Plastic surgery of the face in Byzantium in the fourth century

Oribasius was an eminent Byzantine physician who lived in the fourth century. His greatest contribution to medical history was his anthology of all important medical works of his time, entitled Synagogue Medicae. This complete medical encyclopedia of his era consisted of more than 70 volumes. A significant part of this work has been lost. What remains, however, allows us to glimpse the surprising richness and knowledge of ancient medicine. Chapters 25 and 26 of the original 42nd book of Oribasius are of specific interest to the plastic surgeon, because they deal with reconstruction of facial defects. Reconstructive procedures for defects in the eyebrows, forehead, cheeks, nose, and ears are described. Advancement flaps are suggested for the reconstruction, and recommendations are made about debridement, flap design, and thickness of flaps. It becomes obvious from these texts that Greek, Roman, and Byzantine surgeons had the knowledge and experience to perform several reconstructive procedures of the face and nose. This knowledge was passed to the Arabs and then to Western Europe in the 15th century and became part of the foundation for modern plastic surgery.