Plastic
surgery
Plastic surgery is defined as ‘repair or reconstruction of lost,
injured or deformed parts of the body chiefly by transfer of tissue’. The term
plastic concerns moulding and reshaping of tissues and comes from the Greek plastikos
(‘that may be moulded’). When tissues are moved or reshaped the most
important principle governing this process is respect for their blood supply.
The two fundamental methods by which tissues are moved are grafts or flaps. A
graft is a piece of tissue that is moved without its blood supply and relies on
its recipient bed to re-establish a blood supply. A flap is a piece of tissue
that is moved maintaining its blood supply and is not reliant on the recipient
site for its vascularity. Historically reconstruction was complex and
multistage, with ample opportunity for vascular complications to arise. In the
last 30 years there has been a revolution in our understanding of the blood
supply of the skin and of other tissues(1). Flaps can now be reliably designed
on single named blood vessels, greatly increasing their power and versatility.
Plastic surgical techniques are used in a wide variety of surgical procedures
in all
(
Priorities
in reconstruction
When presented with any defect it is important to recognise that the
most important priority is to achieve primary healing. The purpose of
reconstructive procedures is to avoid the adverse consequences of healing by
second intention in terms of delay and poor function. If one can achieve quiet
primary healing and thereby restore the patient to function a superior result in
terms of appearance will usually result. It is essential, however, that these
three priorities are observed in the correct order: first healing, then function
and lastly appearance. Where these aims cannot be achieved by direct closure of
a wound a more complex technique is selected from the reconstructive toolbox.
Planning and selection are central to the practice of plastic surgery. In any
one patient
Priorities
in plastic surgery
1. Healing
2. Function
3. Cosmetic