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