2.1. plastic surgery

At the end of the session we will be able
to;
define reconstructive surgery
list the aims of reconstructive surgery in Burn
describe the techniques of reconstruction
Learning Objectives
Shristi Shrestha, M.Sc Nursing 2016 Batch 2

Plastic Surgery
Reconstructive
Surgery
Cosmetic
Surgery
Performed on
normal
structures of the
body to improve
appearance
Performed on
abnormal
structures of the
body to improve
function or
approximate
normal
appearanceShristi Shrestha, M.Sc Nursing 2016 Batch 3

Reconstructive Surgery
Reconstructive Surgery
Deals with tumor removal, laceration repair,
scar repair, hand surgery, and cleft lip and
palate surgery.
Following management of the burn wounds,
rehabilitation also involves reconstructive
surgery aiming to restore function, then to
restore esthetic appearances.

The basic concerns in burns reconstruction are
for function, comfort, and appearance.
Burn Reconstructive Surgery

To achieve would closure
To prevent infection
To re-establish the function and properties of
an intact skin
To reduce the effect of burn scars causing
joint contractures
To reduce the extent of a cosmetically
unacceptable scar
Aims

Secondary wound closure
Excision and primary closure
Z-plasty
Skin Graft
Flaps
Tissue expansion
Vacuum assisted closure
Skin substitutes
Implants and prosthesis
Techniques Of Reconstruction

Secondary wound closure
 referred to as closure by secondary intention.
The skin edges of the wound are not sutured
together; the wound is left “open.” Dressings
are applied regularly to keep the wound clean,
and the wound gradually closes and heals on
its own.

requiring incision through the deep dermis
(including subcutaneous and deeper tissues)
of open wounds, burn eschar, or burn scars.
The burn wound is surgically removed and the
edges are sutured together.
Excision and primary closure

to improve the functional and cosmetic
appearance of scars.
used to flatten hypertrophic scars and elevate
depressed scar
Z-plasty

“A skin flap contains
its own vasculature
and therefore can be
used to take over a
wound bed that is
avascular.”
Flaps are tissues that
are transferred with a
blood supply
Skin flaps

TYPES OF SKIN FLAP

Random pattern
flap is further
classified by its
movement.

Skin Flap- epidermis, dermis and superficial
fascia
Fasciocutaneous Flap- epidermis, dermis and
both superficial and deep fascia
Muscle Flap-muscle belly without overlying
structures
Types of skin flaps

Myocutaneous Flap-muscle belly with the
overlying skin
Osseous Flap- bone
Osseomyocutaneous Flap-bone, muscle, skin
Composite Flap- Contains a no. Of different
tissues such as skin, fascia, muscle and bone.
Types of skin flaps

Local Flap
Types of skin flaps

Pedicle flap:
those which are
transferred to
another area of
the body but the
vascular
attachment is
always
maintained
Distant Flap

Free flap
Those in which the tissue is completely separated
from the body and transferred to another area and
the vascular supply is re-established by anastomising
the blood vessels

After a ﬂap has been moved it should be
observed for tissue color, warmth and turgor,
and be pressed to assess blanching and
capillary reﬁll time.
Patients post skin reconstruction should be
kept in a room at higher temperature than
normal in order to encourage vasodilatation.
Nursing Consideration

‘WET, WARM AND
COMFORTABLE’ the best
advice for postoperative ﬂap
care

Tissue Expansion
• A surgical tissue expander is basically an
expandable balloon usually constructed of
silocone rubber with a means of introducing
fluids at intervals usually a self sealing port.
• The expander is placed beneath the skin
adjacent to the defect and port situated at a
convenient place.

Tissue Expanders

• This is achieved by
injecting sterile saline
through the skin into
the port.
• When the desired
expansion is achieved
the expanded skin
may then be
fashioned into a local,
distant or free flap
and used to close the
defect.
Tissue Expansion

Vacuum assisted closure
• The foam is connected by a tube to a suction
device.
• This is effectively a negative pressure pump
that can be controlled to give intermittent
suction.

 “Skin Substitutes are defined as a
heterogeneous group of wound cover
materials that aid in wound closure and
replace the functions of the skin either
temporarily or permanently”
Skin Substitutes

Artificial substitutes for body parts, and
materials inserted into tissue for functional,
cosmetic, or therapeutic purposes.
include solid and soft silicone materials, many
forms of ﬁller including collagen and
polymers.
Implants and Prosthesis

Any Questions??

LET’S SUMMARIZE

 Williams NS, Bulstrode C, O’Connell RP, editors.
Bailey and love’s short practice of surgery. 25th ed.
London: Oxford University Press; 2013 Feb 18. ISBN:
9780340939321.
 Hale A, ’donovan Rhona O, Diskin S, Mcevoy S,
Keohane C, Gormley G. Impairment and disability
short course Physiotherapy in burns, plastics and
Reconstructive surgery. University of Limerick; 2013.
References

 Kemble J.V.H, Lamb.B.E.Plastic surgery and burns
nursing. Wm Clowes Ltd, first edition,Beccles.
 Principles Of Burn Reconstruction - plastic surgery.
Available from:
http://doctorlib.info/surgery/plastic/16.html.
References

2.1. plastic surgery

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