Healing Wounds The Stitchless Way

[Music]

friends

let us begin with a question

would you like any one of you to have

an injection in your ear

or maybe if i would say that you have a

cut in your ear

or stitches around your ear

i i’m sure this very question has made

some of you very uncomfortable it is so

and now if i say that well your damaged

ear can be repaired without a single

stitch around your ear how would you

like that

i’m sure you’re surprised

let me tell you it is possible

i am dr shapir indoorwala i am an eat

surgeon

with 40 years of very active surgical

practice

i am the winner of the prestigious aoi

award for our research on fascia

and i am the pioneer of stitchless ear

surgery

well friends

acute infection of middle ear

is the commonest cause

of childhood infection known to mankind

we have a caseload of 709 million cases

every year

fortunately they respond well to medical

treatment

but

not all

some of them have

their ears severely damaged they get a

hole in the eardrum or a perforation

and this needs to be repaired

we have 310 million cases

who needs this repair at the moment of

time

the perforated eardrum causes deafness

it causes

pain in the ear and recurrent past

discharge from the ear you cannot

neglect this if you neglect it over a

period of time it causes permanent and

irreversible deafness

the damaged ear is repaired by

a fascia craft

there is a loss of tissue in the damaged

eardrum and this is replaced by a fascia

craft

now what is a fascia graft let’s look at

this

if you look at any part of your body it

is covered with skin

it’s very clearly seen over here

under the skin we have a layer of fat

and under the fat we have a flat

connective tissue which is called as

fascia

the flat connective tissue under the ear

is fascia

it’s called a skin under skin or it is

also called as a second skin

this fascia

is composed of soft fibers and elastic

fibers

the properties of elastic fibers and

soft fibers are completely different

and different parts of the body

is covered with the same facial but the

proportion of elastic fiber and soft

fibers changes and the properties of the

facial from part to part of the body

changes

it’s something like your hand

if you look at the skin of your hand it

is taut

it is tough

it is without hair and it’s very

sensitive to touch

look at the back of your hand it is

hairy

it is soft it is supple

and it is very sensitive not to

touch but temperature

in the same way fascias have different

properties it’s the same fasia but

properties are different

surgeons across the world repair damaged

eardrum by taking an incision on the ear

something like this

which is about five centimeter long

and then

they will reflect the ear forward

and make uh

and collect fascia from the

from under the skin from around the ear

and on deeper dissection they would make

a bed for the fascia

leave asia over there

and close the surgical wound

this standard surgical practice has

three serious downsides

if you can avoid

a cut around the ear it causes a

because it causes a lot of pain

scarring second thing is

because they use fascia from around the

year which has a greater tendency to

shrink

and this shrinkage causes recurrent

perforation we will see how this

shrinkage causes recurrent perforation

let’s see if this is the drum

if this is the drum

and if this black thing is a hole in the

drum

and we put

this facia to close that drum it’s a

fascia which has been put to closer drum

unfortunately this will shrink

if this is what is going to happen you

are going to bound to get those black

holes looking staring back at you again

and that is definitely

unacceptable

at the best

the standard surgical procedure has 90

percent success rate

and lastly

it takes about an hour’s time to

accomplish this surgical procedure

the three downsides of standard surgical

procedure needed to be addressed for

merited reason

if you can avoid scar or cut around the

ear it would be greatly helpful because

it will be causing less pain

greater acceptance to the patient

if we can use

some

other tissue which will not shrink

this 90 can jump two hundred percent

theoretically

and lastly

if we can reduce the time for surgery a

lot more patients can be addressed i

just told you that we have 310 million

cases across the globe to address

innovations are only possible if you

have compulsions and ground realities

working together

the compulsions of standard surgical

procedure led us to think about it and

after a lot of thinking we came to a

conclusion that the fascia from lateral

aspect of the from the outer aspect of

the thigh

is

much better at tissue to be used because

it has a high content of collagen or

elastic fibers

this is just a theory this is what we

thought about after this we thought

about after doing a lot of research

this theory had to be put to practical

challenge

how do you do it

we were completely at loggerheads we did

not know what to do

we looked

at all possible avenues and options

available to us we had no animal labs

with us

we had no equipment with us

and the most important factor our

colleagues didn’t believe in us at all

so we were alone people

looking at how to go around

after a lot of research further

we came to the conclusion that the

fascia of dogs

and fascia of human being have quite a

bit of similarities so we can try

this procedure on dogs and see what it

works

and believe me it was again a big

challenge to get the dogs because

street dogs are difficult things

if you put them in captivity they park

the whole night out i had to keep these

dogs in captivity for 20 days

and no neighborhood would allow me to

keep this 20 dogs for 20 days

