KAPLAN’S CORNER THE BIRTHPLACE OF CLINICAL LASER SURGERY Isaac Kaplan The sick fund of Labour’s National Federation Provides medical services for most of Israel’s population, But, until nineteen fifty eight, a Plastic Surgery department didn’t exist, So, when asked to open one at the Beilinson hospital, I couldn’t resist And this I did in nineteen fifty eight, And although it would appear rather late, It was the largest, and remained so to date. Plastic surgery in Israel was still new And there was a lot that was still left to do. It was certainly beyond dispute That in reconstructive surgery we could contribute, As well as in the treatment of anomalies at birth, Where what we introduced had some worth. In the treatment of burns, we played a major part, What with the establishment of our burns unit from the start. It was the first of its kind in the state, And its contribution in wartime was especially great. It is worthy of note that in the Yom Kipur war, We treated all burns that occurred in the tank corps. The establishment of a Plastic Surgery hospital during the Vietnam war, Provided us with opportunities that we did not have before. Our experience there in hundreds of cases, Turned out to be the ultimate basis Because of which it was certainly beyond dispute That our work on cleft palates was of international repute In those days, cancer of the hypopharynx Was treated by excision of the cervical oesophagus and larynx. The oesophagus was then reconstructed by us With an operation that was performed with minimal fuss. Although we didn’t concentrate on competing with Venus, We did revolutionise the reconstruction of the penis. In hand surgery Polydactyle, Syndatyle and Macrodactyle were some Of the cases we treated besides reconstruction of the thumb It was abroad that Sacrococcygeal Teratomata in the newborn were treated Until the establishment of our department was completed. Laser surgery was pioneered from there, And hundreds of foreign surgeons were made aware Of its advantages, and where it should be used, In order to prevent it from being abused. It was there that the International Society for Laser Surgery was founded And its spreading of the gospel throughout the world abounded. All the above is extremely well recorded, 8
available at www.jstage.jst.go.jp/browse/islsm
That the publication of hundreds of professional articles afforded This was beside six books: two on Plastic surgery and four on the Laser Which confirms that that department was really a trail blazer. From that department tens of Plastic surgeons came out, An important achievement without a doubt. I might add, in conclusion, that we not only succeeded In pioneering Laser Surgery, which was sorely needed, But also to convince our skeptical colleagues that in reality Plastic Surgery was not a glorified beauty parlor, but a serious speciality.
GADGETS Isaac Kaplan At the risk of appearing too much of a bore, I should like to stress once more, That there are gadgets galore, That one can easily do without, If one knows what surgery is all about. For instance, “Fractionation” is a word That has never before been heard, And, to me, fractionation is an exaggeration, And, a surgeon who can operate, Doesn’t need to exaggerate, Because, as I’m sure you know, That, for thirty years or so, Without it and scanners, it is true to tell, I, and others, have done perfectly well. Now, “super-” or “ultrapulse” is another name, That can be ignored, just the same Because, they seem to have become outdated, Since, without them, people have operated. Now, in a previous paper I pointed out, What the ideal laser was all about, And, if to operate with it one is proficient, The laser itself will prove sufficient And you won’t need gadgets to help you out, If you know what surgery is all about...
THE CO2 LASER FOR TELANGIECTASIA Isaac Kaplan Emeritus Professor of Surgery And past incumbent of the chair of Plastic Surgery University of Tel Aviv The CO2 laser is the one to prefer For treating telangiectasia and spider nevi, when they occur. At right angles, into the vessel, one fires a single shot, KAPLAN’S CORNER
available at www.jstage.jst.go.jp/browse/islsm
At the power depending on the size of the spot. If, between one and two hundred microns are the size of the spots, The power should be between ten and twenty watts. The impressive part of this procedure is that The results of the treatment can be seen stat. Some tiny marks may be created, Where the skin is penetrated, But, with the first washing they disappear, While, since purpura does not appear, The skin remains perfectly clear. Now, as far as the treatment of telangiectasis goes, In familial telangiectasia of the mucosa of the nose, Which, is also, if you please, Called Osler-Weber-Rendu disease The CO2 laser has a special application, Because, it can avoid perforation When both sides of the septum are treated Because, only the vessels are depleted. The photographs below, Are intended to show, One- a typical case Of telangiectasia of the nose and face, And two- the first case ever treated And the treatment did not need to be repeated. This was over thirty five years ago, And, since then, all cases were treated so.
