Prof. Chakkiri Balakrishnan
“Mahajano Yen gata sa pantha”
(“Follow the path tread by great wise people”)
The Mahabharata (Vana -parva 313.117)
‘Dr. Balakrishnan was a scholarly and modest man. He was original with genuine flair
for Plastic Surgery. Men of his caliber are rare and should be fostered and given
opportunities to match their natural talents and drive.’
Sir Benjamin Keith Rank in the book ‘Head and Hands: An Era of Plastic Surgery’ published
by Harper and Row, Sydney (1987).
Dr. C. Balakrishnan (popularly known as CBK) [[Figure 1]] was a remarkable person, a colossus and can be truly called the Father of Plastic
Surgery in modern India. He envisioned the need of creating the speciality of plastic
surgery in India and relentlessly worked towards achieving this mission. He laid solid
foundations on which the current edifice of the Indian Plastic Surgery has been erected.
The life story of CBK is all about the trials and tribulations of an extraordinary
man who established the very roots of the speciality of Plastic Surgery in India.
Figure 1: Young Captain Balakrishnan in the Indian Army
He was born on April 1918 in Ambathodi House, Marakkara in Southy Malabar of the old
Madras Presidency and was the youngest of the three siblings. Being underage for the
medical school, he first completed his BSc in Physics from Madras Presidency College.
He finished his undergraduate medical studies from the Madras Medical College in 1941
and won almost all the academic medals in the college. He was also a diploma holder
in the German language. Soon after completing his MBBS, he joined the Indian Army
Medical Corps on an emergency war commission as a parachutist. [[Figure 1]] After the war, he had trained for 2 years in plastic surgery with the army. Subsequently,
he was sent to the UK. for higher studies on a scholarship by the Government of India.
He worked in Plastic Surgery units at London, Nuffield, Stoke Mandeville, Manchester
and other places from 1947 to 1949. During this period, he became a Fellow of the
Royal College of Surgeons (London). While he was in the UK, he was in constant touch
with the Government of India through the Director General of Health Services proposing
to start a department of Plastic and Maxillofacial Surgery. He strongly felt the need
for one such facility in India. On his return to India in 1950, he was offered the
post of lecturer in surgery at the Nagpur Medical College. In the next 2 years, he
had performed 233 plastic surgery operations and impressed everyone with his surgical
skills, missionary zeal and commitment. He continued relentlessly in his efforts towards
creating an awareness towards creation of an independent plastic surgery department.
His efforts got a shot in the arm when Dr. B K Frank from Australia came on a goodwill
visit to Nagpur under the Colombo Plan. He was very impressed with the work and enthusiasm
of Dr. CBK. Thanks to the clout and strong recommendations of Dr. Frank, a Plastic
and Maxillofacial Surgery unit was eventually created in Medical college, Nagpur,
with Dr. CBK as its professor and head on 16th December 1957. Later, more posts were created including the lecturer and reader in
plastic surgery, a dental surgeon, a physiotherapist and an occupational therapist.
The first M.Ch. course in plastic surgery was started in 1960. He was joined by Dr.
J L Gupta as a reader who had just come back from the UK. The department became very
famous and soon many young surgeons started flocking to Nagpur for training in Plastic
surgery. Dr. CBK had great ambition to establish an All India Institute of Plastic
Surgery at Nagpur but was often frustrated with the bureaucratic apathy at Nagpur.
Around this time, a new medical institute was coming up at Chandigarh in Panjab in
North India. The dynamic chief minister of Panjab, Partap Singh Kairon convinced Dr.
CBK to join the then-fledgling Plastic Surgery Department at PGIMER, Chandigarh, as
the professor and head in 1966. Dr. Balakrishnan established a department which was
soon to become the benchmark for plastic surgery training in India. He continued to
take his department at PGIMER to greater heights with the help of an excellent faculty,
including Dr. C P Sawhney and trained a large number of students from all the corners of India. He
trained 13 plastic surgeons in Nagpur Medical College and 31 students in PGIMER, Chandigarh.
