RECONSTRUCTIVE AND COSMETIC SURGERY

1. RECONSTRUCTIVE AND
COSMETIC SURGERY

3. PlastIc surgery
The word "plastic" derives from the
Greek plastikos meaning to mould or
to shape; its use here is not connected
with the synthetic polymer material
known as plastic.

4. INTRODUCTION
.
..The field of Plastic Surgery can be broken
down into two main categories –
reconstructive procedures and cosmetic
procedures
..Both are generally considered sub-specialties
of plastic surgery.

5. Plastic surgeon typically mold and reshape the
following tissues of the body; bone, cartilage,
muscles, fat and skin.
Plastic surgery is a medical specialty concerned with
the correction or restoration of form and function of
the body structures damaged by trauma, transformed
by aging process, changed by disease process and
malformed as a result of congenital defects.
While famous for aesthetic surgery, plastic surgery
also includes many types of reconstructive surgery,
hand surgery, microsurgery, and the treatment of
burns.

6. The basic goals of the plastic surgery include
following :
……Correction of perceived disfigurement
…….Restoration of impaired function
…….Improvement of physical appearance

7. The benefits of plastic surgery may
include:
Correction of a congenital or acquired
deformity
Correction of a perceived physical imperfection
Psychological benefits

8. Basic principles of plastic surgery:
Achieving minimal scarring
Careful planning of incisions so that they fall in the
line of natural skin folds or lines
Appropriate choice of wound closure
Use of best available suture materials
Early removal of exposed sutures so that the wound
is held closed by buried sutures
Documentation through photography

9. Techniques and Procedures Common techniques
1. Incision
2. Excision
3. Microsurgery
4. Chemosurgery
5. Electro surgery
6. Laser surgery
7. Dermabrasion
8. Liposution

10. In plastic surgery the transfer of skin tissue (skin grafting) is
one of the most common procedures.
Plastic surgery include closure of wounds, removal of skin
tumors, repair of soft tissue injuries or burns, correction of
deformities and repair of cosmetic defects,
Plastic surgery can be used to repair many parts of the body
and numerous structures such as bone, cartilage, fat, fascia,
mucous membrane, muscle, nerve and cuteneous structures.
During plastic surgery the following procedures are common:
tissue may be removed to fill a depression to cover a wound or
to improve appearance and tissue may be completely removed
to alter the contours of a feature.

11. Plastic surgery can be divided into two
Reconstructive
surgery
Cosmetic
(aesthetic)surgery

12. Reconstructive surgery
in its broadest sense, is the use of
surgery to restore the form and function of the
body.
Reconstructive surgery attempts to restore a
more normal appearance to an abnormal or
absent body part. Reconstructive plastic
surgery is usually performed to improve
function, but it may be done to approximate a
normal appearance.

13. Reconstructive surgery is performed to
correct functional impairments caused
by: burns, traumatic injuries such as
facial bone fractures, congenital
abnormalities such as cleft lip or palate,
developmental abnormalities, infection or
disease and removal of cancers or tumors
such as mastectomy.

14. Common Reconstructive Surgical Procedures There
are several operative and non-operative procedures
available to improve the shape and enhance the
beauty of various body parts. Most commonly
performed procedures for various body parts are as
follows:

15. ….Breast Reconstruction
…..Contracture Surgery for Burn
…..Cleft Lip and Palate
…..Cranio-facial Defects
…. .Ptosis or Drooping of Eyelids
…..Defects of Eras
…….Hand and Anomalies

16. …..Face Injury
…..Hand and finger Injuries
…..Injuries to Limbs Amputations
…..Scars
…..Pressure Sores
……Spinal cord Defects

17. INDICATIONS OF RECONSTRUCTIVE
SURGERY
CONGENITA
L
ACQUIRED

18. Reconstructive Modalities
Skin Grting:
Skin grafting is a type of medical grafting involving the
transplantation of skin. Skin grafting is technique in which a
section of skin is detached from its own blood supply and
transferred as free tissue to a distant (recipient) site.
Skin grafts are commonly used to repair defects that result
from excision of skin tumors, to cover areas denuded of skin
(burn) and to cover wound in which insufficient skin is
available to permit wound closure.
They are also used when primary closure of the wound
increases the risk for complications or when primary wound
closure interfere with function.

19. Skin grafts are often employed after serious injuries
when some of the body's skin is damaged.
Surgical removal (excision or debridement) of the
damaged skin followed by skin grafting.
The grafting serves two purposes: it can reduce the
course of treatment needed and it can improve the
function and appearance of the area of the body
which receives the skin graft Skin grafts may be
necessary to provide protection to underlying
structures or to reconstruct areas for cosmetic or
functional purposes.

