3. OVERVIEW
3
โข THE TERM "PLASTIC
SURGERY" ORIGINATES
FROM THE GREEK WORD
"PLASTIKOS," WHICH
MEANS TO MOLD OR
SHAPE.
4. INTRODUCTION
F
I
N
E
J
E
W
E
L
R
Y
4
๏ข The field of plastic surgery can be broken down into two
main categories โ
๏ข Reconstructive procedures and
๏ข Cosmetic procedures
๏ข Both are generally considered sub-specialties of
Plastic surgery
8. WHO ALL DO RECONSTRUCTIVE SURGERY
๏ข Plasticsurgeons,
๏ข Maxillo-faciasurgeons and otolaryngologists
๏ข Do reconstructive surgery on faces after trauma and to reconstruct
the head and neck after cancer
๏ข Other branches of surgery
๏ถ General surgery
๏ถ Gynecological surgery,
๏ถ Pediatric surgery
๏ถ Podiatric surgery
9. COMMON FEATURE
๏ถTo restore the anatomy or the
function of the body part to
normal
๏ถSurgery represents a small
but critical component of
the comprehensive care of
cancer patients.
11. CONGENITAL
โข CLEFT LIP AND CLEFT
PALATE:
โข Using local flaps and grafts,
surgeons can repair the
โข incompletely fused area of the lip
and palate.
โข VASCULAR ANAMALIES:
โข Arteriovenous malformations
(AVM) and certain
haemangiomas
F
I
N
E
J
E
W
E
L
R
Y
11
12. CONGENITAL
PROMINENT EARS, CONSTRICTED EARS AND MICROTIA
โข Reconstructive surgery is used to
correct all manner of ear defects;
techniques include otoplasty for
prominent or constricted ears and
โautogenous ear reconstructionโ
for the treatment of microtia.
F
I
N
E
J
E
W
E
L
R
Y
12
13. CONGENITAL
โข Hypospadias
โข Soft tissue reconstruction is used
to correct this defect of the
urethra in baby boys.
โข Craniofacial conditions
โข Reconstructive surgery is used to
correct a wide range of cranial
and facial deformations, such as
craniosynostosis
F
I
N
E
J
E
W
E
L
R
Y
13
15. CONGENITAL
HAND DEFORMITIES
โข Plastic surgeons can
also correct birth
defects of the hand
โ e.g. where a child
has been born with
too many or too few
digits.
F
I
N
E
J
E
W
E
L
R
Y
15
16. ACQUIRED
๏ขAcquired conditions are those that develop or occur after birth.
๏ขThey can involve disease and infection, or they can involve
accident and injury.
๏ข Acquired conditions that are treated with reconstructive surgery
include as follows.
F
I
N
E
J
E
W
E
L
R
Y
16
17. ACQUIRED
โข CANCER
โข Reconstructive surgery,
mainly excision, closure
and flap reconstruction, is
used to treat a range of
cancer conditions,
especially cancer of the
skin, breast, head and
neck and sarcoma
F
I
N
E
J
E
W
E
L
R
Y
17
18. ACQUIRED
โข TRAUMA
๏ข Reconstructive surgical techniques are
crucial in the treatment of trauma and
injury.
๏ข These injuries most commonly involve
the hand โ in fact, 50% of the work
carried out in many plastic surgery units
is concerned with hand trauma.
๏ข The treatment of open fractures of the
lower limb is also common, as is
surgery to repair soft tissue injuries of
the face.
F
I
N
E
J
E
W
E
L
R
Y
18
19. ACQUIRED
โข INFECTION
โข Reconstructive surgery is used to
remove dead tissue following severe
infections and to repair the
surrounding area.
โข BURNS
โข Plastic surgeons are the primary
clinicians involved in the resuscitation,
surgical treatment and reconstruction
of patients who have suffered burns
F
I
N
E
J
E
W
E
L
R
Y
19
20. TECHNIQUES
TISSUE EXPANSION
o Tissue expansion is a procedure that enables the
body to โgrowโ extra skin by stretching
surrounding tissue.
๏ข A balloon-like device called an expander is inserted
under the skin near the area to be repaired, and is
then gradually filled with salt water, causing the skin
to stretch and grow.
๏ข The time involved in tissue expansion depends on
the individual case and the size of the area to be
repaired.
F
I
N
E
J
E
W
E
L
R
Y
20
21. TECHNIQUES
SKIN GRAFTS
โข A skin graft involves taking a healthy
patch of skin from one area of the
body, known as the donor site, and
using it to cover another area
where skin is missing or damaged.
