2. Definition- It is a medical specialty concerned
with the correction or restoration and
functions of the body structures damaged by
trauma transformed by ageing process
changed by disease process and malformed
as a result of congenital defects.
3. The word plastic derives from the greek word
plastikos (to mould or to shape).
Plastic surgeon typically mold and reshape
(the tissues of body,bone,cartilage,muscles,fat
and skin).
9. Incision
Excision
Microsurgery: transplanting patient’s own tissue
Chemosurgery: removes samples of he cancerous
tissue in sections and tests each sample before
removing more.
Electrosurgery: to control bleeding.
Laser surgery
Dermabrasion: Dermabrasion is a type of surgical
skin planing, generally with the goal of removing
acne, scarring, and other skin or tissue
irregularities.
liposuction
10. Performed to correct the functional
impairment(burns/traumatic injuries).
11. Common reconstructive surgical procedures
are for:
Breast reconstruction
Face injury
Contracture surgery for burns
Hand and finger injury
Cleft lip and palate
Injuries to limbs.
Craniofacial defects
Pressure sores
Hand anomalies
Spinal cord defects
Congenital cardiac defects repair
12. Reconstructive modalities
Skin grafting- it involves transplantation of
the skin.
It is a technique in which the section of the
skin is detached from its own blood supply
and transferred as free tissue to a distant
recipient site.
13. Removal of excess tissue in the area needed.
Timing of reconstructive surgery should be
individualized.
Early reconstruction does not retard or
influence further treatment or adversely affect
predicted survival.
The extent of reconstruction depends on the
type of surgery done.
Flaps are mostly taken from back or abdomen
An implant may be used in addition to the
flap, if flap does not provide cosmetic results.
14. The natural response to the presence of
foreign substance is the formation of a
fibrous capsule around the implant.
The indication of the surgery is to improve
self image or therapeutic purposes or
palliative.
Tissue expanders may be necessary before
implants are inserted.
15. Indications
Excision of skin tumors
Burns(to cover wound in which insufficient
skin is available to permit wound closure).
Skin damage due to serious injuries
Extensive wound or trauma
Extensive skin loss due to some infection
16. Purposes of skin grafting
Reduce the course of treatment
Can improve the function and appearance of
the area of the body which receives the
skingraft.
Provides protection to the underlying
structures.
17. Classification
Autograft (patient’s own skin).
Allograft (obtained from a donor of the same
species).
xenograft/heterograft (donor of different
species).
18. TYPES OF SKIN GRAFTS
Classification by thickness:
split skin thickness- used to cover large
wounds. Shaving the surface layers of the
skin with dermatome. It involves removing
the top layer of the skin- the epidermis as
well as a portion of the deeper layer of the
skin called dermis.
*Dermatome: is an area of skin in which
sensory nerves derives from a single spinal
nerve root
19. The surgeon removes these layers from the
donor site. Split thickness skin grafts often
comes from the front or outer thigh,
abdomen, buttock or back.
Surgeon uses this skin to cover larger areas
of damaged skin. These grafts have a shiny or
smooth appearance .
20. Full thickness skin grafts- consists of dermis
and epidermis with out the underlying fat. It
involves removing all of the epidermis and
dermis from the donor site. Usually take
healthy skin from the abdomen, groin,
forearm.
Removing layers of the skin with a
scalpel(wolf graft).
The piece of the skin is cut in to correct
shape, the applied to the wound.
It can be used to cover large wounds that
needs to be closed directly.
21.
22. Composite graft- combination of skin and fat,
skin and cartilage or dermis and fat.
Used in patients with injuries who require
three dimensional reconstruction.
Eg. A wedge of ear containing skin and
cartilage can be used to repair the nose.
23. Donor sites.
Dressing present in the donor site will remain
for 7-14 days.
Re-pad if incase of oozing or bleeding.
Donor site will be painful than grafted area.
(analgesics can be provided).
The dressings present at the donor site will
often become stiff or dry or the dressings will
be fall of earlier than 7- 14 days, contact with
healthcare professionals.
24. Achieving closest possible color match.
Matching the texture and hair bearing
qualities.
Obtain thickest possible skin graft.
25. Infection,
Smell from discharge,
High temperature and increased pain,
Redness and swelling around the area
Bleeding
Loss of grafted skin
Rejection
26. Recepient site
Wound should be cleaned and anesthesia to be
given depending the wound size.
The graft spread over the bare area
Held in place by few stitches or surgical staples.
The graft is frequently meshed in order to
prevent fluid accumulation under the graft.
Pressure bandage is applied over the grafted
area.
Special vacuum apparatus placed over the area
for 3-5 days.