Many of his students have gone on to illustrious careers in plastic surgery; notables
among them include Dr. C S Sundararajan, Dr. Sam C Bose, Dr. R Venkataswamy, Dr. L
K Sharma, Dr. S N Sharma, Dr. P S Chari, Dr. R K Nair, Dr. Ashok Govila and Dr. P
A Vinod Kumar.
He introduced the concept of treatment planning sessions in which the resident would
present a case in front of the house that included the residents and the faculty.
It was an exercise in identifying and analysing the problems, defining the aims of
treatment and discussing the modalities of executing the plan. The planning sessions
could be ordeals for the residents and faculty, but CBK's vision and critical analysis
were long remembered by all the participants. His ward rounds were a lesson in bedside
manners, empathy and discipline. He asked very probing questions and applauded the
correct answers. The knowledge of the participants was teased and tested.
He was very particular about the cleanliness and aseptic techniques. He also introduced
the concept of dressing rooms for the plastic surgery patients. He would ensure that
aseptic techniques were followed just like in an operation theatre. His operation
notes were precise with clear diagrams. The case notes of the patients he assisted
at or operated on during his training days during the war services are models of accurate
documentation with good photographs. His operations were methodical with intense concentration
and each phase of the procedure proceeded like an effortless symphony of mind, eye
and hand. Dr. Sam Bose described it as ‘poetry in action.’ He could use both his right
and left hands with ease and the execution of his surgical steps was a sheer joy to
witness. He liked pin-drop silence during the operative procedure and hated any disturbance
while operating and would not tolerate any chatter during the surgery.
He led by example and he would never compromise on doing best for the patient. The
Director PGIMER, Dr. Santokh Singh Anand narrated the following incidence in the first
annual report of PGIMER on the table of Lok Sabha in 1967:
“A specialist surgeon (CBK) on his night rounds in the wards dropped into see what
happened in the Emergency Department at 9.30 pm. He saw a woman just brought in for
loss of her right thumb. She was holding a buffalo calf by the tie-rope. The calf
bolted, the rope tightened round her thumb and pulled it off. Asked where the missing
part was, she said that it had been left at home because people thought it futile
to take it with her to the hospital. Her home was in village 15 miles away, but the
road was good. The surgeon (CBK) opted for the best he could do to reconstruct her
thumb using what could be salvaged from the avulsed part. Speed was vital if the tissues
were to survive. There was no faster transport than his own car. So, he drove to the
village with the woman's husband. The thumb was retrieved and brought back in an ice-container.
It was fast work and took 50 min. Meanwhile the theatre team had prepared the woman
for the operation and everything required was ready when the surgeon got back with
the thumb. The skin of the avulsed thumb with no surviving potential was dissected
off. The viable assembly of bones, joints and tendons valuable for future function
was reattached. It was then fixed under a flap of skin on the abdomen to provide skin
cover and new blood supply. The emergency operation was the first step in a sequence
of four subsequent operations to provide a useful right thumb. The lesson went home
to young doctors under training”.
His sense of dedication to the nation was infectious. Despite shortcomings and national
crisis, he always took an optimistic view of where India was headed, and in the ultimate
success of India as a nation. In his-Gillies Memorial Oration delivered at Calcutta
in 1973, he said ‘the lure of Plastic Surgery in India was that the work was fantastic
in its variety and supremely satisfying to do. Working hard to meet the challenge
of difficult cases and feeling this effort bringing forth our best talents and giving
us great job satisfaction is the major part of our laurels. …We are privileged to
give a great part of our time every day to make some derelict human being more able
to get back into the mainstream of useful independent life….’
He had started the concept of multidisciplinary approach in the management of cleft
lip and palate, head and neck cancer and hand deformities/injuries. The combined clinics
with orthodontist, radiotherapist, occupational therapist, dental surgeons and speech
therapist were started during his time and continue to function as efficiently even
today.
Dr. Balakrishnan was a multitalented person. He was not only a pioneering expert in
the field of plastic surgery but was also an expert machinist with his own workshop
at home, an ace photographer, a ham radio operator, a keen gardening expert and an
exploring traveller who covered every corner of India as well as many countries abroad.
