Cosmetic and reconstructive surgery

• Cosmetic surgery


  Reconstruction of cutaneous or underlying tissues, performed to improve and correct a structural defect or to remove a scar, birthmark, or normal evidence of aging. Also called aesthetic surgery
• Plastic surgery


  The surgical specialty or procedure concerned with the restoration, construction, reconstruction, or improvement in the form, function, and appearance of body structures that are missing, defective, damaged, or misshapen by injury, disease or anomalous growth and development. Encompasses both reconstructive and aesthetic surgery.
• Reconstructive surgery


  Surgery to rebuild a structure for functional or esthetic reasons. Surgery to rebuild damaged or lost structure, e.g. rectovaginal fistula. A procedure that attempts to restore a tissue as closely as possible to its original state.
• Layers of skin


  • Epidermis
  • Dermis
  • Hypodermis (Subcutis)
  • Skeletal musculature

  
• Wound management


  1. Objectives

  2. Phases in wound healing

  3. Considerations in an open wound assessment

  4. Strategies for the management of wounds
• Surgical wound closure


  1. Placement of sutures

  2. Suture knots

  3. Basic suture patterns

  4. Tension relieving techniques
• Tension relieving techniques


  • Undermining
  • Tension suture pattern
  • Walking suture pattern
  • Single or multiple relaxing incision
• Pedicle graft


  A portion of skin and subcutaneous tissue with a vascular attachment moved from one area of the body to another
• Flap classification by circulation

  • Subdermal plexus flap
  • Axial pattern flap (arterial pedicle graft)
  • Compound or composite flaps (e.g. myocutaneous flap, mucocutaneous flap)
• Flap classification by location

  • Local flaps
  • Rotating flaps
  • Advancement flaps
  • Distant flaps (direct, indirect)
• Principles of flap surgery

  • Plan in advance
  • Meticulous technique
  • Large enough & no tension
  • Keep flap cool & moist
  • Drain and/ or bandage
• Preparing the recipient bed

  1. Free of debris, necrotic tissue, infection

  2. Excision of chronic granulation tissue healthy granulation bed within 3-5 days

  3. Removing the epithelialized borders on the wound
• Subdermal plexus flaps


  • Advancement, rotational & transposition
  • Delayed SPF
  • Distant flaps
  • Width of the flap should be no greater than the base
  • Gentle tissue handling
  • No tension on the closure line
• Subdermal plexus flaps


  • Single advancement flap
  • Bipedicle advancement flap
  • Transpositional flap (90°)
  • Transpositional flap (45°)
  • Rotational flap
  • Bilateral rotation flaps
  • Tubed pedicle graft (indirect)
  • Direct tubed pedicle graft (Pouch pedicle graft)
• Axial pattern flaps


  Flaps designed on the basis of the direct cutaneous artery (DCA). Principles: meticulous surgical technique. Indications: major surgical procedures, wide tumour excisions, avascular wound bed, extensive body wounds.
• Axial pattern flap areas

  • Omocervical A. and V.
  • Thoracodorsal A. and V.
  • Deep Circumflex Iliac A. and V.
  • Caudal Superficial Epigastric A. and V.
  • Direct Cutaneous Artery (DCA)
• Skin graft


  A segment of epidermis and dermis that is completely removed from the body and transferred to a recipient site
• Skin graft classifications


  • Autografts (autogenous graft)
  • Allografts (homografts)
  • Xenografts (heterografts)
  • Isografts

  
• Skin graft classifications by thickness

  • Full thickness
  • Split-thickness

  
• Skin graft classifications by shape and size

  • Unmeshed grafts
  • Mesh grafts
  • Seed grafts
  • Strip grafts
• Skin graft acceptance ("graft take")


  • Adherence
  • Plasmatic imbibition
  • Inosculation
  • Penetration and ingrowth of new vessels
• Skin graft technique


  1. Harvesting and donor site

  2. Defatting

  3. Keep moist

  4. Suturing

  5. Bandage
• Complications of skin grafts include fluid accumulation under graft, infection, and necrosis