The Application of Principles of Reconstructive Surgery in Urban Architectural Interventions
The following sources were chosen to explore various facets of reconstructive surgery in the attempt to identify principles that may be applied to an architectural intervention on a derelict urban site. While the sources deal exclusively with medical practice, the chosen formal example employs general surgical analogies in an architectural restoration project.
TECHNICAL PRINCIPLES
Source: McGregor, A.D and McGregor I.A. Fundamental Techniques of Plastic Surgery and Their Surgical Applications, Tenth Edition. London: Churchill Livingstone, 2000.
Description: This book presents basic plastic surgery techniques destined for use by general surgeons with little formal training in the field. The book is divided into two parts. The first outlines the basic techniques of wound management, the Z-plasty, free skin grafts, flaps and additional techniques. Part two focuses on surgical applications, such as limb trauma, radiation injury, and pressure sores.
Excerpt: "The Z-plasty is a procedure which involves the transposition of two interdigitating triangular flaps. The name derives from the 'Z' shape seen when the three limbs of the flaps are drawn out on the skin. Transposition of the flaps has several effects, of which two have special relevance:
1. There is a
gain in length along the direction of the common limb of the Z.
2. The direction of the common limb of the Z is changed.
...When the Z-plasty
is used to release a contracture, the common limb, i.e. the central limb of
the Z, is positioned along the line of the contracture. The size of each of
the angles of the Z is 60º, a compromise figure which has been reached
as a result of experience… Constructed in the way the two triangles together
have the shape of a parallelogram with its shorter diagonal in the line of
the contracture, its longer diagonal perpendicular to it… The common
limb of the Z, being along the line of the contracture, is under tension.
Its ends spring apart when the interdigitating flaps are raised and the fibrous
tissue band responsible for the contracture is divided. The springing apart
of the divided contracture results in a change in the shape of the parallelogram,
and the triangular flaps become transposed, the contractural diagonal lengthens
and the transverse diagonal shortens." (pp.21-22)
SOCIAL ASPECTS
Source: Interplast Official Website. Available online at: http://www.interplast.org
Description:
Interplast is a humanitarian organization whose goal is to provide free reconstructive
surgery and educational training in developing countries. A primary goal of
the organization is to facilitate sustainable models for health care around
the world. The organization has established a web-based medical interchange
network that allows doctors to share advice about case studies.
Excerpt: "Interplast uses technology in innovative ways to provide medical
education and tools for collaboration with surgeons in developing countries…
Interplast Grand Rounds is an innovative web-based program that allows doctors
and surgeons from the poorest parts of the world to come together with expert
medical professionals from the United States and Canada in a 'virtual teaching
hospital' to make cyber-rounds together. Physicians from developing nations
post digital photographs and case summaries of complicated cases requiring
reconstructive surgery, and experts from around the world log on and offer
insight and advice into available surgical techniques and follow-up care.
For example, within hours, or even minutes, of posting an especially challenging
case, a surgeon in Nepal can receive valuable feedback from colleagues in
Peru, Zambia or North America.
While doctors in the United States have helped many of our foreign partners
solve particularly difficult cases, often it is the doctors in other developing
countries who have ideas that are more pertinent within the context of a developing
world medical infrastructure. Sometimes the way a doctor in Zambia would help
a given Bangladeshi patient might be more relevant than advice from his or
her American or Canadian counterpart. Interplast Ground Rounds helps bridge
the digital divide and empowers our partners to share their information, expertise
and opinions."
ETHICAL ASPECTS
Source: Agich, G.J. and Siemionow, M. "Until They Have Faces: The Ethics of Facial Allograft Transplantation". Journal of Medical Ethics. 2005;31: 707-709.
Description: This article discusses the negative portrayal of facial allograft transplantation (FAT) in the media and the ethical and surgical justifications for its use. The authors address the subject of social identity and the human face and the psychological impact of severe facial deformity.
Excerpt: "As the French National consultative ethics committee has pointed out, the face is not just a static mask, but an organ of expressivity. As an expressive organ, the face provides an affective and communicative presence to others. Despite the proliferation of electronic and other more impersonal forms of communication, face to face communication remains the paradigm of communication, Because of its expressive function, the face carries with it important symbolic, social, and psychological significance that cannot be overlooked… FAT for reconstruction of severe facial deformity is not a cosmetic procedure undertaken for vanity; neither is it a facial identity swap (as in the film Face/Off starring John Travolta and Nicholas Cage), nor does it extend the goal of transplantation from legitimate life saving to questionable life enhancement.
Worries about the misuse of the procedure overlook the fact that the candidates for the procedure are individuals with severe facial deformities that make their presentation in normal social settings extremely difficult, if not impossible… They long for an agreeable face that will not elicit revulsion or avoidance. Improving patient welfare is a traditional obligation of medical ethics…" (pp. 707-708)
FORMAL EXAMPLE
Atelier Cinquième
Architects, Katsuhiro Miyamoto
Surgery House (Zenkai House), Takarazuka, Hyogo
Source: Hladik,
Murielle. "Surgery House (Zenkai House), Takarazuka, Hyogo"
L'Architecture d'Aujourd'hui. vol. 338. janvier-février 2002.
Description : An earthquake-striken house is transformed into a workshop using structural techniques inspired by surgical procedures.
Excerpt: "This former two-storey family dwelling… stands on a long lot and -subsequent to the contemporary intervention - its old lightweight wooden structure has been crossed by a clearly readable metal structure painted white. The operation, which consisted in underpinning the old structure, was akin to surgery - the analogy extending to dismembering and dissection. Before the new steel parts could be inserted, carpenters had to cut away the old wooden parts of the construction; only then could the specialist steelworkers undertake their delicate and unusual task." (p.84)
