Reconstructive Plastic Surgery: Common Surgical Techniques

Reconstructive plastic surgery: surgical techniques

The simplest reconstructive plastic-surgical measure consists of the direct closure of the wound, e.g. with sutures. This is followed by wound closure with skin grafts or with flaps and, as the most demanding procedure, free microvascular tissue transfer.

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Skin graft

The prerequisite is a non-infectious, well-perfused wound bed. A distinction is made between full-thickness and split-thickness skin grafts. The former contain both the upper skin (epidermis) and the underlying dermis. Split-skin grafts, on the other hand, contain epidermis, but only parts of the dermis. The graft can be thin, medium or thick depending on the dermis part. With the help of various techniques, the surface of the human can be enlarged up to nine times.

Flap plastic

Flaps of skin can be repositioned to restore shape and function to one location.

• With a local flap, a defect is in the immediate vicinity of the tissue that is used for closure. A skin area is first prepared and mobilized. The resulting flap can then be moved (advancement flap) or rotated around an axis (rotation and transposition), stretched if necessary and sewn into the wound site. In contrast to a skin graft, the local flap has its own blood supply.
• A regional, pedicled flap describes the coverage of a defect with tissue that is close to the defect, left on its vascular supply (flap pedicle) and then rotated to a different position. The tissue is only supplied by one vessel.

Free tissue transfer - microsurgery

Free tissue transfer is a surgical procedure in which tissue is removed from one part of the body (donor region) and transferred to another part of the body (recipient region). During this shift or this tissue transfer, the tissue is completely detached from the body in order to be reconnected to the blood circulation under a microscope (microsurgery).

The microsurgical technique is a prerequisite for the care of amputation injuries, in nerve surgery and for free tissue transplants in plastic-reconstructive surgery.

Microsurgical operations on the smallest vessels and nerves are carried out with the aid of a surgical microscope, special instruments and specially trained staff.

The special main areas of application are replantation (replanting) of severed limbs, care for the severing of small vessels, e.g. finger, metacarpal and foot arteries, care of nerve injuries, grafting of skin, fat and muscle flaps to fill up tissue defects after defect injury or after radical tumor removal, for complicated wounds, hand surgery in the palm area and on the fingers, for many procedures on the hands and feet of infants and small children such as toe transplants as a thumb replacement.

The restoration of muscle functions in the extremities, body trunk or internal organs (e.g. urinary bladder, esophagus) by transplanting muscles, intestinal parts or other tissue parts that are supplied with blood is part of microsurgery.