以下内容转载于中华整形外科杂志
本期向大家推荐阅读"An Updated Definition of Plastic Surgery"[Li Q, Wang W, Zan T, et al. An updated definition of plastic surgery [J]. Ann Plast Surg, 2022, 89(6): 593-594. DOI: 10.109 7/SAP.0000000000003328.]。该文由中国整形外科专家李青峰教授携手来自中国、美国、瑞士、日本的7位学者共同撰写，以"Editorial"的形式刊登在Annals of Plastic Surgery 2022年第6期。
此处略去主体内容946字。
具体定义：整形外科，又名整形与重建外科、整形美容外科等，是对各类先天性和获得性(包括创伤与疾病等)的组织缺损、畸形和功能障碍进行修复、重建，对各类体表肿瘤进行诊治，并通过各种手段改善、增进与美和衰老相关的人体形态和功能的一门外科学科。
主要涉及：人体体表器官、皮肤、软组织、神经、肌肉、骨骼系统和相关的内脏器官等。
治疗手段主要包括：组织修复、组织移植、组织再生和体表器官再造等外科方法，以及声光电、药物、细胞、基因和生物材料、生物医学工程等技术和方法的应用。
主要治疗目的：治愈病患，使伤者不残、残者不废，让缺憾者健康，让健康者更自信。
新的定义不尽臻至，期待同行们的进一步完善，也期待能为青年医师解惑，为整形外科发展助力。
以下内容为原文
来自：2022年12月整形外科年鉴(Annals of Plastic Surgery)第89卷第6期
An Updated Definition of Plastic Surgery
Li, Qingfeng MD, PhDa; Wang, Wenjin MD, PhDa; Zan, Tao MD, PhDa; Xiang, MengPing MD, PhDa; Pu, Lee L. Q. MD, PhDb; Schaefer, Dirk J. MD, PhDc; Ohjimi, Hiroyuki MD, PhDd
Abstract
Modern medicine tends to provide comprehensive medical services based on disease or pathological features. As a result, the overlap between plastic surgery and other surgical departments greatly deepened. What was exclusively done by plastic surgeons are nowadays frequently practiced by other surgeons as well. Thus, generating confusion as to whether plastic surgery is an independent subject or a tool. Therefore, in this new era of modern medicine, it is necessary to reconsider the definition of plastic surgery.
Thanks to ceaseless innovation, plastic surgery has attained impressive achievements throughout the years, especially the 2 Nobel Prize-winning breakthroughs, kidney transplant and transplantation immunity.1,2 Plastic surgery, however, has long been bereft of a defined scope of practice and cries out for a comprehensive definition that can cover the entire range of activities performed in this era when medical services and administrative regulations have changed drastically. Here, we attempt to offer an updated definition of plastic surgery to embrace new challenges and boost future development. In
1597, the Bolognese Gaspare Tagliacozzi (1545–1597),3 founder of plastic surgery, pictured the treatment goal: plastic surgery is the art devoted to “restore what nature has given and chance has taken away. The main purpose of this procedure is not the restoration of the original beauty, but rather the rehabilitation of the part in question”.4 Davis (1919), in his book Plastic Surgery—Its Principles and Practice, defined “the field of plastic surgery extends from the top of the head to the sole of the foot”.5 Gillies (1920) briefly outlined reconstructive surgery and aesthetic surgery by describing the former as an attempt to restore the individual to normal and the latter to surpass the normal.6
Converse (1964) laid stress on the morphological restoration of plastic surgery and professed that “Because of the special nature of plastic surgery, it is largely concerned with form, as is implied in the term plastic”. For McCarthy (1990), plastic surgery is concerned with both the repair of deformities and the correction of functional deficits. Furlow (1992) was also concerned about the confusing use of “plastic and reconstructive surgery” by other specialties and concluded that “plastic surgery is surgery done by plastic surgeons” who were trained and equipped with “broad experience in surgical techniques in many parts of the body”.7 Mathes (2006) defined plastic surgery as a problem-solving specialty where plastic surgeons deal with skin and its contents with no specified anatomical areas.8 Likewise, Neligan (2018) highlighted the uniqueness of plastic surgery as it is not confined to an organ or system. Nor is it linked to a disease.9
None of these descriptions, however, can cover all the current activities performed in the field. Some of them center merely on the reconstructive part, like those presented by Tagliacozzi, Converse, McCarthy, and Mathes. Some of them, contended by Davis, McCarthy, Furlow, and Mathes, portray no definite anatomical boundaries. The descriptions from Gillies and Neligan are conceptual and intangible, failing to offer solid guidance for practitioners striving for excellence in the plastic surgery domain.