Before
Before
after
During
KAPLAN’S CORNER
KAPLAN’S CORNER THE CO2 LASER IN PODIATRY IN A MILITARY SETUP Isaac Kaplan and Jonathan Caplin I.K. was entitled to Sabbatical leave, So he spent it where other professors wouldn’t believe. There was a clinic belonging to the Israeli Defense Force, And, he thought that it would be a good idea of course, If a laser unit was set up there, to provide the excuse, To train Army doctors in the CO2 laser’s use. The commander of the Medical Corp was very cooperative, So, the laser unit soon became fully operative. And so, his leave was spent, Doing something, on what he was bent. This pleased the university no end, Because of the thousands of dollars they didn’t have to spend. Doctors from many specialties received instruction, And, in most cases, in sick leave there was a reduction. The specialties involved were Podiatry, Dermatology, General and Plastic Surgery and even Gynecology. Although other specialties are worthy of mention, To confine ourselves to Podiatry it is our intention, And, on ingrown toenails to concentrate, In order to be able to demonstrate, The special value the unit has, to treat, All sorts of pathology of the feet. To a soldier, an ingrown toenail is a problem par excellence, Because he cannot march and is looked at askance. In them the condition is by no means rare And it is believed to be related to the boots they must wear But also because of the lack of care. Anesthesia having been affected By local anesthetic being injected The nail, a millimeter or two from the ingrown part, Is incised with the laser at the start. Of the ingrown part having then been disposed, Leaving the underlying nail bed exposed. The exposed part of the bed is then vaporized, Which prevents it from having to be excised. If there is granulation tissue, it is vaporized too, And that is all one is required to do. Of dressing material, there should not be a waste, So the dressing applied is a matter of taste. One of us (I.K.), for instance, simply applied a bandaid to the toe, And told the patient that with a clean sock and comfortable shoe he could go But, he is first instructed, How future care should be conducted. Postoperative discomfort is mild indeed And for analgesics there is no need The days required for healing are relatively few, And the toe is then as good as new The soldier needs then have no compunction
9
KAPLAN’S CORNER In order to return to full function. The other, (J.C.) applied an ointment based on iodine Daily, until complete healing was seen. For over twenty years the unit has existed And the above treatment for ingrown nails persisted, Other methods of treatment are available, But we feel that this one is unassailable. In all, around twenty five thousand toes were treated
10
available at www.jstage.jst.go.jp/browse/islsm
And the same treatment was always repeated, Because, the condition being so common in the army, To change it, one is convinced would be barmy. Figure one shows a case that’s a typical one, And figure two, the same case when all is done. Figure three is immediately after treatment of a bilateral ingrown nail And figure four is to show that it heals without fail.
Fig. 1
Fig. 2
Fig. 3
Fig. 4
KAPLAN’S CORNER
available at www.jstage.jst.go.jp/browse/islsm
That the publication of hundreds of professional articles afforded This was beside six books: two on Plastic surgery and four on the Laser Which confirms that that department was really a trail blazer. From that department tens of Plastic surgeons came out, An important achievement without a doubt. I might add, in conclusion, that we not only succeeded In pioneering Laser Surgery, which was sorely needed, But also to convince our skeptical colleagues that in reality Plastic Surgery was not a glorified beauty parlor, but a serious speciality.
GADGETS Isaac Kaplan At the risk of appearing too much of a bore, I should like to stress once more, That there are gadgets galore, That one can easily do without, If one knows what surgery is all about. For instance, “Fractionation” is a word That has never before been heard, And, to me, fractionation is an exaggeration, And, a surgeon who can operate, Doesn’t need to exaggerate, Because, as I’m sure you know, That, for thirty years or so, Without it and scanners, it is true to tell, I, and others, have done perfectly well. Now, “super-” or “ultrapulse” is another name, That can be ignored, just the same Because, they seem to have become outdated, Since, without them, people have operated. Now, in a previous paper I pointed out, What the ideal laser was all about, And, if to operate with it one is proficient, The laser itself will prove sufficient And you won’t need gadgets to help you out, If you know what surgery is all about...
