GOALS OF PLASTIC SURGERY :-•Correction of perceived disfigurement•Restoration of impaired function•Improvement of physical appearan
BENEFITS OF PLASTIC SURGERY:
•Correction of a congenital and acquired
deformity
•Correction of a perceived physical •imperfection
•Psychological benefits.
TYPES :- Plastic surgery can be divided into two major areas :-
1.Reconstructive surgery
2.Cosmetic surgery
RECONSTRUCTIVE SURGERY :-Reconst
ructive surgery is performed to correct functional impairment caused by : burn , traumatic injuries such as facial bone fractures, congenital abnormalities such as cleft lip or cleft palate, developmental abnormalities , infection or disease and removal of cancers or tumors such as mastectomy.
RECONSTRUCTIVE MODALITIES :-
Skin grafting :-
skin grafting is a technique in which a section of skin is detached from its own blood supply and transferred as free tissue to a distant (recipient) site.
Indications
•Extensive wound or trauma
•Burn
•Specific surgeries that may require skin grafts for healing
•Cosmetic reasons or reconstructive surgeries
CLASSIFICATION :-
Classification by thickness
1.Split skin grafts:- A split – thickness graft can be cut at various thickness and is commonly used to cover large wounds or defects for which a full thickness graft or flap is impractical .
2. Full thickness skin grafts:-A full thickness graft consist of epidermis and the entire dermis without the underlying fat.
3. Composite grafts
Classification by transportation of graft :-Autografts are the ideal means of covering burns wounds because the graft are patients own skin and therefore are not rejected by the patients immune system.
They can be split - thickness, full - thickness or epithelial graft.
Homografts are skin obtained from recently deceased or living humans other then the patients. Xenografts consist of skin taken from animals ( usually pig). Biodynthetic and Synthetic dressing , which may eventually replace biologic dressings as temporary wound coverings. One widely used synthetic dressing is biobrane, a dual - layer dressing of nylon and silicon. The material porous semitransparent, and sterile. Biobrane protects the wound from fluid loss and bacterial invasion.it can remain in place until spontaneous re- epithelialization and wound healing occur. It can also be laid on top of a wide meshed autograft to protect the wound until the autograft epithelium grows out to close the interstices. As the Biobrane gradually separates, it is trimmed away, leaving a healed wound.
Site selection :-
The site where the intact skin is harvested is called the donor site.
Selection of the donor site is made to match the color and texture of skin at the surgical site and to leave as little scarring as possible .
Graft application :-The skin graft is taken from the donor or host site and applied to the desired site , called recipient site bed or recipient graft bed .For a graft to survive and be effective , certain conditions must be met:-The recipient site must have an adequate blood supply so that normal physiologic function can resume.The graft must be fixed firmly so that it remains in place on the recipient site.The area must be free of infection.
Complications of skin graft and donor areas:-•Infection
•Smelly discharge from dressing
•High temperature
•Increased pain
•Redness and swelling around the skin and •donor area
•Loss of grafted skin
Care of the graft site :-
1.Protection is the key goal of caring for skin grafts postoperatvely.
2. Occlusive dressings are commonly used initially after grafting to immobilize the graft.
3. The first dressing changes is uaually performed 2 to 5 days after surgery, or earlier in the case of clinical signs of infection or bleeding.
4. The patient is positioned and turned carefully to avoid disturbing the graft or putting pressure on the graft site.
5. The patient may begin exercising the grafted area5 to 7 days after surgery. This may vary with individual burn center's protocols.
Care of Donor site :-
1.The donor site is a clean wound created in a surgical environment.
2. After the donor skin is excised, a thrombostatic agent such as thrombin or epinephrine may be applied directly to the site to decrease bleeding.
3. Donor site must remain clean, dry, and free from pressure. Beacause a donor site is usually a partial - thickness wound, it is very painful and an additional potential site of infection.
4. With proper care, the donor site should heal spontaneously within 7 to 14 days.
2. Skin flaps :-A flap is a segment of tissue that remains attached at one end while other end is moved to a recipient area.A skin flap consists of skin and subcutaneous tissue that survives based on its own blood supply .Flap may consist of skin, mucosa , mucsle , adipose tissue , omentum and bone. Indication :-Skin flaps are used to repair defects caused by congenital deformity , trauma, or tumor ablation in an adjacent part of the body.Skin flaps are also being used to heal extensive wounds from pressure ulcers .Use skin flaps for functional and cosmetic requirements for wound coverage on the face ,particularly around the eye,nose and mouth.
Free flap :-A striking advance in reconstructive surgery is the use of free flaps or free tissue transfer achieved by microvascular techniques. Methods of flap movement :-
Skin flaps can be moved to a local or distant site
.A. Local flap :-use local flaps for defects that are adjacent to the donor site.There are major types of local flaps
•Advancement flap
•Rotational flap
•Transposition flap
•Interpolation flap
The four major types of local flaps include the advancement flap (moves directly forward with no lateral movement), the rotation flap (rotates around a pivot point to be positioned into an adjacent defect), the transposition flap (moves laterally in relation to a pivot point to be positioned into an adjacent defect) and the interpolation flap.The interpolation flap is different from the others in that it rotates around a pivot point to be positioned into a nearby (but not adjacent) defect. The result is that a portion of the flap passes above or below a section of intact tissue, forming a sort of “skin bridge.” This type of flap is intended to be sectioned (separated) from the donor site in a subsequent procedure.