Such a dearth of an accurate and inclusive definition has given rise to a bunch of challenges and adversities in recent decades. Modern medicine tends to provide comprehensive medical services based on disease or pathological features. As a result, the overlap between plastic surgery and other surgical disciplines substantially increases. The fact that plastic surgery does not have its own disease spectrum and pathological characteristics can diminish recognition of the specialty. For instance, in some medical communities, hypospadias has been allocated to urology; oral surgeons are considered to be more specialized in cleft lip and palate. In addition, postburn deformities, for many, fall within the scope of burn surgery. Therefore, plastic surgeons face the challenge of developing new areas of practice while facing areas in their traditional practice being occupied by other specialties. Such is the current situation of plastic surgery and the reason why many specialists are concerned.
Administrative regulations also pose great challenges to the development of the discipline. Health care regulators in many countries define the scope of treatment based mainly on the definition of the discipline together with anatomical regions and pathological features, and the insurance companies follow the same suit. The health care regulations also impose stringent restrictions on cross-disciplinary treatment. Consequently, such innovations have become difficult for modern plastic surgeons. It is now unlikely for a plastic surgeon to apply for a cross-disciplinary program, for example, uterine or bladder transplantation, as most ethics committees may regard this undertaking as the territory of gynecologists or urologists. Likewise, the medical administration may not support this kind of practice for similar reasons. This landscape certainly frustrates trainees and practitioners in plastic surgery.
In response to the lacuna and attendant difficulties and changes in health care regulations, ethics, and community perceptions about seeking medical care, we endeavor to give an updated, comprehensive illustration of plastic surgery. A well-defined medical discipline is expected to entail at least 4 components: scope of practice, anatomical areas, therapeutic options, and treatment goals. Below presents our updated version: Plastic surgery is a specialized branch of surgery that has evolved along the 2 major strands of reconstructive plastic surgery and aesthetic plastic surgery. The anatomical regions incorporate all external appendages, skin, soft tissues, nerves, and musculoskeletal system, along with relevant internal organs. Plastic surgery deals with congenital or acquired abnormalities and functional impairment as well as a myriad of aging-related concerns and aesthetic concerns with both surgical procedures and nonsurgical management (such as cellbased therapies, drug therapy, and photoelectric devices) to improve function, physical appearance, the quality of life, and even psychic well-being of patients and ordinary people.
