Reconstructive surgery encompasses a huge part of plastic
The defects that require reconstruction are usually created by congenital defects, trauma or by tumour surgery. The tumours that are excised can be benign or malignant. Often times I will be called after the oncologic surgeon has removed the tumour and the defect then requires reconstruction. In these cases I would have seen you prior to the surgery and the options of reconstruction will be discussed with you.
Very simply put, there are several techniques that are possible for reconstructive surgery. These include:
- Dressings are used when the defect is expected to heal on its own with time. There are many types of advanced dressings and the choice is made according to the site and the type of defect. Dressings are also used in the situation when I am preparing the defect for definitive surgery.
- Tissue grafts
- Tissue grafts are generally used for smaller or more superficial defects. Examples of tissue grafts are skin grafts, fat grafts, cartilage grafts and bone grafts. Although we are able to insert foreign material in certain places, these are not generally considered as being grafts and we refer to them as implants.
- Surgical flaps
- Surgical flaps are larger pieces of tissue that can be used to reconstruct defects. They are not grafts because they have their own blood supply and they can sustain themselves on that blood supply. These are used when the reconstruction is more demanding and the defect needs durable cover to protect structures such as nerves, vessels and bone. These surgical flaps can be taken from the adjacent areas to the defect (local and locoregional flaps) or they can be taken from a distant area. If they are taken from a distant area they mostly require connection (anastomosis) of the arteries and veins at the defect site so that the flap does not die. This is done by means of microsurgery.
- Prostheses can be made for certain defects where surgical reconstruction is not possible.
In the most part, reconstructive surgery may encompass a combination of the above techniques depending on the nature of the defect.
Generally, reconstructive surgery could be required in any area of the body where there is a defect created for whatever reason.