Reconstructive surgery is essential in order to repair wounds resulting from trauma, burn injury, infection, tumors or disease. Reconstructive surgery is performed to improve the function and physical appearance. Procedures usually involve minimal treatments such as direct wound closure to more complex procedures like microsurgery.
Reconstructive surgery requires planning and a series of procedures done in different stages. The size, nature and extent of the injury will determine what course of treatment the patient will need, type of surgery performed and length of the recovery period. The treatment of a wound or burn is carefully assessed. There are several important factors to consider including the size, severity of muscular, skeletal and nerve damage.
Minor wounds can be repaired through direct closure. This particular procedure focuses on cosmetic and aesthetic results in order to minimize scars.
More complex treatments include skin and bone grafting, tissue expansion, flap surgery, and microvascular surgery.
Skin grafts are most useful for wounds that are wide and difficult to close. A skin graft is a patch of healthy skin that is taken from one part of the body, also called the "donor site", and used to cover another area where the skin is damaged. There are three types of skin grafts including a split-thickness skin graft, a full-thickness skin graft, and a composite skin graft.
A split-thickness skin graft, commonly used to treat burn wounds, uses the layers of skin closest to the surface. If possible, the surgeon will choose a less noticeable donor site.
A full-thickness skin graft may be used to treat a burn wound that is deep and large or to cover jointed areas where skin elasticity is needed. A small scar usually results from a direct wound closure at the donor site.
A composite skin graft is used when a wound needs underlying support. A composite graft requires lifting all the layers of skin, fat, and sometimes the underlying cartilage from the donor site. A scar will remain at the site where the graft was taken but will fade with time.
A bone graft involves a surgical procedure to replace missing bone. Artificial, synthetic or natural substitutes can replace missing bone. The most ideal bone used to replace missing bone comes from the patient's own body. Usually, bone grafts are taken from the pelvis or iliac crest. Many surgeons prefer using small samples of bones from the patient, or autogenous bone grafts because there is no risk of the body rejecting the graft since it came from the same source. New bones grow between the existing bone and the graft material. Over time, the newly formed bone will replace much of the grafted material.
Tissue expansion is a fairly common procedure that enables the body to "grow" extra skin for use in reconstructing almost any part of the body. The procedure involves a silicone balloon expander which is inserted under the skin near the area to be repaired. Gradually, the area is filled with saline solution over time, enabling the skin to stretch and grow. Most commonly used for breast reconstruction, this procedure is also used to repair skin damaged by birth defects, accidents, or surgery.
Flap surgery involves the creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks.
One type of flap surgery involves tissue that remains attached to its original site, retaining its blood supply. The flap consists of skin, fat, and muscle. Another flap technique uses tissue that is surgically removed from the abdomen, thighs, or buttocks. The tissue is transplanted to the area by reconnecting the blood vessels. This procedure requires experience with microvascular surgery.
Flap surgery is more complex than skin expansion. Scars will be present at both the tissue site and on the reconstructed region.
Microvascular surgery involves the transfer of skin, muscle, or bone with the artery and vein to a site needing reconstruction. This type of surgery is used to reattach fingers, hands, arms, and other amputated parts to the body by reconnecting the small blood vessels and restoring circulation. Microvascular surgery also can be used in reconstructive surgery or soft tissue defects created by trauma or tumor surgery.