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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.
There are two basic categories of patients: 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.
To find out more information about the types of reconstruction offered by the Department of Plastic Surgery, click on the items below.
Information provided by the American Society of Plastic Surgeons.
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RECONSTRUCTION AFTER SKIN CANCER
Skin cancer is the most common form of cancer in the United States. More than 500,000 new cases are reported each year-and the incidence is rising faster than any other type of cancer. While skin cancers can be found on any part of the body, about 80 percent appear on the face, head, or neck, where they can be disfiguring as well as dangerous.
The different techniques used in treating skin cancers can be life saving, but they may leave a patient with less than pleasing cosmetic or functional results. Depending on the location and severity of the cancer, the consequences may range from a small but unsightly scar to permanent changes in facial structures such as your nose, ear, or lip.
Reconstructive techniques- ranging from a simple scar revision to a complex transfer of tissue flaps from elsewhere on the body-can often repair damaged tissue, rebuild body parts, and restore most patients to acceptable appearance and function.
Most skin cancers are removed surgically. The procedure may be a simple excision, which usually leaves a thin, barely visible scar. Or curettage and desiccation may be performed. In this procedure the cancer is scraped out with an electric current to control bleeding and kill any remaining cancer cells. This leaves a slightly larger, white scar. In either case, the risks of the surgery are low.
If the cancer is large, however, or if it has spread to the lymph glands or elsewhere in the body, major surgery may be required. Other possible treat- ments for skin cancer include cryosurgery (freezing the cancer cells), radiation therapy (using x-rays), topical chemotherapy (anti-cancer drugs applied to the skin), and Mohs surgery, a special procedure in which the cancer is shaved off one layer at a time. (Mohs surgery is performed only by specially trained physicians and often requires a reconstructive procedure as follow-up.)
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Information provided by the American Society of Plastic Surgeons
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CLEFT/LIP PALATE
In the early weeks of development, long before a child is born, the right and left sides of the lip and the roof of the mouth normally grow together. Occasionally, however, in about one of every 800 babies, those sections don't quite meet. A child born with a separation in the upper lip is said to have a cleft lip. A similar birth defect in the roof of the mouth, or palate, is called a cleft palate. Since the lip and the palate develop separately, it is possible for a child to have a cleft lip, a cleft palate, or variations of both.
In cleft lip surgery, the most common problem is asymmetry, when one side of the mouth and nose does not match the other side. The goal of cleft lip surgery is to close the separation in the first operation. Occasionally, a second operation may be needed.
In cleft palate surgery, the goal is to close the opening in the roof of the mouth so the child can eat and learn to speak properly. Occasionally, poor healing in the palate or poor speech may require a second operation.
A cleft lip can range in severity from a slight notch in the red part of the upper lip to a complete separation of the lip extending into the nose. Clefts can occur on one or both sides of the upper lip. Surgery is generally done when the child is about 10 weeks old.
To repair a cleft lip, the surgeon will make an incision on either side of the cleft from the mouth into the nostril. He or she will then turn the dark pink outer portion of the cleft down and pull the muscle and the skin of the lip together to close the separation. Muscle function and the normal "cupid's bow" shape of the mouth are restored. The nostril deformity often associated with cleft lip may also be improved at the time of lip repair or in a later surgery.
In some children, a cleft palate may involve only a tiny portion at the back of the roof of the mouth; for others, it can mean a complete separation that extends from front to back. Just as in cleft lip, cleft palate may appear on one or both sides of the upper mouth. However, repairing a cleft palate involves more extensive surgery and is usually done when the child is nine to 18 months old, so the baby is bigger and better able to tolerate surgery.
To repair a cleft palate, the surgeon will make an incision on both sides of the separation, moving tissue from each side of the cleft to the center or midline of the roof of the mouth. This rebuilds the palate, joining muscle together and providing enough length in the palate so the child can eat and learn to speak properly.
Information provided by the American Society of Plastic Surgeons
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CRANIOFACIAL SURGERY
Craniofacial surgery is concerned with the treatment of patients with rare and complex congenital or acquired anomalies which together affect the head, upper face and jaws. The repair of these abnormalities restores to normal and optimizes the future health and well-being of the patient as well as optimizes the educational development of the child by protection of sight, hearing and speech.
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CRANIOMAXILLOFACIAL TRAUMA
Thousands of people sustain trauma to the head and face resulting in complex soft tissue injuries as well as fractures to the underlying skeleton, which, if not correctly diagnosed and treated, may cause permanent functional and cosmetic deformities. Although immediate treatment is the best way to attain pre-injury facial appearance, advances in craniofacial surgery offer hope for patients with pre-existing post-traumatic deformities that require revisional surgery, as well.
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FLAP AND MICROSURGERY
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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.
Information provided by the American Society of Plastic Surgeons
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HEAD AND NECK CANCER RECONSTRUCTION
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The current treatment in head and neck cancer is based on combined therapy, which includes surgery, radiation therapy, and chemotherapy. The Department of Plastic Surgery works in close coordination with our colleagues in the Department of Otolaryngology and the Department of Dermatology in order to offer the highest quality care to our patients, both in the removal of the cancer and its reconstruction. Successful reconstruction requires careful preoperative patient assessment and development of an individualized treatment plan. Important considerations include tumor stage and prognosis, patient age, sex, body habitus and functional status, available reconstructive donor sites, and the psychosocial make-up of the patient. Advances in the multidisciplinary treatment of these patients have led to improvements in the quality of life after cancer reconstruction.
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UPPER AND LOWER EXTREMITY RECONSTRUCTION
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Severe upper and lower extremity trauma can be a devastating injury, leading to significant functional consequences. Advances in surgical and microsurgical techniques have dramatically improved the treatment of complex limb injuries. Injuries such as complex open fractures, injuries involving loss of skin and soft tissue, and amputations can frequently be successfully reconstructed leading to functional outcomes.
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