Reconstructive surgery encompasses a huge part of plastic
surgery.
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
- 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
- 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.