Reconstructive Surgery: Procedures at a Glance
We bring back, refashion and restore to wholeness the features that nature gave but chance destroyed, not that they may be an advantage to the living soul, not as a mean artifice but as an alleviation of illness, not as becomes charlatans but as becomes good physicians and followers of the great Hippocrates. For though the original beauty is indeed restored . . . the end for which the physician is working is that the features should fulfill their offices according to nature’s decree.
Gaspare Tagliacozzi, 1597
What Is Reconstructive Surgery?
It is estimated that more that one million reconstructive procedures are performed by plastic surgeons every year. Reconstructive surgery helps patients of all ages and types – whether it is a child with a birth defect, a young adult injured in an accident, or an older adult with a problem caused by aging.
The goals of Reconstructive Surgery differ from those of Cosmetic Surgery. Reconstructive Surgery is performed on abnormal structures of the body, caused by birth defects, developmental abnormalities, trauma or injury, infection, tumors, or disease. It is generally performed to improve function, but may also be done to approximate a normal appearance.
Cosmetic surgery is performed to reshape normal structures of the body to improve the patient’s appearance and self-esteem.
Although no amount of surgery can achieve “perfection,” new advances in technology allow for marked improvements in achieving form and function thought to be impossible 10 years ago.
Who Can Benefit From Reconstructive Surgery?
There are two basic categories of patients in Reconstructive Surgery: those who have congenital deformities, otherwise known as birth defects, and those with developmental deformities, acquired as a result of accident, infection, disease, or in some cases, aging.
Some common examples of congenital abnormalities are birthmarks; cleft-lip and palate deformities; hand deformities such as syndactyly (webbed fingers), or extra or absent fingers; and abnormal breast development.
Burn wounds, lacerations, growths, moles of concern and aging problems are considered acquired deformities. In some cases, patients may find that a procedure commonly thought to be aesthetic in nature may be performed to achieve a reconstructive goal. For example, some older adults with redundant or drooping eyelid skin blocking their field of vision might have Eyelid Surgery. Or an adult whose face has an asymmetrical look because of paralysis might have a balancing Facelift. Although appearance is enhanced, the main goal of the surgery is to restore function.
Large, sagging breasts are one example of a deformity that develops as a result of genetics, hormonal changes, or disease. Breast Reduction, or reduction mammaplasty, is the reconstructive procedure designed to give a woman smaller, more comfortable breasts in proportion with the rest of her body.
In another case, a young child might have Reconstructive Ear Surgery to correct overly-large or deformed ears. Usually, health insurance policies will consider the cost of reconstructive surgery a covered expense. During your initial consultation, our staff will help you to determine the extent of your coverage as it relates to your procedure.
Certain factors may increase the risk of complications in healing, it is important to let us know prior to your procedure if any of the following apply:
- If you are a smoker
- If you have a connective-tissue disease
- If you have any areas of damaged skin as a result of radiation therapy
- If there is a possibility of decreased circulation to the surgical area
- If you have an impaired immune system, or immune system condition such as
If you regularly take aspirin or some other medication that affects blood clotting, it’s likely that you’ll be asked to stop a week or two before surgery.
Planning Your Surgery
The size, nature and extent of your particular concern will determine what treatment option is chosen and how quickly the surgery will be performed. Reconstructive surgery frequently demands complex planning and may require a number of procedures done in stages.
Because it’s not always possible to predict how growth will affect outcome, a growing child may have to plan for regular follow-up visits on a long-term basis to allow additional surgery as the child matures.
Everyone heals at a different rate-and it is not possible to provide an exact “back-to-normal” date following surgery. It is important that you carefully follow your post-operative instruction to maximize your healing time as well as results.
In the case of wound treatment, our skilled surgeons will assess its size, severity, and features, including
- Is there skin missing from the area?
- Has there been any damage to the nerves or muscles?
- Has skeletal support been affected?
Direct closure is usually performed on skin-surface wounds that have straight edges, such as a simple cut. Maximum attention is given to the aesthetic result, taking extra care to minimize any noticeable stitch marks.
A wound that is wide and difficult or impossible to close directly may be treated with a skin graft. A skin graft is a patch of healthy skin taken from one area of the body, called the “donor site,” and used to cover another area where skin is missing or damaged. There are three basic types of skin grafts.
