Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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Complex fractures involve breaks where the bone is shattered (comminuted), penetrates the skin (open fracture), or involves a joint surface. These injuries disrupt the skeletal stability required for movement and weight-bearing. They often present with significant soft-tissue damage.
Reconstruction involves aligning the bone fragments and stabilizing them with internal hardware (plates, screws) or external fixators. This restores the limb’s length and alignment. Addressing the associated soft-tissue injury is critical to cover the hardware and prevent infection adequately.
Soft tissue avulsion occurs when skin and subcutaneous tissue are torn away from the underlying muscle or bone. This is common in “degloving” injuries from machinery or road rash. It leaves vital structures like tendons, nerves, and vessels exposed and vulnerable to desiccation and infection.
Reconstruction focuses on immediately covering these exposed structures. If the avulsed tissue is viable, it may be replanted. If not, skin grafts or flaps are used to provide durable coverage. The goal is to seal the wound and protect the deep anatomy.
Traumatic amputation is the complete severance of a body part. Replantation is the gold standard if the part is viable and the injury is clean (sharp cut). This involves microsurgical repair of arteries, veins, and nerves to restore blood flow and function to the severed part.
If replantation is not possible due to crush injury or contamination, reconstruction focuses on shaping the residual limb. This involves padding the bone end with muscle, ensuring good skin coverage, and preserving as much length as possible to optimize prosthetic fitting and function.
Scar contracture is a biological response to deep injury, particularly burns. As the wound heals, myofibroblasts pull the edges together, shrinking the tissue. Over a joint, this creates a tight band that physically prevents full extension or flexion.
This biological process leads to functional disability. Reconstruction involves releasing the scar band (scar release) and introducing new tissue into the gap using Z-plasties or skin grafts. This restores the surface area needed for the joint to move through its full range of motion.
Sometimes, fractured bones fail to heal (non-union) due to poor blood supply, infection, or instability. This results in a persistent “false joint” that is painful and unstable. Biological factors like smoking or diabetes can contribute to this failure.
Reconstruction involves removing the scar tissue between the bone ends and filling the gap with a bone graft. This graft provides the biological scaffold and cells needed to stimulate healing. Sometimes, vascularized bone grafts (such as the fibula) are transferred to provide a new blood supply to the non-healing site.
Trauma can sever or crush peripheral nerves, leading to loss of sensation and muscle paralysis. When a nerve is cut and not repaired, the cut end can form a painful ball of scar tissue called a neuroma. This biological response causes debilitating pain.
Reconstruction involves repairing the nerve continuity or burying the painful nerve end deep in muscle. Nerve transfers rerouting a healthy nerve to do the job of a damaged one are used to restore function in cases where direct repair is impossible.
The hand is a complex instrument of interaction. Trauma can disrupt the delicate balance of tendons, bones, and nerves. Stiffness, loss of grip strength, and loss of fine motor control are major functional issues.
Hand reconstruction is highly specialized. It involves tendon repairs, fracture fixation, and joint releases. The goal is to restore the “functional cascade” of the fingers and the opposition of the thumb, allowing the patient to grasp, pinch, and hold objects.
Facial trauma can damage the facial nerve, leading to facial paralysis. This causes functional issues like the inability to close the eye (risking corneal damage), drooling, and difficulty speaking. It also causes significant asymmetry and loss of expression.
Reconstruction aims to restore dynamic movement. This can involve nerve grafts, static suspension to support the face, or transferring muscles (like the temporalis) to reanimate the smile. Protecting the eye and restoring oral competence are the primary functional goals.
Lower extremity trauma can compromise the ability to walk. Loss of muscle compartments, instability of the knee or ankle, or leg-length discrepancies can lead to a severe limp or an inability to bear weight.
Reconstruction focuses on limb salvage and stability. This involves bone-lengthening procedures, muscle transfers to restore dorsiflexion (lifting the foot), and ensuring a stable, sensitive foot sole. The goal is a plantigrade foot that can support the body during gait.
Trauma to the face often involves fractures of the orbit (eye socket), maxilla (upper jaw), and mandible (lower jaw). These fractures can cause double vision (diplopia), malocclusion (bad bite), and airway obstruction.
Reconstruction involves accessing the fractures, often through incisions inside the mouth or eyelids, and fixing them with mini-plates. This restores the facial projection, protects the eye, and realigns the teeth for proper chewing function.
Burns destroy the skin and its appendages. Deep burns result in thick, inelastic scar tissue that does not grow with the patient or stretch with movement. This leads to contractures and aesthetic deformity.
Reconstruction is a lifelong process for burn survivors. It involves excision of scar tissue, skin grafting, and laser resurfacing to improve texture. Tissue expansion is often used to grow healthy skin to replace areas of alopecia (hair loss) or severe scarring.
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Yes, this is a scar contracture. We can perform a surgery called a “Z-plasty” or use a skin graft. This lengthens the scar and adds healthy tissue, relaxing the tightness and allowing your finger to straighten and bend freely again.
This is called osteomyelitis. It is serious. We first have to perform surgery to remove all the infected and dead bone. Then, we treat you with antibiotics. Once the infection is gone, we rebuild the bone using grafts or bone transport techniques.
Replantation is possible if the finger is preserved correctly (kept cool, not frozen) and the cut is relatively clean. We use microsurgery to reconnect the arteries, veins, and nerves. Success depends on the type of injury and how quickly you get to surgery.
If you have a large open wound on your leg with exposed bone, we might take a piece of muscle and skin from your back or thigh (a free flap) and transplant it to your leg. We reconnect the blood vessels to keep the tissue alive and cover the bone.
We make small incisions, often inside the eyelid, to reach the broken bones. We gently lift the eye back into position and place a thin sheet of titanium or plastic over the hole in the socket floor to support the eye and prevent double vision.
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