โข The piece of skin that is moved is
entirely disconnected, and requires
blood vessels to grow into it when
placed in the โrecipient site
F
I
N
E
J
E
W
E
L
R
Y
21
24. TECHNIQUES
FLAP SURGERY
โข 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.
๏ข Unlike a skin graft, flaps carry their own blood supply,
So can be used to repair more complex defects.
๏ข Flap surgery can restore form and function to areas of the
body that have lost skin, fat, muscle movement, and / Or
skeletal support.
F
I
N
E
J
E
W
E
L
R
Y
24
25. TECHNIQUES
THREE MAIN TYPES OF
FLAP
1.LOCAL FLAP
๏ข Uses a piece of skin and
underlying tissue that lie near to
the wound.
๏ข 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.
F
I
N
E
J
E
W
E
L
R
Y
25
26. TECHNIQUES
2.REGIONAL FLAP
โซIt uses a section of tissue that
is attached by a specific blood
vessel.
โซWhen 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.
F
I
N
E
J
E
W
E
L
R
Y
26
27. TECHNIQUES
REGIONAL FLAP
โข This pictures shows
muscle from the calf
being transferred,
keeping its blood
supply intact to cover
an open fracture
below the knee.
F
I
N
E
J
E
W
E
L
R
Y
27
28. TECHNIQUES
3.FREE FLAP/MICROSURGERY
๏ข 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.
๏ข 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.
F
I
N
E
J
E
W
E
L
R
Y
28
29. TECHNIQUES
FREE FLAP/MICROSURGERY
The patient has an open fracture of his
right lower leg. A muscle is taken from
his inner left thigh and transferred to
his right leg. The blood vessels that
keep this muscle alive are dissected out
of his left thigh along with the flap,
divided, and then joined up micro
surgically to blood vessels in his right
leg.
F
I
N
E
J
E
W
E
L
R
Y
29
31. COMMON TYPES OF RECONSTRUCTIVE
SURGERIES
31
F
I
N
E
J
E
W
E
L
R
Y
BREAST RECONSTRUCTION SURGERY
๏ข The goal of breast reconstruction is to reform or
reshape one or both breasts after a mastectomy or
lumpectomy.
๏ข This reconstruction process can help a person find
their self-confidence again and feel better during their
cancer recovery
๏ข Although many factors can help determine the most
suitable type of breast reconstruction, there are three
main options
32. BREAST RECONSTRUCTION SURGERY
32
F
I
N
E
J
E
W
E
L
R
Y
โซThere are three main options
โซ Implants or prosthetics:
โข This type of surgery uses silicone or saline implants.
โซ Autologous or skin flap surgery:
โข This method uses tissue from another part of the
โข body.
โซ Combined:
โข In some cases, a surgeon might use a combination of both techniques to
create a more natural reconstruction of the breast or breast
34. BREAST RECONSTRUCTION SURGERY
โข IMPLANTS:
โข 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.
โข 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.
โข 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.
F
I
N
E
J
E
W
E
L
R
Y
34
36. IMPLANTS
โข 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.
โข 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.
๏ข 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.
F
I
N
E
J
E
W
E
L
R
Y
36
38. SKIN FLAP SURGERY
๏ข With skin flap surgery, the surgeon takes tissue from
another part of the body and moves it to the chest to
rebuild the breast.
๏ข 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.
๏ข Two methods are available for this surgery:
๏ข Free flap surgery
๏ข Pedicle flap surgery
F
I
N
E
J
E
W
E
L
R
Y
38
39. SKIN FLAP SURGERY
โข FREE FLAP SURGERY
โข In free flap surgery, a surgeon completely removes
the tissue and the blood vessels that provide it with
circulation for placement in the breast.
F
I
N
E
J
E
W
E
L
R
Y
39
40. SKIN FLAP SURGERY
โข PEDICLE FLAP SURGERY
๏ข 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.
๏ข A surgeon usually uses tissue from the
abdomen or back for pedicle flap surgery.
F
I
N
E
J
E
W
E
L
R
Y
40
41. RISK AND COMPLICATION
๏ข Bleeding or blood clots
๏ข Infection
๏ข Potential complications with anesthesia
๏ข Fluid buildup in the breast or at the donor site (for skin flap
surgery)
๏ข Extreme fatigue
๏ข Slow or disrupted wound healing
๏ข Tissue death, or necrosis, which may develop in the skin, fat, or
tissue flap
F
I
N
E
J
E
W
E
L
R
Y
41
42. RISK AND COMPLICATION
๏ข Uneven breasts.
๏ข Problems with the implant, such as movement , rupture, leakage,
or scar tissue.
