruction. 2699 2699 2700 2700 2701 2701 ## TABLE 47.1 A selection of key advances in the history of plastic surgery innovation. 2702 2702 2703 2703 2704 2704

Year	Surgeon	Nationality	Innovation
c. 1800 BCE	–	Ancient Egypt	Wound care techniques
c. 600 BCE	Sushruta	India	Local flaps for nasal reconstruction
c. 25 CE	Celsus	Rome	Local flaps for lip reconstruction
c. 1000 CE	Al-Zahrawi	Spain	Introduced catgut sutures and developed numerous surgical instruments
c. 1400 CE	Branca	Sicily	Distant (arm) flap for nasal reconstruction
1789	Desault	France	Recognition of the importance of definitive wound debridement
1854	Hamilton	USA	Concept of flap 'delay' with the distant cross-leg flap
1862	Wood	UK	Concept of axial pattern flaps with the pedicled groin flap (Figure 47.1)
1889	Manchot	Germany	Cutaneous arterial supply using cadaveric arterial injection studies
1894	Dauriac	France	First description of a pedicled muscle (rectus abdominis) flap
1896	Tansini	Italy	Breast reconstruction using a pedicled musculocutaneous latissimus dorsi flap
1912	Carrel	France	Nobel Prize for the development of vascular anastomosis and its application to organ transplantation
1916–1917	Filatov and Gillies	Russian Empire and UK	Tubed pedicled flaps and concept of 'waltzing'
1954	Murray	USA	Nobel Prize for the first renal transplant between identical twins
1968	Cobbett	UK	Free toe-to-hand transfer
1973	Daniel and Taylor	Australia	Free groin flap to foot