Plastic and Reconstructive Surgery

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Plastic Surgery is the speciality, which is concerned with healing of wounds, restoration and improvement of form and function. The speciality had its origin at around 600BC when Sushruta laid down the foundations of Surgery and described a method to reconstruct the amputated nose, which is still practiced today. Unlike other surgical super specialities (such as Cardiothoracic Surgery or Neurosurgery), Plastic Surgery is not a regional speciality. Today, a Plastic Surgeon operates from head to toe and hence, it is one of the broadest specialities. The word ‘Plastic’ was derived from Greek word “Plastikos” which means fit for moulding. The term was coined by Desault, a French surgeon and was likely published in 1798 by his pupil Bichat.

Aristotle, as quoted by Webster, wrote- Art indeed consists in the conception of the result to be produced before its realization in the material. This is just one of the teachings that goes into the rigorous training of a Plastic Surgeon. Sir Harold Delf Gillies, considered by many to be the Father of modern Plastic Surgery, often said- While Reconstructive Surgery aims to restore an individual to normal, Cosmetic Surgery attempts to surpass the normal. It is this dictum, which most aptly defines the difference between Cosmetic Surgery and Reconstructive Surgery, both being branches of Plastic Surgery. Though the subspecialities of plastic surgery are mostly interlinked, these may be stated as-

Cosmetic and Antiaging Surgery : An individual, who comes for cosmetic surgery is not suffering from any disease as defined conventionally. Rather, he aims to improve upon his appearance, which helps in restoring his self esteem and improves the body image. Cosmetic surgery is described in detail, elsewhere on this website. Similarly, an individual who wishes to reverse the effects of age on body form and appearance also opts for cosmetic surgery. This topic is discussed in detail on another page in this website.

Reconstructive Surgery : Typically, the patient is an individual, who has suffered the loss or mutilation of a body part. Reconstructive surgery aims to restore this to normal. The examples are reconstruction of a breast in a patient, who has undergone its removal in the treatment of breast cancer. Similarly, reconstruction of lower jaw, following its resection to treat cancer, is reconstructive surgery. In addition to post cancer resection reconstructive surgery, it is also carried out when the body part has been lost due to injury, infection, other diseases and birth defects. Reconstructive surgery may be carried out with the help of local flaps (tissue situated near the site of defect), distant flaps (tissue situated away from the site of defect, but which can be brought near the site ie cross leg flap) or microvascular free tissue transfer (in this case, the block of tissue consisting of various structures is detached from the site of origin and transferred to the site of defect. At the same time, the blood vessels and if required, nerve are joined to the recipient site vessels and nerve with the help of microsurgery).

Microsurgery : In microsurgery magnification from operating microscopes is used to visualize, dissect and join structures, that are very small, such as blood vessels and nerves which supply fingers and toes. Magnification ranges from 4 to 25 times. Thus amputated parts such as fingers, hand, feet, penis, can be joined if brought within time. Microsurgery is also used to transfer large chunks of tissue consisting of skin, soft tissue and sometimes bones from one area in body to another, joining the blood vessels and nerves to recipient area, thus restoring its circulation, sensation and function. Without joining the micro structures, this transferred tissue would die. This procedure is also known as free flap transfer. Microsurgery is also done to restore blood circulation to hand and feet when this disrupted due to severe injury such as in road accidents, industrial accidents, warfare etc. Microsurgery is also carried out to create AV Fistulae in patients with chronic kidney disease, so that dialysis can be carried out.

Surgery of Birth Defects : Those individuals, who are born with birth defects such as cleft lip, cleft palate, craniofacial defects, limb defects, chest wall defects, meningomyelocoeles etc can be treated with the help of Plastic Surgery. This is dealt with in detail, elsewhere in this website.

Treatment of Burns : Management of burn injuries, healing of wounds, release of post burn contractures, relief from hypertrophic scars etc is an integral part of Plastic Surgery.

Hand Surgery : Hand injuries, amputations, birth defects, nerve paralysis resulting in loss of function, tumours and other conditions are managed by Plastic Surgeons.

Transsexual ( Gender Affirmation Surgery) : Transsexual Surgery is also dealt with detail, elsewhere on this website.

Genital Surgery : Male and Female Genital Surgery is covered elsewhere on this website.

Maxillofacial, Craniofacial and Orthognathic Surgery : Facial Trauma with fractures of facial bones, birth defects with deformed face and head, abnormalities of jaws are dealt with by Plastic Surgery. These are discussed in detail, elsewhere on this website.

Breast Surgery : Includes augmentation, reduction, lifting of female breast. Also includes reduction of male breast. This is discussed in detail elsewhere on this website.

Treatment of Wounds : The speciality of Plastic Surgery was born out of the need to heal complex acute and non healing wounds. Proper debridement of wounds followed by skin graft/ flap coverage or application of VAC leads to healing of nearly all wounds. Pressure sores (bedsores) are treated by using the same principles.

Treatment of some skin and appendage conditions : These include melanocyte transfer and skin grafting for vitiligo (white patches), treatment of deep scars and pits such as those caused by severe acne, removal of skin cancers and coverage with graft/ flap etc.

Improvement of scars : Scars, which are present as a result of previous injuries, burns, surgeries or other diseases can be improved with the help of plastic surgery. An important technique, often employed for this purpose is tissue expansion. In this technique, normal tissue adjacent to the scar is expanded with the help of tissue expanders. After expansion, the expender is removed, scar is excised or defect is freshened. Expanded skin flap is then advanced to cover this defect. This topic is discussed in detail, elsewhere on this website.

Cosmetic suturing of cuts (lacerations) : Use of much finer techniques, better appreciation of tissue vascularity, regional anatomy and application of cosmetic surgery principles by a Plastic Surgeon result in much better result when the lacerations are sutured by Plastic Surgeons

CASE 1 : Reconstruction of cheek with microvascular free tissue transfer

CASE 2 : Reconstruction of right side of lower jaw with microvascular transfer of fibula (leg bone)

CASE 3 : Crush injury foot with exposed bones. Reconstructed with microvascular transfer of muscle from back and skin graft

CASE 4 : Shotgun wound of leg with exposed bone and fracture site. Covered with microvscular transfer of tissue from forearm

CASE 5 : Crush injury of foot. Reconstructed with microvascular transfer of tissue from thigh.Plastic-and-Reconstructive-Surgery