Healing begins by Plasmatic imbibition( initial
stage of graft healing within 24-48 hrs)
Capillary inosculation( new blood vessels begin
growing from the recipient area into transplanted
skin within 36 hrs).
Revascularization and reattachment of skin graft
to the recipient site is referred to as ‘take’.
27. Most skin grafts are successful. but in some
cases they need repeat grafting.
28. Clean and free from infection
Avoid stretching or moving around the graft.
Firm dressings is to be in place.
29. Adequate bed rest is to be provided.
Patient should support the graft with bandage.
Grafted skin needs to be lubricated.
Try to avoid scratching the wound.
Administration of medications.
Cotton clothes needs to be provided to avoid too
hot.
Massage gently 2-3 times in a day with the
cream.
The graft and donor site need to be protected
from the sun.(it will burn more than rest of the
skin).
30. The graft should be protected from trauma or
significant stretching for 2-3 weeks. Exercise
to be avoided for 3-4 weeks. Dressings
necessary for 1-2 weeks.
31. Flap Surgery
Flap surgery involves transporting healthy,
live tissue from one location of the body to
another - often to areas that have lost skin,
fat, muscle movement, and/or skeletal
support. There are several different types of
flap surgery methods that may be utilized,
depending upon the location of the flap and
the structures that need to be repaired.
32. Flap surgery is a technique
in plastic and reconstructive surgery where any
type of tissue is lifted from a donor site and
moved to a recipient site with an intact blood
supply. This is distinct from a graft, which does
not have an intact blood supply and therefore
relies on growth of new blood vessels. This is
done to fill a defect such as a wound resulting
from injury or surgery when the remaining
tissue is unable to support a graft, or to rebuild
more complex anatomic structures such as
breast or jaw.
33. Flaps can be fundamentally classified by their
level of complexity, the types of tissues
present, or by their blood supply.
34. Local flaps
Local flaps are created by freeing a layer of
tissue and then stretching the freed layer to
fill a defect.
37. B) Rotational flaps-It is a semicircular flaps that
rotates about a pivot point to fill the defect. In
design, it is critical that the flap should extend
beyond the defect. To ensure primary closure ,it is
essential that the flap be quite large, often with a
circumference 5-8 times width of the defect.
38. C) Transposition flaps- moves laterally about a pivot
point in to an adjacent defect.
Design the flap longer than the defect. Since the
transposition decreases the length. The donor site
can be closed directly or closed with a skingraft or
skin flap.
39. 1. Z plasty- It is a type of transposition flap in
which two triangular flaps, designed with limbs
of equal length, are interposed to exchange
width and length.Classically,it is designed with
60 degree angles, which yield maximum length.
40.
41. 2.Rhomboid flap – it is designed in a rhomboid
shape with 60 degree and 120 degree angles.
Designed by Limberg.4 flaps can be designed
surrounding a rhomboid-shaped defect.
42.
43. A) Advancement skin flaps
Moves directly forward in to a defect without lateral
movement. A triangle of skin can be excised from the
base of the flap to aid in closure. Thus gaining
advancement. It is otherwise popularized as
rectangular sliding flaps.
44. Regional flaps
Regional or interpolation flaps are not immediately
adjacent to the defect.
The freed tissue "island" is moved over or
underneath normal tissue to reach the defect to be
filled, with the blood supply still connected to the
donor site via a pedicle.
This pedicle can be removed later on after new
blood supply has formed.
45.
46.
47. Cutaneous flaps contain the full thickness of the
skin and superficial fascia and are used to fill
small defects.
Fascia-cutaneous flaps add subcutaneous tissue
and deep fascia, resulting in a more strong blood
supply and ability to fill a larger defect.
Musculo-cutaneous flaps further add a layer of
muscle to provide bulk that can fill a deeper
defect.
Muscle flaps can provide bulk or functional
muscle. If skin cover is needed, a skin graft can
be placed over it.
Bone flaps are used to replace bone, such as in
jaw reconstruction.
48.
49.
50.
51. Random-pattern flap. The blood supply for the flap
is not derived from a recognized artery but, rather,
comes from many little unnamed vessels. Many local
cutaneous flaps fall into this category.
Axial-pattern flap
The blood supply for the flap comes from a
recognized artery. Most muscle flaps have axial
blood supplies.
52. Free flap.
Free flap is defined as the vascular detachment of an
isolated tissue, followed by transfer to another region
of the body with reattachment of the divided artery
and vein to separate artery and vein.
Perforator flap.
The vessels that supply blood to the flap are isolated
perforators derived from a deep vascular system
through the underlying muscle or intermuscular septa.