20. Indications
Skin grafting can be used to repair almost any
type of wound and is the most common form of
reconstructive surgery. Skin grafting is often used
to treat
Extensive wounds or trauma
Burns
Specific surgeries that may require skin grafts for
healing
Areas prior infection with extensive skin loss
Cosmetic reasons or reconstructive surgeries

21. Classification
1 . Autografts: An autografts is tissue obtained from the
patient's own skin.
2. Allografts: An allograft is tissue obtained from a
donor of the same species; these grafts are also called
allogenic or homografts.
3. Xenografts: A xenografts or heterograft is tissue from
a donor of a different species

22. Classification by Thickness
Split skin grafts:
A split-thickness graft can be cut at
various thicknesses and is commonly used to cover large
wounds or defects for which a full-thickness grafts or flap
is impractical. This type of skin graft is taken by shaving
the surface layers (epidermis and dermis) of the skin with
a large knife called a dermatome. The shaved piece of
skin is then applied to the wound. This type of skin graft
is often taken from the leg. A split skin graft is often used
after excision of a lesion on the lower leg.

23. Full thickness skin grafts:
Full-thickness graft consists of
dermis and the entire dermis without the underlying fat.
This type of skin graft is taken by removing all the layers
of the skin with a scalpel . The piece of skin is cut into
the correct shape, and then applied to the wound. This
type of skin graft is often taken from the arm, neck or
behind the ear. It is often used after excisions on the hand
or face. It is used to cover wounds that are too large to be
closed directly.

24. Composite Graft
A composite skin graft is
sometimes used, which consists of combinations of skin
and fat, skin and cartilage, or dermis and fat. Composite
grafts are used in patients whose injuries require three-
dimensional reconstruction. For example, a wedge of ear
containing skin and cartilage can be used to repair the
nose.

25. Donor Site
The common areas which are used as donor sites are the
buttocks, thighs and upper arms.
The donor site is dressed in theatre and the dressing will
usually be left in place for 7-14 days.
We may have to re-pad the dressing as this area often
oozes/ bleeds after the operation .
The donor site area is usually more painful than the
grafted area as the top layers of the skin are removed
exposing the nerve endings. Regular painkillers will need
to be given to help ease the discomfort.

26. All dressing need to be kept dry and in place until you are
told differently by the nursing staff. The dressing on the
donor site will often become stiff and dry out.
The donor site is selected with several criteria in
mind:
Achieving the closest possible color match
Matching the texture and hair bearing qualities Obtaining
the thickest possible skin grafts without jeopardizing( put
someone or something)into a situation in which there is a
danger of loss, harm, or failure.) the healing of donor site
Considering the cosmetic effects of the donor site after
healing so that it is in an incons-picuous ( not clearly
visible )location.

27. GRAFT APPLICATION
The wound is prepped for surgery. The wound is cleaned
and measured, and then a pattern is traced for transfer
over to the donor site.
Anesthesia is administered. Depending on the size,
severity, and location of the wound, as well as the type
of graft, the procedure may require local anesthesia,
regional anesthesia, iv sedation, general anesthesia, or a
combination thereof.

28. The donor skin is harvested and prepared. The skin is
either removed with a scalpel, skin grafting knives or
with the help of a special harvesting machine called a
dermatome. The graft may also be "meshed," a
process wherein multiple controlled incisions are
placed in the graft. This technique allows fluid to leak
out from the underlying tissue and the donor skin to
spread out over a much larger area. With a full-
thickness or composite graft, the donor site is then
closed with sutures. With a split-thickness graft,
sutures are not needed at the donor site.

29. The skin graft is taken from the donor or host site and applied
to the desired site called the recipient site or graft bed. It is held
in place by a few small stitches or surgical staples.
Once in place, the graft is fastened to the surrounding tissues
with sutures or staples. A pressure bandage is applied over the
graft recipient site. A special vacuum apparatus called a wound
VAC may be placed over the area for the first 3 to 5 days to
control drainage and increase the graft's chances of survival
The graft is initially nourished by a process called plasmatic
imbibitions in which the graft literally drinks plasma. New
blood vessels begin to grow within the first 36 hours in a
process called capillary inosculation, followed by new skin
cells which then begin to grow from the graft to cover the
recipient area with new skin

30. The process of revascularization and reattachment of
skin graft to a recipient bed is referred to as a take.
After a skin graft is put in place, it may be left exposed
or covered with a light dressing or a pressure dressing
depending on the area . Post-Op Care: Both the donor
and recipient sites should be kept moist and well-
protected

31. Z-plasty is a plastic surgery technique that is used to
improve the functional and cosmetic appearance of scars.
With this technique, it is possible to redirect a scar into
better alignment with a natural skin fold or the lines of
least skin tension.
Contracted scars may be lengthened with this technique.
Z-plasty involves the creation of two triangular flaps of
equal dimension that are then transposed.