(参考文献略)
中文翻译：
整形外科的新定义
现代医学倾向于提供基于疾病或病理特征的全⾯医疗服务。因此，整形外科和其他外科部门之间的重叠⼤⼤加深。如今，整形外科医⽣专门做的事情也经常被其他外科医⽣实践。因此，在整形⼿术是⼀个独⽴的主题还是⼀个⼯具上引起了混乱。因此，在这个现代医学的新时代，有必要重新考虑整形外科的定义。
由于不断的创新，整形⼿术多年来取得了令⼈印象深刻的成就，特别是两项诺贝尔奖得主肾脏移植和移植免疫。1,2然⽽，整形外科长期以来⼀直没有明确的实践范围，并要求有⼀个全⾯的定义，该定义可以涵盖这个医疗服务和⾏政法规发⽣巨⼤变化的时代所进⾏的所有活动。在这⾥，我们试图提供整形外科的最新定义，以迎接新的挑战并促进未来发展。
1597年，整形外科创始⼈博洛尼亚GaspareTagliacozzi（1545-1597）描绘了治疗⽬标：整形外科是致⼒于“恢复⼤⾃然给予和夺⾛的机会的艺术。这个⼿术的主要⽬的不是恢复原始的美丽，⽽是恢复相关部分的康复。”4Davis（1919）在他的《整形外科——其原则和实践》⼀书中定义了“整形外科领域从头顶延伸到脚底”。5Gillies（1920）简要概述了重建⼿术和美容⼿术，将前者描述为试图将个⼈恢复到正常状态，后者超越正常。6
Converse（1964）强调了整形⼿术的形态恢复，并声称“由于整形⼿术的特殊性，它主要关注形式，正如整形⼀词所暗⽰的那样”。对McCarthy（1990）来说，整形⼿术既涉及修复畸形，也涉及纠正功能缺陷。Furlow（1992）还担⼼其他专业对“整形⼿术和重建⼿术”的混乱使⽤，并得出结论，“整形⼿术是由受过培训并配备了“⾝体许多部位⼿术技术⽅⾯的⼴泛经验”的整形外科医⽣完成的⼿术”。7Mathes（2006）将整形⼿术定义为⼀个解决问题的专业，整形外科医⽣处理⽪肤及其内容，没有特定的解剖区域。8同样，Neligan（2018）强调了整形⼿术的独特性，因为它不局限于器官或系统。它也不与疾病有关。9
然⽽，这些描述都不能涵盖⽬前在该领域进⾏的所有活动。其中⼀些仅以重建部分为中⼼，如Tagliacozzi、Converse、McCarthy和Mathes提出的那些。Davis、McCarlow和Mathes认为，其中⼀些没有明确的解剖界限。Gillies和Neligan的描述是概念性的和⽆形的，未能为在整形外科领域追求卓越的从业者提供坚实的指导。
近⼏⼗年来，缺乏准确和包容性的定义引发了⼀系列挑战和逆境。现代医学倾向于提供基于疾病或病理特征的全⾯医疗服务。因此，整形外科和其他外科学科之间的重叠⼤幅增加。整形⼿术没有⾃⼰的疾病谱系和病理特征这⼀事实可能会削弱对该专业的认识。例如，在⼀些医学界，尿道下裂已被分配给泌尿科；⼜腔外科医⽣被认为更擅长唇腭裂。此外，对许多⼈来说，烧伤后的畸形属于烧伤⼿术的范围。因此，整形外科医⽣⾯临着开发新实践领域的挑战，同时⾯临着传统实践中被其他专业所占据的领域。这就是整形外科的现状，也是许多专家关注的原因。
⾏政法规也对该学科的发展构成了巨⼤挑战。许多国家的医疗保健监管机构主要根据学科的定义以及解剖区域和病理特征来定义治疗范围，保险公司也遵循同样的措施。医疗保健法规还对跨学科治疗施加了严格的限制。因此，这种创新对现代整形外科医⽣来说已经变得困难。现在整形外科医⽣不太可能申请跨学科项⽬，例如⼦宫或膀胱移植，因为⼤多数道德委员会可能将这项⼯作视为妇科医⽣或泌尿科医⽣的领域。同样，出于类似的原因，医疗部门可能不⽀持这种做法。这种景观⽆疑让整形外科的学员和从业者感到沮丧。
为了应对医疗保健法规、道德和社区对寻求医疗的看法的空⽩和随之⽽来的困难和变化，我们努⼒提供最新、全⾯的整形⼿术插图。定义明确的医学学科预计将包含⾄少4个组成部分：实践范围、解剖领域、治疗选择和治疗⽬标。以下是我们的更新版本：整形外科是外科的⼀个专业分⽀，沿着重建整形外科和美学整形⼿术的2条主要分⽀发展。解剖区域包括所有外部附属物、⽪肤、软组织、神经和肌⾁⾻骼系统，以及相关的内脏器官。整形⼿术涉及先天性或获得性异常和功能障碍，以及与⼿术程序和⾮⼿术管理（如细胞疗法、药物治疗和光电设备）相关的众多与衰⽼相关的问题和审美问题，以改善患者和普通⼈的功能、外表、⽣活质量，甚⾄⼼理健康。
（以上为机器翻译）
