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Reconstructive Surgery

RECONSTRUCTIVE SURGERY

Reconstructive surgery repairs the function and appearance of a specific body part or feature defect. It is usually performed for medical reasons, when there is traumatic injury, or when there is a congenital defect that inhibits daily living. The most common reconstructive surgical procedures are breast reduction, scar revision, tumor removal, hand surgery, laceration, repair, and maxillofacial surgery.

This is a congenital malformation that results in a physical alteration of the skin, mucosa, and muscle of the lip, with secondary deformation in the anatomy of the lower third of the nose. The intrauterine insult happens during the period of upper lip development which results in a partial to a full thickness cleft defect in the upper lip. The deformity will depend on the extent of the disturbance/disruption on the developing lip and may involve the area surrounding the lip such as nasal tip, alar lobule, collumela, and maxillary area. Cleft lip surgery restores the lip anatomy of individuals with inborn deformities, making them look as normal as possible. It could be done either as an out-patient or hospital procedure, under local or general anesthesia, depending on the age of the patient. Medical clearance for patients in the pediatric age group is usually required. There could be some lip swelling immediately after the operation, but it usually subsides after several weeks to months. Sutures are removed on the fourth to seventh day after the procedure.

A cleft palate is a congenital deformity that may occur in combination with a cleft lip. It is an inborn separation of the roof of the mouth, which acts as a barrier between the mouth and the nasal cavity. The palate, or the roof of the mouth, has a hard and soft part. When you roll your tongue upwards, you can feel the hard palate. The soft palate is way at the back, and it is integral for speech. Affected children have hypernasal speech, feeding difficulty, and frequent ear infection. Palate surgery restores the anatomy of the soft and hard palate to as normal as possible. Studies show that patients who had undergone palatal surgery also had improved hearing and a drop in ear infection rate. The procedure is done under general anesthesia and with hospital admission for a few days. Medical clearance for patients in the pediatric age group is usually required.

Female patients who have insufficient breast tissue and volume or a complete absence of the breast due to surgery (after breast cancer or breast siliconoma removal), trauma, or congenital anomaly, could undergo breast reconstruction surgery. The new breast without the nipple areola is called the breast mound. Reconstruction can be done immediately after tumor excision, or delayed for months or years depending on the need for adjuvant treatment or other medical conditions. Usually, the lower abdominal soft tissue are used and transferred to reconstruct the breast mound (TRAM). A breast implant, alone or in combination with a muscle flap, may be used after mastectomy in breast siliconoma or cancer surgery. Usually, the nipple-areolar complexes are best reconstructed after two to three months since much of the swelling of the new breast mound would be gone by then and better symmetry would be attained. The length of the operation varies according to the technique used by the surgeon. It is done under general anesthesia, with the patient confined for a few days in the hospital.

Burns are the most painful and devastating injuries that could affect man. Wounds from burn injury usually result in an unsightly and permanent scar. The scar could cause acute and chronic disabilities particularly in areas of the major joints such as the neck, knee, ankle, elbow, and shoulder. The scar in these areas tends to be thicker and less pliable thus restricting joint mobility and, consequently, causing functional disability. Plastic surgeons often refer to it as post-burn contracture, the most common morbidity or complication after a burn injury. There are several options to manage scar contracture, and they would depend on the maturity of the scar, soft tissue availability around the scar, and the involved joint. The main purpose of all surgical treatments is to release the tension created by the scar contracture over the joint thereby increasing joint mobility. This could be done by a simple Z-plasty, or local flap advancement. But there are cases that would require skin grafting and regional flap rotation to cover the defect after release. The surgery is done either as an out-patient or hospital procedure. Release of contracture would be done under local or general anesthesia depending on the extent/ complexity of the scar. Surgical splints are usually applied after the procedure, and they are removed depending on the technique used by the surgeon. Patients must be aware that some post-burn scars would require a series of operations for complete release. There are also other deformities that could result from burn injury, so feel free to ask you surgeon who must be knowledgeable about them.

A scar is the human body’s natural response to any form of bodily insult or injury. It could result from multiple causes such as surgery, trauma, disease, infection, etc. Each person is unique, in the sense that each individual has a different way of healing capability. Some would heal faster, while others would have better-looking scars. This would depend on several factors like the patient’s age, nutrition, the body parts involved, the patient’s medical condition, and so on. A plastic surgeon usually gives a scar time to mature (usually from six to 18 months) before suggesting any procedure or revision. The procedure would make the scar less noticeable or improve its appearance. Please bear in mind that a scar is permanent, and the most that could be offered is to make it more inconspicuous. The procedure is done under local anesthesia at our out-patient clinic.

A mole is usually a pigmented lesion of the skin that may have been present since birth or developed through time as we age or as a result of sun exposure. It could appear in any area of our body, but it is more noticeable on the face. There are a lot of treatment options for pigmented lesion of the skin. They include laser treatment, dermabrasion, chemical peeling, and surgical excision. Most plastic surgeons prefer to have the mass excised and the specimen submitted for histopath analysis. This is done to rule out the malignant nature of the mass, which would require a more aggressive and invasive treatment. Incision lines are usually oriented along the natural folds of the body or face to ensure that the resulting scar would be inconspicuous and fades with time. But patients must be informed that the resulting scars are much better at the face area than the extremities. The procedure is usually performed under local anesthesia at our out-patient surgery clinic. Non-absorbable sutures are usually used because they have better results compared to absorbable suture materials, and they are removed on the fourth to seventh day after the operation. The patient could experience minor swelling and bruising which eventually subsides after seven to ten days.

Microtia is a congenital deformity resulting from the failure in the development of the external ear apparatus which comprises the ear lobule, auricle (helix), tragus, and choncal depression. It could result from multiple factors such as viral infection, genetic predisposition, and anatomic deformation. The condition usually causes psychological inferiority in afflicted patients and should be addressed as early as childhood. The earliest time when ear deformity could be corrected is five years of age. Treatment options and possible complications should be discussed extensively with the surgeon. It usually requires a series of operations, with each procedure done four to six months apart. Initially, it would involve the creation of the cartilage framework with inset in a subcutaneous pocket behind the rudimentary ear. This is followed by lobule flap rotation, or elevation of the cartilage framework. The last stage of the procedure is choncal deepening, or tragal reconstruction, which results in a more natural ear. All these procedures would require hospital admission and are done under general anesthesia. Other specialty services such as those from a pediatrician and pediatric anesthesiologist may be required during the admission.

Piercing an earlobe increases the risk of tearing or stretching. Regardless of their size and shape, earrings not only exert pressure on the soft fatty tissue of the ear lobe, but they can also get tangled with clothing or seized by a child and ripped out. Tears from a tiny piercing hole can be immediately repaired. If the tear results from the gradual enlarging of the ear hole until the tiny piece of tissue at the bottom of the lobe is worn through, repair can be made after the wound has healed. Earlobe repair restores the delicate earlobe to its former shape. After the procedure, the head should be elevated during sleep, and sleeping on one’s side should be avoided. Patients may experience some numbness and mild swelling and/or discomfort at the incision site, but this is normal and will subside with time. Pain at the incision site is usually minimal, and it can be controlled with medication if necessary. The procedure is done under local anesthesia at our out-patient clinic. Sutures are removed after four to five days.