33. Complications of skin grafts
Infection
Smelly discharge from dressing
High temperature
Increased pain
Redness and swelling around the skin graft and donor area
Bleeding through the dressing caused by trauma or
infection which may cause clots and lift the graft
Loss of grafted skin
Rejection may occur in heterologous graft. To prevent this,
the patient usually must be treated with long term
immunosuppressent drugs

34. FLAP SURGERY
Flap reconstruction involves the transfer of a living
piece of tissue from one part of the body to another,
along with the blood vessel that keeps it alive.
…Unlike a skin graft, flaps carry their own blood
supply, so can be used to repair more complex defects.
….Flap surgery can restore form and function to areas of
the body that have lost skin, fat, muscle movement ,
and/or skeletal support.

35. TYPES OF FLAP
There are three main types of flap.
1. Local flap
……Uses a piece of skin and underlying tissue that lie
near to the wound.
………The flap remains attached at one end so that it
continues to be nourished by its original blood supply
and is repositioned over the wounded area

36. REGIONAL FLAP
….It uses a section of tissue that is attached by a specific
blood vessel.
…..When the flap is lifted, it needs only a very narrow
attachment to the original site to receive its nourishing
blood supply from the artery and vein.

37. FREE FLAP/MICROSURGERY
…..Free flap reconstruction also involves the transfer of
living tissue from one part of the body to another, along
with the blood vessel that keeps it alive.
…….A free flap is a further modification of flap transfer
where the flap is entirely disconnected from its original
blood supply and then reconnected using microsurgery in
the recipient site.

39. COMMON TYPES OF RECONSTRUCTIVE SURGERIES
Breast reconstruction surgery
……….The goal of breast reconstruction is to reform or reshape
one or both breasts after a mastectomy or lumpectomy.
……This reconstruction process can help a person find
their self-confidence again and feel better during their cancer
recovery
……Although many factors can help determine the most
suitable type of breast reconstruction, there are three main
options

40. BREAST RECONSTRUCTION SURGERY
Implants or prosthetics:
This type of surgery uses silicone or saline implants.
Autologous or skin flap surgery:
This method uses tissue from another part of the body.
Combined
In some cases, a surgeon might use a combination of both
techniques to create a more natural reconstruction of
the breast or breast

41. ……………When reconstructing a breast with implants, a surgeon
will insert silicone or saline implants underneath the skin or muscle,
in the place of the previous breast tissue.
…..For most people, this is a two stage procedure. During the first
stage, a surgeon places a tissue expander underneath the remaining
breast skin, or pectoralis muscles.
The expander serves as a temporary saline implant that gradually
stretches the remaining tissue.

42. ………………. After the person has fully healed
following surgery, surgeon will inject sterile saline or
salt water through the skin into the tissue expander on
a weekly basis.
This balloon gradually grows, stretching the overlaying
skin and muscle until the breast reaches a size with
which the person is comfortable

44. IMPLANTS
When the chest tissues heal and the surgeon has
added enough saline to the tissue expander in preparation
for the implants, they will perform the
second procedure to insert the implants.
The surgeon removes the tissue expanders and
replaces them with either a silicone or saline implant. They
will usually reopen the original scar. This often means that
the procedure leaves no new scars on the chest.
In some cases, a surgeon may place a permanent
saline or silicone implant at the time of the mastectomy,
without use of a tissue expander.

45. SKIN FLAP SURGERY
With skin flap surgery, the surgeon takes tissue from
another part of the body and moves it to the chest to
rebuild the breast.
The surgeon usually removes this tissue from the
abdomen. However, it may come from other places on
the body, including the buttock, back, or thigh.
Skin flap surgery highly complex, as it involves
transferring tissue from one area of the body to
another.

46. Two methods are available for this surgery:
Pedicle flap
surgery
Free flap
surgery

47. FREE FLAP SURGERY
In free flap surgery, a surgeon completely
removes the tissue and the blood vessels that provide it
with circulation for placement in the breast.
They stitch the blood vessels into other blood vessels
in the chest at the intended site of placement. These
blood vessels are very small, so the surgeon will use a
microscope to sew them together in a procedure called
microsurgery

48. PEDICLE FLAP SURGERY,
In pedicle flap surgery, a surgeon will not entirely
remove the transplanted tissue from its blood vessels.
Instead, the tissue remains attached to the body, and
the surgeon usually rotates this into the chest to form
the breast.
……….A surgeon usually uses tissue from the
abdomen or
back for pedicle flap surgery

49. A breast lift, also known as Mastopexy, raises the breasts
by removing excess skin and tightening the surrounding
tissue to reshape and support the new breast contour.
The goal of surgery is to improve the shape of the breast
while minimizing visible scars.
Reasons for Mastopexy
To restore a better breast shape following pregnancy &
breastfeeding.
To improve breast contour after significant weight loss.

