Although reconstructive problems can be the result of a congenital deformity, far more commonly they are associated with acquired conditions like trauma, acute or chronic medical conditions, tumors and surgical treatments. Regardless of the cause, a soft tissue or composite defect will need a functional and aesthetically appropriate reconstructive surgery. In order to accomplish this goal, as a common rule, a tissue defect is reconstructed with tissues of a similar texture/type, recruited locally or from different area of the body.
Reconstructive plastic surgery, performed in any part of the body, can be done in several different ways, depending on the nature of the problem/condition causing the acquired deformity or wound. Thus, the treatment is individually tailored so it will imitate original tissues, as best as is possible. For this purpose, treatment can range from simple dressing changes to local tissue rearrangements or flaps, to skin grafts and microsurgical distant free tissue transfers. Although some of these methods may need to be combined in the course of your treatment, for a better understanding, here are some of their common descriptions:
Dressings:
there are a wide variety of dressings available. There use is based on a number of variables, patient and wound specific. This may include 1-3 times per day applications of wet-dry sterile saline, ¼% acetic acid, ½% Dakin’s solution or Bacitracin/Bactroban/Iodosorb gel or similar ointment. VAC (vacuum assisted negative pressure dressing) is changed every three days.
Debridment:
removal of infected or non-viable tissues to reduce the risk of infection and enable a proper wound base for healing or further reconstruction; often multiple debridments are needed, together with antibiotic therapy.
Primary wound closure:
immediate, primary wound closure (example: a clean laceration or wound following a skin lesion removal)
Delayed/secondary wound closure:
if initial wound conditions do not permit immediate closure, then wound closure is done on a later date (example: a wound that initially didn’t appear clean enough to be closed immediately is closed after few days later)
Healing by secondary intention:
wounds that are not closed, but are left to heal (granulate in) on their own (example: conditions where the location of the wound, its size or patient’s health status preclude direct wound closure or other reconstructions); healing of these wounds is facilitated by some form of dressing changes.
Local tissue rearrangement:
reconstruction by recruitment of local (adjacent) tissues, enabling wound closure (examples: various rotational or advancement local flaps like z-plasty, rhomboid, bilobed or V-Y tissue rearrangements)
Skin grafts:
split thickness skin grafts transfer a fraction of the dermis from the donor site to the wound, leaving enough skin behind that the donor site will heal on its own, via dressing changes. Full thickness donor sites require primary closure since no skin is left behind. Skin discoloration, pain or scar can follow skin grafting.
Local flaps:
local tissues (fasciocutaneous, muscle or composite)used for larger wounds requiring coverage of important (vital) exposed structures; used for more complex wounds
Free flaps:
distant tissues (fasciocutaneous, muscle or composite) used for larger wounds requiring coverage of important (vital) exposed structures when no adequate local tissues are available for reconstruction. Free tissue transfer is used for coverage of complex wounds. Free tissue transfer requires microsurgical techniques.
Microsurgical technique:
the most complex reconstructions are done with the use of microsurgical instruments and techniques, ensuring precise and safe surgery.