55. Distant flaps
Distant flaps are used when the donor site is far
from the defect. These are the most complex
class of flap. Direct or tubed flaps involve having
the flap connected to both the donor and recipient
sites simultaneously, forming a bridge. This allows
blood to be supplied by the donor site while a new
blood supply from the recipient site is formed.
56.
57.
58.
59. Congenital abnormalities
Trauma
Tumor ablation in an adjacent part of the
body
Extensive wounds due to pressure sores.
Functional and cosmetic requirements(wound
coverage on the face/around the eyes, nose
and mouth.
60. Types of transposition flap
Z plasty flap
Rhomboid flap
61. Donor site is far from the defect.
It used to cover nonadjacent defects. They
may be transferred directly, tubed or
transferred by micro-vascular techniques.
62. Direct flap- It is transferred to a distant site
directly so that the donor site and recipient
sites are approximated. The flap is later
divided after 1-3 weeks and inset.
63. Tubed flap-it is transferred to a recipient site
with the lateral flap edges sewn together,
while the new blood supply is incorporated
from the distant end of the flap. Sewing the
edges together result in decreased risk of
infection and contraction of the flap.
64. Micro-vascular free flaps – is a type of distant
flap in which the flap ,with its vascular
pedicle, is divided completely from its donor
vessels and anastomosed to the recipient
vessels at the recipient site using a micro-
vascular surgical technique(his is done by
reconnecting the small blood vessels.)
67. Pre-operative management
Proper history collection and physical
examination(latex sensitivity, cardiovascular
problems, bleeding problems, high blood
pressure.
Encourage to take proper nutrition and advise
to avoid smoking, alcoholism in order to
enhance healing.
All needed blood investigation reports need
to be collected(especially PT-INR).
Advise to discontinue aspirin, NSAID and
vitamin E
Operative site should be free of make-up.
68. Initial dressings need to be in place for 24-48
hours.
If oozing, apply firm pressure for 10-15 min.
Do not give aspirin or aspirin containing drugs
Clean site and apply ointment.
Keep the graft edges moist with antibiotic
treatment.
Protect from the sun
Check for any complications
Avoid strenuous exercise.
69. It is a sub-speciality of medicine and surgery
Concerned with maintaining and restoring
normal appearance.
Its directed to all areas of head ,neck and
body
70. BODY RESHAPING PROCEDURES
1. Liposuction
2. Tummy tuck
3. Brachioplasty
4. Thighplasty
5. Butt augmentation/implant
6. Male breast reduction
7. Aesthetic genital surgery
71. Liposuction
Break up or sucks fat from the body.
Abdomen,thighs,buttoks,neck,chin,upper and back
of arms
Tummy tuck
This surgery flattens the abdomen by removing extra
fat and skin, and tightening muscles in abdominal
wall.
brachioplasty
It is a surgical procedure to reshape and provide
improved contour to the upper arms and connecting
area of chest wall. A brachioplasty is a surgery that
reshapes the back part of your upper arm, from your
arm to your elbow. It's also called an arm lift. It
removes extra skin and tissue. It makes your upper
arm look smoother. When a person gains a lot of
weight, his or her skin slowly stretches over time.
72. Thighplasty- It is a cosmetic surgical
procedure to tighten and improve the
appearance of your thighs due to excess skin
on the thighs that can be a result of aging,
pregnancy, or a significant weight loss.
73. Buttock augmentation/gluteal augmentation,
It is used to improve the contour, size and/or
shape of the buttocks. This is done through
the use of buttock implants, fat grafting or
sometimes a combination of the two.
Male breast reduction
It reduces breast size in men, flattening and
enhancing the chest contours.
74. Aesthetic genital surgery
There is a variety of aesthetic genital plastic
surgery procedures that may enhance
appearance and reduce discomfort. These
procedures include labiaplasty, clitoral hood
reduction, labia majoraplasty, monsplasty(is a
type of cosmetic surgery where excess skin
and fatty tissue are removed from the fatty
pad over the pubic bone) and vaginoplasty.
76. It is the removal of bulging fat and excess skin
around the eyes.
Eg. Repairs droopy eyelids
Procedure
Can be done under local or general anaesthesia
Marking the excess skin and fat in standing
position
Excess skin is removed and fat is excised and the
incision is closed by sutures.
77. Risk - it can cause ectropion( eyelid turns
outward)
Post –operative care:
Ice application
Local antibiotic creams
Eye drops
Sun glasses
Sutures can be removed within 5 days
Lubricants
Proper wound care
Advice to avoid exercise
Elevate the head end of the bed
78. Browlift/foreheadlift
It is a cosmetic procedure to raise the brows.