๏ข Changes in breast or nipple sensation
๏ข Need for more surgical procedures if complications occur
F
I
N
E
J
E
W
E
L
R
Y
42
43. COMMON TYPES OF RECONSTRUCTIVE
SURGERIES
โข BREAST REDUCTION SURGERY:
โข Also called reduction mammaplasty, breast
reduction is a procedure that removes excess
breast fat , tissue and skin to reach a breast
size thatโs more in proportion with the body.
๏ข It can also be to relieve discomfort from
overly large breasts.
๏ข Men can also undergo breast reduction.
F
I
N
E
J
E
W
E
L
R
Y
43
44. CLEFT LIP AND PALATE REPAIR
F
I
N
E
J
E
W
E
L
R
Y
44
45. CLEFT LIP AND PALATE REPAIR
โขSYMPTOMS
๏ข Difficulty with feedings
๏ข Difficulty swallowing, with
potential for liquids or foods
to come out the nose
๏ข Nasal speaking voice
๏ข Chronic ear infections
F
I
N
E
J
E
W
E
L
R
Y
45
46. CAUSES
โข Interaction of genetic and environmental factors
โข A definite cause isn't discovered.
โขRISK FACTORS:
โข Family history.
โข Exposure to certain substances during pregnancy
โข Having diabetes.
โข Being obese during pregnancy
โข COMPLICATION:
๏ข Ear infections and hearing loss.
๏ข Dental problems , Speech difficulties
F
I
N
E
J
E
W
E
L
R
Y
46
47. TREATMENT
โข 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
๏ข Team of doctors and experts, including:
โซ Plastic Surgeons, ENT specialists, Pediatricians
โซ Pediatric dentists , Orthodontists,
โซ Nurses
โซ Auditory or hearing specialists
โซ Speech therapists
โซ Genetic counselors
โซ Social workers
โซ Psychologists
F
I
N
E
J
E
W
E
L
R
Y
47
48. CLEFT LIP AND PALATE REPAIR-
SURGERY SCHEDULE
๏ข Cleft lip repair โ within the first 3 to 6 months of
age
๏ข Cleft palate repair โ by the age of 12 months, or
earlier if possible
๏ข Follow-up surgeries โ between age 2 and late
teen years
F
I
N
E
J
E
W
E
L
R
Y
48
49. COMMON TYPES OF RECONSTRUCTIVE
SURGERIES
โข HAND AND FOOT SURGERY:
โข Carpal tunnel syndrome,
โข Rheumatoid arthritis and Dupuytren's contracture
โข These surgeries can treat diseases that cause pain and impair
strength, function and flexibility in the wrists and fingers.
๏ข They can also correct some abnormalities that may have been
present at birth.
๏ข Foot surgeries may also be available for people affected by
tumors, or by webbed or extra toes
F
I
N
E
J
E
W
E
L
R
Y
49
51. SCAR REVISION:
o 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.
๏ข Treatments can range from mild,
topical treatments and minimally
invasive procedures to surgical
revision.
๏ข Know that while scars can be reduce they
cannot be completely removed.
F
I
N
E
J
E
W
E
L
R
Y
51
COMMON TYPES OF RECONSTRUCTIVE
SURGERIES
52. ADVANTAGES AND DISADVANTAGES OF
RECONSTRUCTIVE SURGERY
โข Advantages of Reconstructive Surgery:
โข It gives a normal look to the patient.
โข A great effect on the patient's self esteem and will give her an
emotional well being,
โข Disadvantages of Reconstructive Surgery:
โข costs involved
โข Poor quality work ,which may require a new surgery to fix
F
I
N
E
J
E
W
E
L
R
Y
52
53. NURSES ROLE
F
I
N
E
J
E
W
E
L
R
Y
53
ASSESSMENT OF SIGN & SYMPTOMS OF INFECTION
AT THE SITE OF RECONSTRUCTION
๏ข Fever of over 101F
๏ข Feeling of overall malaise
๏ข Green, cloudy (purulent) or malodorous
drainage
๏ข Increasing or continual pain from
wound
๏ข Redness around wound
๏ข Swelling of wounded area
๏ข Hot skin near wound
๏ข Loss of function and movement
54. NURSES ROLE
54
F
I
N
E
J
E
W
E
L
R
Y
๏ข ASSESS COLOR OF FLAP:
โซ Dusky? Blue? Pink? Pale?
๏ข Assess flap for changes in size and swelling:
ASSESSING DRAIN STATUS:
โข Jps are to be stripped Q2 hrs for 48 hrs
โข to prevent clotting.
โข Penroses are to be rolled q2 hrs for 48
โข hrs to express fluid out and prevent
โข swelling.
