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

11n part this has been a rediscovery since much work was done by Manchot in the nineteenth century by means of cadaver dissections and Salmon in the 193 Os and 1940s by means of meticulous radiographs of injected cadaver skin.)

  parts of the body, and in the treatment of a wide variety of pathologies. These techniques can be learnt and used by other specialists, but most plastic surgeons would feel that optimal care is provided where the plastic surgeon works together with a surgeon from another discipline to each bring their own expertise to bear on the problem.

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 there is a number of reconstructive options. The reliability and quality of the reconstruction must be balanced against the donor site morbidity.

Priorities in plastic surgery

1.      Healing

2.      Function

3.      Cosmetic