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Dermatology => Skin => Plastic Surgery
Plastic Surgery
INTRODUCTION
Plastic Surgery, branch of surgery, dealing with the remodeling of any portion of the human body that has been damaged or deformed. The malformation may have occurred congenitally, that is, at birth, as a child born with a cleft palate or a harelip. Disfigurement may also be the result of injury or of deforming surgery required in treating such diseases as cancer. The primary objectives of plastic surgery are the correction of defects, the restoration of lost function, and the improvement of appearance.
Plastic surgery is one of the oldest forms of surgery practiced.
Nose-reconstruction operations were probably performed in ancient India as early as 2000BC, when amputation of the nose was a form of punishment; the caste of potters eventually devised a method for rebuilding the nose by using a portion of the forehead, a technique still employed today. Some discussion of such surgery also appears in ancient Greek and Roman tracts. Significant further development of surgical techniques did not take place, however, until about the 16th century, particularly in the work of the Italian physician Gasparo Tagliacozzi. In the 20th century the psychotherapeutic importance of plastic surgery was demonstrated following World War II; victims of war wounds and burns regained the use of the injured parts of their bodies and were able to experience cosmetic improvements as well.
RECONSTRUCTIVE AND COSMETIC SURGERY
Reconstructive surgery involves the restoration of function to a damaged body part and the rebuilding of normal physical contours when parts of the body-such as the nose, jaw, ears, or fingers-are missing or disfigured. The large number of automobile accidents in modern times has resulted in many patients requiring reconstructive surgery of the face. Cancer patients who have undergone cures of the face and neck area may also need reconstructive surgery. Facial surgery is one of the most intricate aspects of plastic surgery, requiring artistic as well as technical skills. Surgery of the hand also involves complex techniques, because of grafting of tendons and the transfer of muscles to restore usefulness to the disabled part.
Plastic surgery today is often done also for cosmetic reasons, to remove blemishes or to change contours. Among the most common of the cosmetic plastic surgery operations are rhinoplasty (remodeling of the nose), oroplasty (remolding of the external ear), blepharoplasty (removing excess skin and fatty tissue from eyelids and the eye area), and face-lifting, to remove the signs of aging. Another cosmetic technique is the removal of conspicuous scars by cutting out scar tissue and adjusting the wound edges. With the growing popularity of cosmetic surgery since the 1950s, plastic surgery has become misidentified with "beauty" surgery. In fact, only a small percentage of plastic surgeons have practices limited to cosmetic operations.
GRAFTING TECHNIQUES
A major technique used in plastic surgery is grafting, the transplanting or implanting of living tissue from one part of the body to another, or from one person to another, with the expectation that the tissue will adhere and grow to supply a missing part. Several techniques of skin grafting are commonly used. One is the transfer of tissue from an adjacent part to the defect by transposition or rotation of flaps of skin. Another frequently used technique, particularly in relatively minor facial defects, is full-thickness grafting, in which the full thickness of the skin is removed and transferred as a free transplant to the defective area. A third technique, called split-thickness grafting, is used especially for severe burn victims with deep burns covering large areas of the body. By means of an electrical device called a dermatome, a piece of skin at the donor site can be removed at a precise thickness that will contain enough living dermal cells to coalesce at the burn site, while leaving enough cells at the donor site for the skin to grow back. Sometimes a burn victim's life can be saved by temporarily covering the surviving dermal cells at the burn site with skin grafts from donors who are genetically incompatible; these grafts do not survive permanently and are eventually rejected by the patient.
Other types of skin transfer are required in more complicated cases, such as those in which a full-thickness loss of the cheek or a loss of the entire nose occurs. The transplant must be nourished by blood vessels from its original site until established in its new position. In such cases, a tube-flap of skin with underlying tissue-is left to connect the transplant with its original blood supply. The procedure necessitates a two-step operation, the second step involving the removal of the connecting tube after the transplanted portion has acquired a new blood supply from the recipient site.
Other types of grafts are also employed in plastic surgery. For example, cartilage taken from a patient's rib may be sculpted to reproduce the shape of a missing ear. The cartilage is then transplanted at the site of the new ear. Bone grafts removed from the hipbone or from the rib are used to reconstruct various types of defects, for example, to replace a missing jawbone. Nerve grafts are used to alleviate facial paralysis if the facial nerve has been severed as a result of an accident.
MEDICAL TRAINING
The training requirements for a plastic surgeon include an M.D. degree, a minimum of five years of additional study and experience in an accredited general hospital, and two more years' experience as a resident in plastic surgery. The American Board of Plastic Surgery, founded in 1938, supervises the training of physicians specializing in plastic surgery and holds examinations for their certification to practice.
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