Plastic Surgery
1)BURNS:-
Burns are injuries caused by heat or chemical damage. Clinically burns are Superficial or Deep.
Superfical burns are the ones where the Skin appendages as Hair Roots, Sweat glands are not burnt. The Epithelium will grow outwards from these appendages and cover the burnt areas.
Deep burns are those where the skin with the appendages is burnt. It then cannot generate any epithelium from within.
Burn area of more than 10% in child and more than 20% in adult is taken as serious and needs active medical attention in the hospital. Burn in elderly is also serious where chances of survival are calculated as- area of burn injury add age of patient This should be less than 100. The fluid needs to be replaced by Intravenous route along with liberal helping of oral fluids. If there is loss of Blood and its components as in deep burns then they need replacement.
For the burnt areas protective dressing are applied usually. The superficial burns would heal in 2-4 weeks time. Areas that are not healed by this time are Deep and require surgery. If left to its own in an average clean raw area the epithelium will grow at rate of about 1mm per day. The skin graft applied any where is taken in 5-10 days. It is therefore logical to advise skin grafting on any area above 1-2 cm. Once healed the patient is covered with epithelium(the purpose of epithelium is to provide a waterproof protective layer so that neither the body fluid leaks outside nor the infection enter inside). He is alive and home. The patient then requires long term management.
Long term management :-
The new healed skin, the graft and the donor site are neither same as normal in colour or texture.
Colour- The new skin is pink/red. The skin needs protecting from sunlight for about 3 months otherwise they tend to become Darker in colour.
Texture- If the Burn is deep or the skin graft applied is superficial then the Texture is different. This is because the normal elasticity that determines the texture is missing. This takes a longer time to return almost 6 months to 2 years.
Sometimes the loss of elasticity is permanent to some degree this leads to shrinkage and contractures.
Some patients need pressure garment to help nature. Some would require further surgery for deformities/contractures and scars .
2)Treatment of Hand Deformities, diseases and injuries (Immediate and delayed treatment -Emphasis is on hand function recovery).Hand as a unit is from tip of digits to inclusive of the wrist .The basic purpose of hand is usability which would mean reasonable in sensation (touch, protect) and function (provide Pinch and Grip function).
The thumb forms almost 40 % of the hand function.This forms the basic philosophy of hand surgery.
If the thumb or multiple digits are missing from birth or accident then reconstruction is essential using cut digit/thumb or transferring finger to make thumb or transferring toe or toes to make thumb and digit. The purpose is to provide Pinch along with grip function. This requires microvascular surgery.
3)Treatment of Birth defects as
Cleft lip and Palate, Hypospadius and Angiomas/
Cleft lip :-
Children are sometimes born with a gap in the upper lip this could be on one side or on both sides with a small middle segment attached to the nose. The defect basically a cosmetic defect in the appearance of the face of the new born.
In these children the Upper jaw bone(maxilla) does not usually grow at the same pace as the normal side . One tends to wait for this correction if possible till the face growth is complete.
Cleft Palate:-
When the birth gap is in the roof of the the oral cavity it is called Cleft palate.
These children cannot create vaccum in the throat to suck milk form
Later these children need help in learning to speak.
Even after surgery the palatal muscle is not powerful enough to stop air leak from nose at the time of speaking especially continuous speech. Speech therapy is essential to teach these children to speak. A clear audible speech is the purpose of this surgery.
Hypospadius:-
In male children the urinary opening is sometimes not present at the tip of the penis. When this opening is any where from near tip of penis to perineum on the under surface it is called Hypospadius. If the same is present on the upper surface of the penis it is called Epispadius. Epispadius is comparatively rare birth defect. Surgical correction must finish before the child goes to school.
Angiomas:-
Angiomas are defect/tumour of the blood vessles. They can be Arterial, Venous or Lymphatic or mixed.
4) Reconstructive surgery
The basic principles are:-
Replace lost tissue with as similar as possible tissue.
Provide a good skin cover-colour texture match.
Provide a good contour.
The donor area morbidity should be least.
Recovery of functional is priority over cosmetic appearance.
Work should finish fast i.e. try to finish as mush as work possible in one sitting.
Proper planning is essential. Surgical procedure is to be done because it required not because it is technically possible to do so.
Try to use simpler procedures rather than complicated procedures.
Reimplantation :- where an amputated part can be put back, be it a digit or a limb.
The reimplantation is most sucessful within 6 hours of injury.
Return Home