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Reconstruction

 

 

 

 

 

 

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With flap surgery, tissue, sometimes including underlying fat and muscle, is taken from the back and tunneled to the front of the chest wall to support the reconstructed breast.

 

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The transported tissue forms a flap to cover a breast implant, or it may provide enough bulk to form the breast mound without an implant.

 

 

 

 

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 otoplasty (outer-ear surgery) to correct overly-large or deformed ears. Usually, health insurance policies will consider the cost of reconstructive surgery a covered expense. Check with your carrier to make sure you're covered and to see if there are any limitations on the type of surgery you're planning. Work with your doctor to get pre-authorization from the insurer for the procedure.

All Surgery Carries Some Uncertainty and Risk

When reconstructive surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor. However, individuals vary greatly in their anatomy and healing ability and the outcome is never completely predictable.

As with any surgery, complications can occur. These may include infection; excessive bleeding, such as hematomas (pooling of blood beneath the skin); significant bruising and wound-healing difficulties; and problems related to anesthesia and surgery.

There are a number of factors that may increase the risk of complications in healing. In general, a patient is considered to be a higher risk if he or she is a smoker; has a connective-tissue disease; has areas of damaged skin from radiation therapy; has decreased circulation to the surgical area; has HIV or an impaired immune system; or has poor nutrition. 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

In evaluating your condition, a plastic surgeon will be guided by a se t of rules known as the reconstructive ladder. The least-complex types of treatments-such as simple wound closure-are at the lower part of the ladder. Any highly complex procedure-like micro-surgery to reattach severed limbs-would occupy one of the ladder's highest rungs. A plastic surgeon will almost always begin at the bottom of the reconstructive ladder in deciding how to approach a patient's treatment, favoring the most direct, least-complex way of achieving the desired result.

The size, nature and extent of the injury or deformity 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 plastic surgeons cannot pinpoint an exact "back-to-normal" date following surgery. They can, however, give you a general idea of when you can expect to notice improvement.

Options in Wound Treatment

In deciding how to treat a wound, a plastic surgeon must carefully assess its size, severity, and features: Is skin missing? Have nerves or muscles been damaged? Has skeletal support been affected?

As you and your plastic surgeon form your surgical plan, it's important to have a clear understanding of what will happen during the procedure. Asking questions is key to making an informed decision.

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 noticeable stitch marks.

Skin Grafts

A wound that is wide and difficult or impossible to close directly may be treated with a skin graft. A skin graft is basically a patch of healthy skin that is 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, your plastic surgeon will choose a less conspicuous donor site. 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 might 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. As its name implies, the surgeon lifts a full-thickness (all layers) section of skin 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. It will fade with time.

 

 

Advanced Wound Care: Flap Surgery/MicroSurgery

Though success will largely depend on the extent of a patient's injury, flap surgery and microsurgery have vastly improved a plastic surgeon's 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, plastic surgeons can now replant amputated fingers or transplant large sections of tissue, muscle or bone 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, plastic surgeons also regularly treat both cancerous and non-cancerous growths and problems with the supporting structures beneath the skin.

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.

 

 
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