Reconstructive Plastic Surgery: Common Procedures

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-11-27 18:19

Reconstructive Plastic Surgery: Common Procedures

Restorations in different parts of the body are particularly common. Tumors are also removed and peripheral nerves - often microsurgically - treated. Other important areas of application for plastic-reconstructive surgery are hand surgery and burn surgery.

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Reconstructions

The restoration of functional and / or visually appealing areas of the body is an important area of activity in plastic-surgical surgery.

Face, head and neck area

In addition to congenital malformations of the face such as hemangiomas, growths of the lymphatic system or birthmarks, deformations caused by soft tissue tumors can lead to functional disorders in all areas of the head and neck, e.g. on the eyelids, ears, nose or lips. Treatment goals are the reconstruction or preservation of the sensory perception, the act of swallowing or the formation of the voice as well as the most favorable aesthetic result possible. In the case of complex malformations, multi-stage operative concepts are often required.

chest

Congenital malformations and the surgical removal of tumors often cause a distortion of the body shape. This can be associated with functional complaints and impair the quality of life. To regain form and function, there is a wide range of options to choose from - starting with silicone implants and moving flaps to free, microsurgical tissue transplantation. Here, skin and fat tissue can be removed from an inconspicuous donor region (e.g. lower abdomen, back, buttocks) from the patient and used to restore defects. This also makes it possible to replace a removed breast with its own tissue in an almost anatomical shape. The advantage over silicone prostheses is the lack of rejection reactions and the natural texture of the reconstructed breast.

Abdominal wall

In the area of the abdominal wall, recurrent incisional hernias may require surgical repair. Larger defects can be remedied with sliding flaps. Plastic implants are also an option for smaller fractures. However, this can lead to intolerance reactions and thus to a rejection reaction.

extremities

The multitude of different injuries and the resulting defects after tumor removal require a wide range of reconstruction methods - from simple skin grafts and nerve reconstructions to free skin-muscle-bone grafts. Nowadays it is possible to preserve the extremities in 90 percent of cases. In most cases, it is possible to maintain or restore form and function.

Genitourinary area

The most common malformations of the external genitals concern changes in the male urethra. This can be too short and open at the bottom or top of the penis. The aim is to restore the natural length and function. Urogenital malformations are less common in girls.

Surgical correction should be carried out in the first few years of life. Local tissues that are well supplied with blood are used for this, and free skin and mucous membrane transplants if necessary.

Intersex malformations require exact diagnostics, accompanying psychosocial therapy and early surgical adaptation to the definitive gender. Transsexual patients can be given a new identity through plastic-surgical adjustments to the perceived gender.

Removal of tumors

Surgical removal of malignant tumors is aimed at a cure; in the case of benign changes, the desire for an aesthetically pleasing result is often in the foreground.

skin

• Skin cancer: the complete removal of a malignant tumor (especially melanoma) is necessary with a safety margin Care is taken to leave as few visible or annoying scars as possible.
• Benign changes: These include naevi (birthmarks), superficial neoplasms of the horny layer (keratoses) and blood sponges (hemangiomas). A wide variety of surgical procedures are used to remove them. In some cases (e.g. with hemangiomas or benign changes) laser treatment is also a good option.

Soft tissues

In addition to benign neoplasms such as lipomas (fatty growths), the so-called sarcomas (malignant tumors of various soft tissues) represent a focus in tumor treatment in plastic surgery. Often, close cooperation between different disciplines (e.g. orthopedics) is necessary, with plastic surgery being a particular focused on restoring form and function.

Pedunculated or free tissue transfer and nerve transplants are often used for this. Small blood vessels of the transferred tissue block have to be reconnected to the body's circulation in order to allow blood flow and healing of the transplanted tissue. In the case of very extensive defects after a tumor resection, it may be necessary to transfer large, also "composite" blocks of tissue such as skin and subcutaneous tissue, combined with muscle, cartilage, bone or mucous membrane tissue from more distant regions of the body.

Peripheral Nerve Surgery

In addition to particularly precise anatomical and functional knowledge, this surgery also requires the skills of microsurgery. With plexus palsy (arm paralysis), the affected extremity is completely or partially unusable. During the birth process, the child can also injure the nerve plexus in the shoulder / neck area. The aim of the operation is to restore usability. Different procedures are used depending on the extent and timing of the supply.

On the one hand, the nerve plexus can be restored in the event of damage to the damaged nerve endings by microsurgical suturing (using a surgical microscope) or by nerve transplantation. If this is no longer possible, on the other hand, motor replacement operations, ie repositioning or transplantation of muscles or tendons, can improve the mobility or position of the extremity to a certain extent.

This branch of reconstructive surgery also includes the removal of nerve tumors and the surgical treatment of nerve compression syndromes ("nerve entrapment", e.g. carpal tunnel syndrome).

Hand surgery

Hand surgery deals with diseases, injuries, malformations and functional disorders of the hand and arm, especially:

• Treatment of acute injuries and their consequences,
• Nerve surgery (e.g. peripheral nerve compression syndromes such as carpal tunnel syndrome),
• Correction of hand malformations (sometimes even in early childhood),
• Rheumatoid surgery,
• Tumor surgery,
• Treatment of inflammatory joint diseases.

The most frequently performed interventions relate to the treatment of Dupuytren's contracture, peripheral nerve compression syndromes such as carpal tunnel syndrome, reconstruction of the arm nerve plexus in the case of paralysis and interventions in rheumatic diseases and deformities of the hand. The greatest progress is undoubtedly the spread of microsurgery with all its possibilities, both in the primary care of severely injured hands and in the context of secondary restorative interventions. The scope here ranges from acute replantation surgery to free functional tissue transfer for restoring function or definitive soft tissue coverage.

Burn surgery

Burn surgery deals with the largest and most sensitive human organ - the skin. If it is scalded, burned, burned, injured by electricity or lightning, a painful and protracted healing process begins. While a light burn (first degree or superficial second degree) heals on its own, more severe burns require(2b and 3 degree burns) plastic-surgical help. The burn surgeon usually has to deal with emergencies. The focus is on the stabilization of the circulation, the supply of painkillers and protection against hypothermia. Furthermore, the surgeon must prevent the large-scale wounds from becoming infected and, if necessary, carry out a skin transplant. In addition to restoring the movement functions, for example in the case of a burned and scarred elbow or elbow or fingers or hands with restricted mobility, the burn surgery also takes care of the aesthetic treatment. Disfiguring scars or burn marks are removed from visible parts of the body that cannot be hidden by clothing. For extensive burns (>10 percent body surface), treatment in a burn center is necessary.

For more information, see Emergency: Burns and Burns.

For deep burns (2b and 3 degree burns), an operation is performed within three to seven days. The dead tissue is removed (necrectomy) and the resulting wound is covered depending on the depth. Different methods can be used for this. Skin grafting is the treatment of choice for 3-degree burns. With the help of various techniques, the human surface can be enlarged up to nine times. If there is not enough healthy skin available, you can grow your own skin cells in special laboratories. Biological or synthetic skin replacement materials can also be used temporarily to cover burned areas.

Circular burns of the trunk and limbs and the necrotic scabs result in a narrowing of the surrounding skin with compression of the underlying structures. The trunk and extremities can be relieved by means of mostly zigzag-shaped incisions in superficial skin areas.

After surgical treatment and all wounds have healed, special treatment of the scars is required. Exercise therapy, scar compression using specially made suits and possibly surgical scar corrections are used.