A split-thickness skin graft, commonly used to treat burn wounds, uses only the layers of skin closest to the surface. When possible, a less conspicuous donor site will be chosen. Location will be determined in part by the size and color of the skin patch needed. The skin will grow back at the donor site, however, it may be a bit lighter in color.
A full-thickness skin graft may be used to treat a burn wound that is deep and large, or to cover jointed areas where maximum skin elasticity and movement are needed. A full-thickness (all layers) section of skin is lifted from the donor site. A thin line scar usually results from a direct wound closure at the donor site.
A composite graft is used when the wound to be covered needs more underlying support, as with skin cancer on the nose. A composite graft requires lifting all the layers of skin, fat, and sometimes the underlying cartilage from the donor site. A straight-line scar will remain at the site where the graft was taken, which will fade with time.
Tissue expansion is a procedure that enables the body to “grow” extra skin by stretching adjacent tissue. A balloon-like device called an expander is inserted under the skin near the area to be repaired and then gradually filled with salt water over time, causing the skin to stretch and grow. The time involved in tissue expansion depends on the individual case and the size of the area to be repaired.
The advantages of tissue expansion include:
- Offering a near-perfect match of skin color, sensation, and texture
- Decreased risk of tissue loss as the skin remains connected to its original blood and nerve supply
- Scars are less apparent than those in flaps or grafts.
Advanced Wound Care: Flap Surgery/MicroSurgery
Though success will largely depend on the extent of the injury, flap surgery and microsurgery have vastly improved the ability to help a severely injured or disfigured patient. Using advanced techniques that often take many hours and may require the use of an operating microscope, muscle or bone can be transplanted from one area of the body to another with the original blood supply in tact.
A flap is a section of living tissue that carries its own blood supply and is moved from one area of the body to another. Flap surgery can restore form and function to areas of the body that have lost skin, fat, muscle movement, and/or skeletal support.
A local flap uses a piece of skin and underlying tissue that lie adjacent to the wound. The flap remains attached at one end so that it continues to be nourished by its original blood supply, and is repositioned over the wounded area.
- A regional flap uses a section of tissue that is attached by a specific blood vessel. When the flap is lifted, it needs only a very narrow attachment to the original site to receive its nourishing blood supply from the tethered artery and vein.
- A musculocutaneous flap, also called a muscle and skin flap, is used when the area to be covered needs more bulk and a more robust blood supply. Musculocutaneous flaps are often used in Breast Reconstruction to rebuild a breast after mastectomy. This type of flap remains “tethered” to its original blood supply.
- In a bone/soft tissue flap, bone, along with the overlying skin, is transferred to the wounded area, carrying its own blood supply.
- A microvascular free flap is a section of tissue and skin that is completely detached from its original site and reattached to its new site by hooking up all the tiny blood vessels.
Other Reconstructive Procedures
In addition to correcting cuts and other surface wounds, both cancerous and non-cancerous growths and problems with the supporting structures beneath the skin can be treated with Reconstructive Surgical Procedures.
Tumors, both cancerous and benign, vary widely in type, severity and recurrence. The removal method chosen will depend largely on the type of growth, what stage it’s in, and its location on the body.
Skin cancers and growths are usually removed by excision and closure, in which the growth is simply removed completely with a scalpel, leaving a small thin scar. If the cancer is large or spreading, major surgery may be necessary, using flaps to reconstruct the affected area.
Whether the defect is congenital or acquired, Reconstructive Surgery can restore comfort, mobility, and normal appearance to patients with hand problems. Acquired defects include:
- Trauma related injuries to nerves, tendons, and skin loss of the hand.
- Fractures of the finger and hand.
- Carpal tunnel and other painful conditions caused by pressure on the nerves (usually at the wrist or elbow).
- Trigger fingers, a condition caused by swelling of a flexor tendon in the hand.
- Ganglion cysts, a benign cystic growth and scar contracture which occurs when a wound or burn on the hand heals poorly and forms scar tissue that curls the fingers or restricts mobility.
- Dupuytren’s disease, which causes a similar problem of hand contracture.
Be sure to ask questions: It’s very important to address any concerns you have with our experienced staff. All successful surgeries begin with open and honest communication between doctor and patient. Are you considering plastic surgery? Contact us to schedule a consultation and let us educate you about your options and the procedures available.