CHECKING CIRCULATION OF THE FLAP:
56. TIPS TO REMEMBER AND THINGS TO REPORT
TO PHYSICIAN
๏ข The donor extremity site must be elevated at all times.
๏ข Call physician immediately for and change in color, dopple
sounds, or increased swelling/firmness at the related flap or
donor site.
๏ข Confirm that all flap patients have a blood thinner ordered to
assist with perfusion to flap area.
F
I
N
E
J
E
W
E
L
R
Y
56
57. COSMETIC SURGERY
57
F
I
N
E
J
E
W
E
L
R
Y
Cosmetic surgery is performed to
enhance overall cosmetic appearance
by reshaping and adjusting normal
anatomy to make it visually more
appealing. Unlike reconstructive
surgery, cosmetic surgery is not
considered medically necessary.
60. TYPES OF SURGICAL
PROCEDURES
60
F
I
N
E
J
E
W
E
L
R
Y
โข Abdominoplasty (Tummy tuck)
โข Blepharoplasty (Eyelid surgery)
โข Phalloplasty (Penile liposuction)
โข Mammoplasty โ Breast augmentation (Breast implant)
Reduction mammoplasty (Breast reduction)
Mastopexy (Breast lift)
62. TYPES OF SURGICAL PROCEDURES
62
F
I
N
E
J
E
W
E
L
R
Y
โข Rhytidectomy (Face lift)
โข Neck lift
โข Browplasty (Brow lift or Forehead
lift)
โข Midface lift (Cheek lift)
โข Genioplasty (Chin implant)
โข Cheek augmentation (Cheek implant)
64. TYPES OF NON - SURGICAL PROCEDURES
64
F
I
N
E
J
E
W
E
L
R
Y
โข Muscle paralysis, such as injections of
botulinum toxin (Botox)
โข Dermal fillers
โข Chemical peels
โข Microdermabrasion
โข Non-surgical laser and intense light
treatments
65. ABDOMINOPLASTY
65
F
I
N
E
J
E
W
E
L
R
Y
โข Abdominoplasty or tummy tuck is a type of
cosmetic surgery used to make the abdomen
more firm.
โข The surgery involves the removal of excess skin
and fat from the middle and lower abdomen in
order to tighten the muscle and fascia of the
abdominal wall.
โข Indications - Patients with loose or sagging
tissues after pregnancy and major weight loss
66. ABDOMINOPLASTY
โข TYPES
o Complete abdominoplasty
o Partial abdominoplasty
o Extended abdominoplasty
o High lateral tension tummy tuck
o Floating abdominoplasty or FAB technique
o Circumferential abdominoplasty
F
I
N
E
J
E
W
E
L
R
Y
66
67. ABDOMINOPLASTY-RISK
โข Bleeding,
โข Fluid accumulation,
โข Poor wound healing,
โข Skin loss,
โข Anaesthesia complications,
โข Skin discoloration,
โข Asymmetry,
โข Recurrent looseness of skin,
โข Nerve damage,
โข Suture rupture or visible scar.
F
I
N
E
J
E
W
E
L
R
Y
67
68. BLEPHAROPLASTY
โข Goal - Restoration of the correct
functioning to the affected eyelids
โข Blepharoplasty or eyelid surgery is the plastic
surgery for correcting defects, deformities,
and disfigurations of the eyelids and for
modifying the eye region of the face.
โข Excision and removal, or the repositioning
(or both) of excess tissues, such as skin and
adipocyte fat, and the reinforcement of the
corresponding muscle and tendon tissues.
F
I
N
E
J
E
W
E
L
R
Y
68
69. BREAST AUGMENTATION
โข Breast augmentation or augmentation mammoplasty are plastic surgery
approaches used to increase the size, change the shape, and alter the
texture of the breasts of a woman.
โข Indication โ
o Post - mastectomy breast reconstruction
o Repair of the chest wound consequent to the removal of a cancerous
breast
o Correct congenital defects of the breast
F
I
N
E
J
E
W
E
L
R
Y
69
70. REDUCTION MAMMOPLASTY
โข Reduction mammoplasty is the plastic surgery for reducing the
size of large breasts.
โข Indications - Restoration of the bust that is proportionate to the
woman's body, of the woman's self-image, and of her mental health.
โข Contraindications โ
o Lactating women or has recently ceased lactating
o If breasts contain unevaluated tissue masses
o If she is suffering a systemic illness
F
I
N
E
J
E
W
E
L
R
Y
70
71. MASTOPEXY
โข Mastopexy or breast lift is the procedure for
raising sagging breasts upon the chest of the
woman by correcting and modifying the
size, contour, and elevation of the breasts.
