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!