Techniques in Plastic Reconstructive Surgery

Reconstructive surgery is a fairly unique form of plastic surgery. The goal of reconstructive surgery is to restore function and provide patients with a more normal appearance. This is in contrast to most cosmetic procedures that seek to provide patients with an ideal of beauty. Many plastic surgeons consider reconstructive surgery the noblest of disciplines within their field since they are giving people the chance at a more normal life.

 

There are generally two groups of people that seek reconstructive surgery: patients that have a disfiguring abnormality that was present at birth or patients that have had their physical appearance altered by an accident, such as a burn or trauma. In the former group, the surgeon tries to make the patient’s physical appearance more in line with what others of the same race, heritage and age group look like. In the latter group, the surgeon can work from photos of the patient to try to restore the appearance that they had prior to the traumatic accident.

 

 

Surgeons that perform reconstructive surgery need to be highly resourceful because they are trying to form normal structures from injured and misshapen skin, cartilage and bone. The new tissue not only needs to have the proper structure and contour, but it also needs to be completely covered with skin and have an abundant blood supply. Without adequate skin, there is a serious risk of infection and scarring. A rich blood supply assures timely and proper healing of the reconstructed area.

 

Blood supply is the main consideration in reconstructive surgery. If the tissue does not have enough blood getting to it, it will die or heal poorly. From this need, flap surgery was born. Every area of skin in the body has its own blood supply provided by an artery. Surgeons will identify an area of skin to be used in the reconstruction and cut the surface, leaving the blood supply intact. This skin flap is then moved underneath the skin to the area that is the focus of the reconstruction. The key here is that the artery is not stretched too much and that only the required amount of skin is moved. The skin that was donated heals in its new location and the donor area is sutured closed.

 

There are several techniques that have been pioneered and developed by reconstructive plastic surgeons that help provide useful, viable tissue. Skin grafts have been used for quite some time to provide skin to various areas of the body. They are fast, efficient, and are usually not rejected by the body. A newer method of providing skin is through skin expansion. An inflatable device is placed under the skin and inflated in small increments over time. As that skin is stretched by the device, it grows to compensate. Also, new blood vessels are created to supply that growing skin with blood. Once the skin has grown to a sufficient quantity, it can be surgically removed, its blood vessels carefully dissected and reconnected to cover the deficient area. In the future, human skin may be able to be created in a laboratory by the use of stem cells and other technologies.

 

Surgeons are continually pushing the envelope of reconstructive surgery. Surgeons are now able to suture arteries of very small diameter through a process called microsurgery or microvascular surgery. This has greatly expanded the options for reconstructive surgery and has accelerated the entire process.

 

While scientific advances have permitted new approaches to reconstructive surgery, it is still the creativity and artistic talents of the plastic surgeon that determines the outcome to a large degree. Reconstructive surgery has and continues to be a profession in which art and science are inextricably linked.