B. Distant Flaps :- use distant flaps to cover nonadjacent defects . They may be transferred directly , tubed or transferred by microvascular techniques.
1.Direct flap
2. Tubed flap
3. Microvascular free flap
Direct or tubed flaps involve having the flap connected to both the donor and recipient sites simultaneously, forming a bridge. This allows blood to be supplied by the donor site while a new blood supply from the recipient site is formed.Microvascular free-tissue transfer is a technique that involves the harvest of the patient's own soft tissues and/or bone from remote anatomical sites. These flaps, along with their defined vasculature, are then used to reconstruct defects.
Preoperative management :-
1.History taking
2.Physical examination
3. Encourage patients to avoid smoking and alcohol
.4. The procedure is usually done under local anesthesia, so no meals are withheld.
5. The operative site should be free of makeup.
Post operative management:-
1. Initial pressure dressing will be left in place for 24 to 48 hrs.
2. If found begins to ooze apply firm pressure for 10 -15min.
3. Do not give aspirin and aspirin containing medication.
4. Keep the graft edges moist with antibiotic ointment
5. Protect the graft from sun.
6. Avoid strenuous exercise
.COSMETIC SURGERY:-Cosmetic surgery is a very popular form of plastic surgery performed to reconstruct or alter congenital or acquired defects or to restore or improve the body’s appearance.Cosmetic surgery is performed for changes that result from aging,to alter inherited features because of a client’s personal desire.
Various cosmetic surgery procedures:-There are several operative and non-operative procedure available to improve the shape and enhance the beauty of various body parts.
A. Surgical procedures :-
Body reshaping procedures
1. Liposuction (body & facial ) surgery :- Liposuction permanently removes fat cells from these areas and the body is sculpted back into shape.
2. Tummy tuck (Abdominoplasty surgery):- liposuction which involves removing only fat allowing the skin to shrink , abdominoplasty is more extensive and is associated with removal of fat , excess skin and tightening of the musculature. Abdominoplasty takes care of the hanging abdominal skin.
3. Brachioplasty ( Arm Lift Surgery):- brachioplasty is the medical term for an upper arm lift procedure. A brachioplasty can enhance the appearance of arms that, with age or weight loss ,have lost their natural firmness and shape.
4. Thigh Lift (Thigh Plasty): A thigh lift is done to remove excess skin from the thigh and buttock area. This sagging of skin is usually caused by weight loss ar ageing.
5. Butt augmentation / implant :- Butt lift will reduce fat reshape the buttock region ; butt implant are made of silicon and have been in use for a long time .
6.Aesthetic genital surgery:- self esteem is intimately related to a person's perceived image of his or her genitalia . Self esteem may be impaired if a person feels inadequate compared with a perceived ideal.
1.male genital cosmetic surgery -
A. Penile lengthening
B.penile girth increase
2. Female genital cosmetic surgery:-
•Labia minora reduction
• Labia majora enhancement
•Pubic fat liposuction
•Pubic lift
•Vaginal tightening (VAGINOPLASTY)
Facial cosmetic procedure:-
1. Blepharoplasty :- Blepharoplasty , repairs droopy eyelids by removing excess skin , muscle and fat.
2. Endoscopic Forehead & Browlift :- we perform brow and forehead lifts to raise eyebrows and reduce ridge and furrow on the forehead , thus creating a smoother , more youthful appearance .
3. Rhydectomy (facelift) surgery :- Face lift or rhydectomy, is designed to restore a more youthful appearance by removing major wrinkles and sagging skin.It involves tightening of the facial and neck muscles as well as the removal of any excess skin.
4. Liposculpture :-Liposculpture , also called autologous fat transplantation or micro - lipoinjection , plumps up facial features with patients own fat , and is a popular option in anti ageing treatments.
5. Nose surgery / Rhinoplasty:-The surgery of the nose involves changes to all or some parts in the nose and reshaping.
Breast reshaping procedures:-
1. Breast implant /augmentation (mammoplasty):-Breast implant is an artificial reshaping or augmenting a breast for cosmetic reasons . Enhancement of the breasts can be done at any age after the breasts are develop. Types
● saline Breast implants
● silicon gel Breast implants
2. Breast reduction:- Breast reduction can be defined as the surgical reduction of breast volume to achieve a smaller aesthetically shaped breast mound with concomitant relief of the potential symptoms of large breast.
3. Breast lift :-Matopexy /breast lift is the procedure to breast reshape as well as reposition the breasts in its youthful position . Implant may be required to replace the loss of volume.
B.NON SURGICAL PROCEDURES:-
1.Botox
2.Fillers
3.chemical peel
1.Botulinum Toxin Injection This treatment involves injecting the botulinum toxin directly into the muscle, which blocks signals from nerve cells, preventing muscles from contracting and smoothing out their appearance.These injections can also be used for non-cosmetic reasons such as treating hyperhidrosis (excess sweating) or to lessen migraines.
2. Cosmetic fillers :-Cosmetic fillers are substances that smooth wrinkles and folds by bulking up the tissue underneath. Doctors inject them directly into problem areas. Collagen is the oldest and best-known cosmetic filler. Newer options include hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, polymethylmethacrylate beads (PMMA), and ordinary fat that comes from your own thigh or belly.
3. Chemical Peels :-Chemical peels use chemicals to remove the outer layer of skin cells on the face, removing dead skin to reveal a new and fresh layer. These come in different strengths, categorised as ‘superficial’, ‘medium’ or ‘deep’.
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