A brow lift improves the appearance of the
forehead, the brow and the area around the
eyes by raising the soft tissue and skin of the
forehead and brow.
Recovery phase:
Antibiotics
Ice compress and eye exercises
Sutures can be removed within one week
79. Lifting and repositioning of the lower two
thirds of the face and neck to improve
appearance
Can remove facial wrinkle and sagging skin
Involves tightening of the facial and neck
muscles.
Indications
Asymmetric redundancy of soft tissue
Periauricular lesions
Redundant soft tissue from trauma
80. It can be done in under LA or moderate
sedation in out patient department.
Complications
Sloughing of the skin
Partial facial paralysis
Infection
Bleeding
numbness
81. Management
Rest
Head end to be elevated
Advice to avoid neck flexion
Analgesics
Liquid diet
Topical ointment
Advice not to bend for 7-10 days
82. More advanced cosmetic surgery
reshapes larger amount of fat
Can use local anesthesia
Procedure
Fat is removed with the use of small needle
attached with syringe.
This fat is processed to remove excess fluid,and
then reinject by using another needle,which is
placed under the skin beneath the area that
requires fat.
It can be repeated until the desired correction
has been achieved.
83.
84. Love handles” are areas of skin that extend
outward from the hips. They indicate excess
fat accumulation around the hips and
abdominal area.
85. Removal of excess cartilage and tissue from
the nose with the correction of septal defect.
Indication
Deviated nasal septum
Reducing or enlarging certain areas in the
nose
Procedure
Under GA
Incisions made inside the nose
Skin of nose is raised and necessary changes
are made to the bones, cartilages , and soft
tissues.
Nose is packed for 48 hours
Recovery-takes couple of weeks.
86. After care:
Proper dressing
Reduce activities
Head to be elevated
Avoid bending and heavy lifting
Ice application.
87. It is a surgical procedure to minimize the
appearance of scars, restore function and
correct disfigurement resulting from an
injury.
Smoothens the surface of the scar by shaving
or scrapping off the top layers of skin
Performed by dermatological surgeon.
88. Shaping of chin and improves chin contours.
It involves the placement of an implant
around the patient’s existing chin to augment
the size and shape of the chin and achieve
natural attractive facial features.
facial dressing (7 days).
90. FILLERS
Helps to fill out deep facial wrinkles
CHEMICAL PEEL:
A technique used to improve the appearance
of the skin on the face, neck and hands.
A chemical solution is applied to the skin and
it causes to exfoliate and eventually peel.
91. BOTULINUM TOXIN:
It is produced by the bacterium Clostridium
botulinum and can be used as a treatment to
reduce the appearance of wrinkles in the
upper areas of the face and other cosmetic
surgeries.
Neurotoxin temporarily interfere with
neuromuscular transmission, paralysing the
fine muscles especially in the forehead and
around the eyes.
92. INJ.LIPOLYSIS:
It is an FDA approved non surgical procedure
that reduces the number of fat cells in the
targeted area. It is minimally invasive
aesthetic surgery treatment that uses a
chemicals called deoxycholic acid or
phosphatidylcholine to damage and kill fat
cells.
Process of permanent fat removal.
Anesthesia not required
Full effect can be seen after 4-6 weeks.
94. It an artificial reshaping or augmenting a
breast for cosmetic reasons. It can be done
after breast development.
It can be done under local anesthesia’.
An implant(prosthesis) is placed through an
incision, under the breast tissue or under the
muscle. the incision can be made under the
breast, around the nipple .
The entire procedure will take nearly 2-3
hours.
95. Saline breast implants
It is a pouch made of silicone rubber or elastomer.
This is surgically inserted under the chest tissue or
muscle and then filled with saline water through a
valve.
Silicone gel breast implants
These implants have multiple layers of silicone
elastomer around the implant and these are
prefilled.it can produce firmer and softer effect
than saline implants.
* Most saline and silicon implants are FDA
approved for 10-20 yrs, but it does not mean that
it should be changed every 10-20 yrs.
96. Infra mammary crease approach
A fine 5 cm incision is made beneath the
breast
Circum areolar approach
Incision is made in the lower half circle of
the areola.
97. Procedure:
Locations
Below the gland(sub glandular)
Below the muscle(sub muscular)
Dual plane(upper half below the muscle)
(lower half below the gland)
98. Minor discomfort
Feeling of stretch
Swelling
Bruising
Decreased sensation over the breast
99. Collection of serous fluid or blood
Sensory changes
Infection
Implant malposition
Capsular contracture (late): Capsular
contracture is a local complication thought to
occur due to an excessive fibrotic foreign
body reaction to the implant. It is thought to
be an inflammatory reaction which causes
fibrosis through the production of collagen.
