Plastic surgery sa redefining plastic and reconstructive surgery
An Introduction to Reconstructive Plastic Surgery
description
Transcript of An Introduction to Reconstructive Plastic Surgery
An Introduction to Reconstructive Plastic Surgery
Hannah Dobson
What is Plastic Surgery From the Greek ‘plastikos’ Reshaping the tissues of the body to restore
form and function Encompasses both cosmetic (aesthetic) and
reconstructive surgery
Ancient Plastic Surgery First performed by Indian potters ~3000 BCE
Ritual amputation of the nose as punishment to thieves and adulterers
Flap of tissue turned down from the forehead to cover the defect
Indian physicians used skin grafts ~800 BCE
Modern Plastic Surgery
Cosmetic SurgeryReconstructive Surgery
Facelifts Injectable fillers Nose surgery Hair replacement surgery Breast augmentation / lift Arm lift Tummy tuck Sclerotherapy Body contouring Liposuction Chemical peel
Cancer Skin, head & neck, breast and soft
tissue sarcoma Congenital
Craniofacial surgery Cleft lip & Palate Skin, giant naevi, vascular
malformations Urogenital Hand and limb malformations
Trauma Soft-tissue loss (skin, tendons, nerves,
muscle) Hand and lower limb injury Faciomaxillary Burns
Breast reconstruction / reduction
Primary Wound Closure Clean the wound Anaestheic
Injectable lignocaine or bupivacaine Adrenaline to decrease bleeding
Do not use on the fingers, nose, toes or penis Allow 5-10 minutes for the anaesthetic to take
effect Suture the wound
Face: 5/0 or 6/0 Other areas: 4/0 or 4/0 Non-absorbable sutures cause less noticeable
scarring
Key principles Optimise wound by adequate debridement or
resection Wound or flap must have a good blood supply
to heal Place scars carefully – lines of minimal tension Replace defect with similar tissue – ‘like with
like’ Observe meticulous surgical technique Remember donor site ‘cost’
Split-thickness Skin Grafts Epidermis and part of
the dermis Commonly from
anterior or lateral aspect of the thigh
Graft obtained with a Zimmer dermatome or Humby knife
Split-thickness Skin Graft
Split-thickness Skin Graft
Full-thickness Skin Graft Epidermis and entire
dermis Palmar surface of
hand Commonly from
above the inguinal crease
Full-thickness Skin Graft
Flaps
Transposition flap Advancement flap
Bilobed flapIntraop and at 6-weeks post-transfer
Pedicled Myocutaneous Flap
Myocutaneous free flap
Common causes of flap failure Poor anatomical knowledge when raising the
flap (such that the blood supply is deficient from the start)
Flap inset with too much tension; Local sepsis or a septicaemic patient; Dressing applied too tightly around the
pedicle; Microsurgical failure in free flap surgery
(usually caused by problems with surgical technique).
Sagittal Craniosynostosis
Apert Syndrome Mutation in FGFR2 on
chromosome 10 Classic features
Complex, symmetrical syndactyly of hands & feet
Multi-suture synostosis
Small mid-face Relative exorbitism
Indications for fronto-orbital advancement To release the synostosed suture and
decompress the cranial vault To reshape the cranial vault and advance the
frontal bone To advance the retruded supraorbital bar,
providing improved globe protection and an improved aesthetic appearance
Scalp is retracted
Frontal Advacement
Calvarial remodel
Postoperative results
Post-operative Results
Thanks!