An Introduction to Reconstructive Plastic Surgery

1. An Introduction to Reconstructive Plastic Surgery Hannah Dobson

2. 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

3. 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

4. Modern Plastic Surgery Cosmetic Surgery Reconstructive 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

5. 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

6. 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’

7. 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

8. Split-thickness Skin Graft

9. Split-thickness Skin Graft

10. Full-thickness Skin Graft • Epidermis and entire dermis • Palmar surface of hand • Commonly from above the inguinal crease

11. Full-thickness Skin Graft

12. Flaps Transposition flap Advancement flap

13. Bilobed flapIntraop and at 6-weeks post-transfer

14. PedicledMyocutaneousFlap

15. Myocutaneous free flap

16. 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).

17. Sagittal Craniosynostosis

18. Apert Syndrome • Mutation in FGFR2 on chromosome 10 • Classic features • Complex, symmetrical syndactylyof hands & feet • Multi-suture synostosis • Small mid-face • Relative exorbitism

19. 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

20. Scalp is retracted

21. Frontal Advacement

22. Calvarial remodel

23. Postoperative results

24. Post-operative Results

25. Thanks!