THE CO2 LASER FOR TELANGIECTASIA Isaac Kaplan Emeritus Professor of Surgery And past incumbent of the chair of Plastic Surgery University of Tel Aviv The CO2 laser is the one to prefer For treating telangiectasia and spider nevi, when they occur. At right angles, into the vessel, one fires a single shot, KAPLAN’S CORNER
available at www.jstage.jst.go.jp/browse/islsm
At the power depending on the size of the spot. If, between one and two hundred microns are the size of the spots, The power should be between ten and twenty watts. The impressive part of this procedure is that The results of the treatment can be seen stat. Some tiny marks may be created, Where the skin is penetrated, But, with the first washing they disappear, While, since purpura does not appear, The skin remains perfectly clear. Now, as far as the treatment of telangiectasis goes, In familial telangiectasia of the mucosa of the nose, Which, is also, if you please, Called Osler-Weber-Rendu disease The CO2 laser has a special application, Because, it can avoid perforation When both sides of the septum are treated Because, only the vessels are depleted. The photographs below, Are intended to show, One- a typical case Of telangiectasia of the nose and face, And two- the first case ever treated And the treatment did not need to be repeated. This was over thirty five years ago, And, since then, all cases were treated so.
Before
Before
after
During
KAPLAN’S CORNER
KAPLAN’S CORNER THE CO2 LASER IN PODIATRY IN A MILITARY SETUP Isaac Kaplan and Jonathan Caplin I.K. was entitled to Sabbatical leave, So he spent it where other professors wouldn’t believe. There was a clinic belonging to the Israeli Defense Force, And, he thought that it would be a good idea of course, If a laser unit was set up there, to provide the excuse, To train Army doctors in the CO2 laser’s use. The commander of the Medical Corp was very cooperative, So, the laser unit soon became fully operative. And so, his leave was spent, Doing something, on what he was bent. This pleased the university no end, Because of the thousands of dollars they didn’t have to spend. Doctors from many specialties received instruction, And, in most cases, in sick leave there was a reduction. The specialties involved were Podiatry, Dermatology, General and Plastic Surgery and even Gynecology. Although other specialties are worthy of mention, To confine ourselves to Podiatry it is our intention, And, on ingrown toenails to concentrate, In order to be able to demonstrate, The special value the unit has, to treat, All sorts of pathology of the feet. To a soldier, an ingrown toenail is a problem par excellence, Because he cannot march and is looked at askance. In them the condition is by no means rare And it is believed to be related to the boots they must wear But also because of the lack of care. Anesthesia having been affected By local anesthetic being injected The nail, a millimeter or two from the ingrown part, Is incised with the laser at the start. Of the ingrown part having then been disposed, Leaving the underlying nail bed exposed. The exposed part of the bed is then vaporized, Which prevents it from having to be excised. If there is granulation tissue, it is vaporized too, And that is all one is required to do. Of dressing material, there should not be a waste, So the dressing applied is a matter of taste. One of us (I.K.), for instance, simply applied a bandaid to the toe, And told the patient that with a clean sock and comfortable shoe he could go But, he is first instructed, How future care should be conducted. Postoperative discomfort is mild indeed And for analgesics there is no need The days required for healing are relatively few, And the toe is then as good as new The soldier needs then have no compunction
9
KAPLAN’S CORNER In order to return to full function. The other, (J.C.) applied an ointment based on iodine Daily, until complete healing was seen. For over twenty years the unit has existed And the above treatment for ingrown nails persisted, Other methods of treatment are available, But we feel that this one is unassailable. In all, around twenty five thousand toes were treated
10
available at www.jstage.jst.go.jp/browse/islsm
And the same treatment was always repeated, Because, the condition being so common in the army, To change it, one is convinced would be barmy. Figure one shows a case that’s a typical one, And figure two, the same case when all is done. Figure three is immediately after treatment of a bilateral ingrown nail And figure four is to show that it heals without fail.
Fig. 1
Fig. 2
Fig. 3
Fig. 4
KAPLAN’S CORNER