50. RISKS AND COMPLICATIONS
………Bleeding or blood clots
………Infection
………Potential complications with anesthesia
………Fluid buildup in the breast or at the
donor site (for skin flap surgery)
….........Extreme fatigue
………Slow or disrupted wound healing

51. COMPLICATIONS…..
Tissue death, or necrosis, which may develop in the skin, fat, or
tissue flap
Loss of muscle strength at the donor site (for skin flap surgery)
Changes in breast or nipple sensation
Need for more surgical procedures if complications occur
Uneven breasts
Problems with the implant, such as movement, rupture, leakage,
or scar tissue
Need to have the implants removed

52. CLEFT LIPAND PALATE REPAIR
Cleft lip and cleft palate are some of the most common birth
defects.
This type of plastic surgery is designed to correct this
abnormal development and restore a more normal appearance.
Cleft lip and cleft palate are openings or splits in the upper lip,
the roof of the mouth (palate) or both.
Cleft lip and cleft palate result when facial structures that are
developing in an unborn baby don't close completely.

53. SYMPTOMS
……Difficulty with feedings
…….Difficulty swallowing, with potential for
liquids or foods to come out the nose
.........Nasal speaking voice
……..Chronic ear infections

54. CAUSES
cases of cleft lip and cleft palate are caused by an
interaction of genetic and environmental factors.
In many babies, a definite cause isn't discovered.
The mother or the father can pass on genes that
cause clefting , either alone or as part of a genetic
syndrome that includes a cleft lip or cleft palate as
one of its signs

55. RISK FACTORS
Family history.
Exposure to certain substances during pregnancy. Cleft lip and
cleft palate may be more likely to occur in pregnant women who
smoke cigarettes, drink alcohol or take certain medications.
Having diabetes.
Being obese during pregnancy.

56. COMPLICATIONS
Difficulty feeding.
Ear infections and hearing loss.
Dental problems.
Speech difficulties.
Challenges of coping with a medical condition
PREVENTION
Consider genetic counseling.
Take prenatal vitamins.
Don't use tobacco or alcohol

57. TREATMENT
The goals of treatment for cleft lip and cleft palate are
To improve the child's ability to eat, speak and hear normally
and to achieve a normal facial appearance.

58. Care for children with cleft lip and cleft palate often
involves a team of doctors and experts, including:
Plastic Surgeons, ENT specialists, Pediatricians
Pediatric dentists
Nurses
Auditory or hearing specialists
Speech therapists
Genetic counselors
Social workers
Psychologists

59. SURGERY SCHEDULE
Cleft lip repair — within the first 3 to 6 months of age
Cleft palate repair — by the age of 12 months , or
earlier if possible
Follow-up surgeries — between age 2 and late teen
years
Surgery can significantly improve your child's
appearance, quality of life, and ability to eat, breathe
and talk.
Possible risks of surgery include bleeding, infection,
poor healing, widening or elevation of scars, and
temporary or permanent damage to nerves, blood
vessels or other structures.

60. HAND OR FOOT SURGERY
Hand surgery can improve conditions that impair the
hand, including carpal tunnel syndrome, rheumatoid
arthritis
These surgeries can treat diseases that cause pain
and impair strength, function and flexibility in the
wrists and fingers.
They can also correct some abnormalities that may
have been present at birth.
Foot surgeries may also be available for people
affected by tumors, or by webbed or extra toes.

61. SCAR REVISION
This is a group of treatments that attempt to minimize
the appearance of a scar and help it blend in more
effectively with the surrounding skin.
Treatments can range from mild, topical treatments
and
minimally invasive procedures to surgical revision.
Know that while scars can be reduce they cannot be
completely removed.

62. Advantages of Reconstructive Surgery
The main advantage of the Reconstructive Surgery
is that it gives a normal look to the patient.
This will also have a great effect on the patient's
self esteem and will give her an emotional well
being, which is important in all aspects of life,
including the professional and personal aspects.

63. Disadvantages of Reconstructive Surgery
The main disadvantage of Reconstructive Surgery
may be the costs involved. Depending on the
complexity of the surgery, the costs may not be within
the budget of many patients.
Another disadvantage is that choosing an
inexperienced surgeon can result in poor quality
work, which may require a new surgery to fix.

64. ASSESSMENT OF SIGN & SYMPTOMS OF
INFECTION AT THE SITE OF
RECONSTRUCTION
Fever of Over 101F
Feeling of Overall Malaise
Green, Cloudy (Purulent) or Malodorous
Drainage
Increasing or Continual Pain from Wound
Redness Around Wound
Swelling of Wounded Area
Hot Skin Near Wound
Loss of Function and Movement