barking the whole night out

so we had to get to a farm we had to

create an artificial a temporary

operation theater over there and we did

this experiment it took us a huge amount

of effort though i’m telling you in very

short having got these things

done we could establish for with

certainty that fascia from outer aspect

of thai

shrinks significantly less

look at this graph

now i will have to explain you this a

little bit this up over here and this up

over here that is first row and third

row

are the fascia taken from

high

and fascia taken from around the ear

they have been cut to a standard size of

10 mm by 25 mm

we had seven dogs like that in this

particular set of experiment

we have

we collected graft from them we cut them

to this particular size and all of them

were implanted again in the same dock

after five days we re-operated this dog

and collected the fascia again and the

second line is the fascia off from the

lateral aspect of the thigh after five

days and this

is fascia from the around the ear after

five days

look at it it’s obvious

the fascia from lateral aspect of the

thigh has maintained its rectangular

shape and has shrunken slightly but look

at the fascia from around the ear

it has become roundish it has lost its

rectangular shape and some of them

particularly the first one has shrunken

significantly

now if this was what was to happen in

the year this would cause perforation

there is nothing else that can happen

when we were doing this experiments and

my passion for repair of ear drum

perforation was known to my patients

it was at that time

for the first time that the lady luck

smiled at us

she came in the form of a lady one of my

lady patient had a perforation

which was operated four times before

without luck

she was tired of her ears

she approached me and she knew

everything about the experiments and she

said that i want to be your first

patient to do this

this was unbelievable to us i never knew

that i could get a live human

who would say that all right i submit

myself to you

well

again long thing cut short we did the

surgery but after a lot hell of a lot of

precautions and cautions we did that

surgery and for next 20 days i was on

tender hooks i was restless

i would call up her up almost twice a

day asking her how was she and she would

always say i’m fine

and i wouldn’t believe that she’s

absolutely fine how can that be so

after 10 days i said i want to see you

anyway

just meet me

and yes she was absolutely fine

and after 20 days my dear friends she

had her ear drum perforation sealed

closed we had soon after that as soon

after would mean six months down the

line another patient coming the same way

that i know of that patient you do the

same thing for me also

we did it and again it worked

and now we were getting more and more

confident and

sure that this is a doable thing the

animal experiments

made it very clear that the fascia

shrinks

from the lateral aspect outer aspect of

the thighs significantly less

and so it can be used

this experiments changed us completely

now we would do surgery from directly

inside the ear we would not cut make any

cuts around the ear

we would use fascia from outer aspect of

the thigh

and we would

have

no problems

in terms of time because

taking fascia from here and doing

surgery from here would be two different

side two different people can be working

simultaneously on the same patient

our surgical time dropped down from one

hour to 20 minutes

this resulted obviously in our patient

accepting our surgery very well because

they had very little pain

our success rate jumped from 90 to 98

and our operation time came down from

one hour to 20 minutes a saving of

40 minutes

this obviously has an immense

repercussion

on the fact that if we have 310 million

cases to be operated upon and if we all

do that by a standard procedure we have

31 million cases to be re-operated

obviously because of failure

and if we have 40 minutes of time saving

per patient

we have 226 million surgeon hours

226 million

assistant hours and 226 million

nurse hours which can be saved

this is tremendous

our surgical experience further went on

and we had one downside about it and it

wasn’t very amusing downside we realized

that

most of the colleagues

found it very difficult to work from

within the canal they were very

unwilling to change

since the teachers don’t change the

students don’t adapt to the new

techniques

that’s

the way we find

the world around us today

by now we have done more than 10 000

cases

they do extremely well we get patients

coming from across the country for this

particular procedure

particularly we get patients from

aviation industry because pilots are not

allowed to fly if they have a perforated

ear

nor are they allowed to fly if they get

the rear terms repaired by standard

procedure

they have now no choice but to get their

eardrum repaired by this procedure so

they have absolutely choiceless

situation

well my dear friends

it’s a brilliant way of doing

the repair of ear drum perforation

it is considerably less painful

extremely effective and very quick

nobody thought of stitch lesser surgery

we thought about it

we believed in what our thoughts were

our colleagues called us crazy

we worked over

it we developed it

and it worked

all of you

have brilliant sparks in your dreams

do you believe in the idea that you have

do you have an idea do you believe in

that idea

and do your colleagues call you crazy

if these three things that is having an

idea one

believing in that idea that’s important

and your colleagues calling you crazy

then develop it

work over it

and you will be the next dead speaker

thank you very much