โข In surgical practice, mastopexy can be
performed as a discrete breast-lift
procedure, and as a subordinate surgery
within a combined mastopexy - breast
augmentation procedure.
F
I
N
E
J
E
W
E
L
R
Y
71
72. RHINOPLASTY
โข Rhinoplasty or a nose job is a
type of plastic surgery for
correcting and reconstructing
the form, restoring the
functions of the nose.
โข Indications โ
o To resolve nasal trauma
o Congenital defect
o Failed primary rhinoplasty
F
I
N
E
J
E
W
E
L
R
Y
72
73. RHINOPLASTY
โข The non-surgical
rhinoplasty procedure
modifies slight defects of
the nose by means of
subcutaneous injections
of biologically inert
fillers.
F
I
N
E
J
E
W
E
L
R
Y
73
74. OTOPLASTY
74
F
I
N
E
J
E
W
E
L
R
Y
โข Otoplasty denotes the surgical procedure for correcting the
deformities and defects of the pinna.
โข Indications - Reconstructing a defective, deformed, or absent
external ear, consequent to congenital conditions and trauma.
76. 76
F
I
N
E
J
E
W
E
L
R
Y
๏ฑLip reduction is a surgery which is
done classically for reduction of lip
volume.
๏ฑFor macrocheilia or excessive
prominent lip
Side effects
๏ฑDrooling( due to improper closure of
the mouth)
๏ฑDifficulty in speech
LIP REDUCTION
77. LIPOSUCTION
77
F
I
N
E
J
E
W
E
L
R
Y
๏ถ Liposuction or lipoplasty is a cosmetic surgery
that removes fat from many different sites on
the human body.
๏ถ Areas affected can range from the abdomen,
thighs and buttocks, to the neck, backs of the
arms and elsewhere.
๏ถ Liposuction or lipoplasty is a cosmetic surgery
that removes fat from many different sites on
the human body.
๏ถ Areas affected can range from the abdomen,
thighs and buttocks, to the neck, backs of the
arms and elsewhere.
78. LIPOSUCTION
78
F
I
N
E
J
E
W
E
L
R
Y
Side effects
๏ผ Bruising, swelling, varying sized scars, pain
and numbness
Complications โ
oAllergic reaction to medications
oInfection
oDamage to the skin
oSkin necrosis (rare complication)
oPuncture of an internal organ
oContour irregularities
oThromboembolism
79. BOTOX
79
F
I
N
E
J
E
W
E
L
R
Y
๏ฑ Botox is a purified form of botulinum toxin
A. They work by blocking the nerves that
contract muscles, softening the appearance of
wrinkles.
๏ฑ Botulinum toxin injections block certain
chemical signals from nerves, mostly signals
that cause muscles to contract. The most
common use of these injections is to
temporarily relax the facial muscles that
underlie and cause wrinkles, such as frown
lines and forehead furrows.
๏ฑ Other conditions are lazy eye, cervical
dystonia, muscle contractures or chronic
migraine.
80. 80
F
I
N
E
J
E
W
E
L
R
Y
๏ถ Botulinum toxin injections usually
begin working a few days after treatment.
Depending on the problem being treated,
the effect may last for three to 12
months. To maintain the effect, regular
follow-up injections should be done.
๏ถ Side effects includes headaches,
bruising, pain at the site of injection,
and, in fewer than 1% of cases, drooping
eyelids or eyebrows that return to their
natural position within a few months.
81. CHEMICAL PEEL
81
โข A chemical peel is a technique used to improve
and smooth the texture of the facial skin using a
chemical solution that causes the dead skin to
slough off and eventually peel off.
โข The regenerated skin is usually smoother and less
wrinkled than the old skin.
82. CHEMICAL PEEL
82
F
I
N
E
J
E
W
E
L
R
Y
๏ฑ Possible complications
โข photosensitivity, prolonged erythema, pigmentary
changes, skin atrophy, and textural changes.
๏ฑ Types -
o Alpha hydroxy acid peels
o Beta hydroxy acid peels
o Jessner's peel
o Retinoic acid peel
83. LASER TREATMENT
โข Laser in cosmetic surgery can reduce facial wrinkles, scars and
blemishes.
โข Laser treatment can improve minor facial flaws, such as:
oFine lines or wrinkles around or under your eyes, forehead or
mouth
oScars from acne or chickenpox
oAged or sun-damaged skin
oWarts
oBirthmarks such as linear epidermal nevi
oEnlarged oil glands on the nose
83
84. HAIR TRANSPLANT
โข Common type of
treatment nowadays
โข Standard hair
restoration method
โข For severe hair fall
patients โbald people
F
I
N
E
J
E
W
E
L
R
Y
84