He was a long-standing member of the Rotary Club. In 1957, the Plastic Surgery section
of the Association of Surgeons of India was formed during Harold Gillies visit and
Dr. Balakrishnan remained President from 1958 to 1960. Gillies continued his close
relations with the Nagpur unit of Dr. CBK [[Figure 2]].
Figure 2: A group photograph with Harold Gillies in Nagpur in 1959
In 1978, he received the Dr. B. C. Roy Award in recognition of merit as an Eminent
Medical Teacher in Plastic Surgery. He was Fellow of the National Academy of Medical
Sciences. He was also a Life member of the Indian Association of the Advancement of
Medical Education, Convener of specialty group for Plastic Surgery of the National
Board of Examinations and Founder Secretary (and later President) of the Nagpur Association
for Rehabilitation of Children with Orthopedic Deformities (1956–1966). The Medical
Council of India accepted his recommended ‘Training in Plastic Surgery’ as the basis
for courses leading to the M.Ch. (Plastic Surgery) in 12 centres in India.
Dr. Balakrishnan innovated several operative techniques though he did not publish
them. He was kind of averse to the idea of publishing in the journals. It has been
such a big loss to the future generations of budding plastic surgeons. I could collect
the following innovations of CBK:
-
Triple wedge technique for cleft lip repair
-
Two types of vomer flaps complete unilateral and bilateral clefts of the lip and palate
-
Classification of cleft lip and palate, now known as Nagpur classification
-
Toe to thumb transfer by skin flaps and sutured hand to foot by a system of pulleys
and weights on a Balkan frame
-
Toe joint transfer for adults with temporo mandibular joint ankylosis
-
A pull though-shoe lace knot with loop on the mucosa, vertical oblique mattress suture
for reconstruction of the anterior urethra in hypospadias
-
Cheek skin-buccinator mucosa flap carried on upper lip for reconstruction of major
loss of upper eyelid after excision for carcinoma
-
Acromio-scapular sandwich flap for reconstruction of major defects after excision
of oral cancers
-
Pharyngoplasty using fascia lata sling.
The senior faculty members of PGIMER surgical fraternity remember Prof. CBK very reverently
and all of them say that he was very honest, hardworking and commanded respect from
one and all. His patients literally worshipped him. We do keep seeing his operated
patients of cleft lip and palate and all these patients bear the stamp of his craftsmanship.
The speech of most of these patients is excellent. Some of the patients of cheek defect
and cancrum oris treated with conventional arm/back tubes are a lesson in perfect
execution of well thought out plan.
His teachers had high praise for CBK. Professor Kilner wrote. ‘He had distinguished
himself in our discussion sessions by his often lucid and ingenious presentation of
cases or of subjects handed to him for study and critical review. As an assistant
and operator, his surgical craftsmanship is outstandingly good.’ Mr. AHR Champion
of Manchester wrote: ‘I have formed a very high opinion of Dr. Balakrishnan's ability
as a Plastic Surgeon. He is extremely patient and meticulous of detail which is so
important in work of this nature.’
He retired in April 1980 and continued giving care to the needy in private practice
at a very nominal fee. We had an occasion to see him during the APSICON 1985 at Chandigarh.
All the people jostled around him in a rare group photograph [[Figure 3]]. He, unfortunately, developed Parkinsonism that gradually eroded his surgical skills
and he stopped operating in the mid-90s. He succumbed to this crippling disease in
1997.
Figure 3: Group photograph during the APSICON 1985 at Chandigarh
The Plastic Surgery fraternity in India will always be grateful to the vision of CBK
for establishing the roots of Modern Plastic Surgery in the country.
The famous couplet from Allama Iqbal befittingly sums up the persona of Dr. Balakrishnan.
Hazaron Saal Nargis Apni Benoori Pe Roti Hai
Bari Mushkil Se Hota Hai Chaman Mein Didahwar Paida
(For 1000 years, the narcissus has been lamenting its blindness; with great difficulty,
the one with true vision is born in the garden.)
His legacy will continue to guide us forever. We are indeed blessed to have someone
like him guide the destiny of the speciality in India.
Financial support and sponsorship
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