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10.02.2016
Plastic surgery is a very wide field and has its application in rather every surgical speciality. This speciality is concerned with correction of externally apparent deformities and functional deficits.
Ancient Indian Plastic surgeon Sushrut (Father of Plastic Surgery) was famous for performing various reconstructive procedures especially of nose and ear. Purpose of plastic surgery is to restore the individual to normal whereas cosmetic surgery is an attempt to surpass the a€?normala€™ e.g. Most important role of plastic surgery is in injuries involving skin, muscle, tendons, nerves, vessels, facial bones. Face is our most important means of identity and interaction in society; also it houses all the five sense organs of body. Management of wounds especially facial and hand is no longer governed by rule of 6 hours though earlier the repair better it is. Over the past years there has been tremendous change in management of facial bone fractures.
Skin lacerations: All lacerations of face should be treated by using plastic surgery techniques so as to get better cosmetic and functional results and early recovery. Jaw bone fractures (upper as well as lower) are associated with malocclusion loss of appropriate relationship between upper & lower teeth.
Nasal bone fracture is the cause of bleeding from nose and depression or deviation of the nose. These fractures tend to get sticky by tenth day so ita€™s always better to start treatment as early as possible. Forehead fracture usually involves underlying sinus and must be treated in time otherwise this may in future be a cause of osteomyelitis (infection of bone). Firearm or blast injuries: These injuries are always associated with extensive tissue loss (soft tissue as well as bony) and wound contamination.
Clefts: Cleft lip & palate is one of the most common congenital anomaly with incidence of about one in every 600 child.
Congenital nevi (black spots): Small spots may be removed in single stage with local skin flaps but method of tissue expansion is better for larger lesions.
Two important things needed for total ear reconstruction are ear framework that is covered by skin on both sides. Ear Framework- Ear a€?frameworka€? may be made from patienta€™s own rib cartilage (preferable) or commercially available silicon or porex implant. Skin Cover- Skin on mastoid bone area ie behind the actual site of ear, is used for the cover.
Congenital deformities: Syndactyly, polydactyly, absence of thumb, contractures, constriction rings, cleft hand, macrodactyly, hypoplasia etc. Age for surgery: As far as possible all major surgical reconstructions should be complete before school going age so that maximum possible function can be achieved during development period. In fingertip injuries nail bed is usually damaged and if left unrepaired it may cause tender scar or odd looking non-adherent nail.
Severity of hand injury may vary from a simple skin laceration to loss of a major part or whole hand.
In finger tip injuries nail bed is usually damaged and if left unrepaired it may cause tender scar or odd looking non-adherent nail.
Incised or lacerated wounds on wrist or forearm are associated with tendon or neuro-vascular injuries. Reimplantation surgery: Amputated part should be cleaned, wrapped in moist saline gauge and put in a dry polythene bag. Apart from artery and vein our circulatory system consists of lymphatic vessels that run approximately parallel to blood vessels in superficial plane. Water along with certain nutrients, O2 and small amounts of plasma proteins are continuously filtered away from arterial capillaries in tissues and substances to be excreted are similarly taken back by venous capillaries. Trend now a days is of management of deep burn injuries by early excision of burn wound and skin grafting wherever possible. At times people are dissatisfied from their looks or body shape that may be changed by means of cosmetic surgery. Rhinoplasty (change in shape of nose): For broad, depressed, deviated nose, parrot beak shaped nose, acquired defects or other unsightly problems.
Genioplasty (change in shape, size of chin): For disproportionately protruding or recessed chin.
Facelift, browlift and necklift: For aging face a€” to correct wrinkles & sagging skin of face, neck and sagging eyebrows. Breast augmentation a€” For underdeveloped and small breasts that may be a cause of lack of self-confidence and depression.
Brest reduction a€” For hyperplastic, large, ptotic breasts, which not only look awkward, but are also a cause of shoulder, neck and back-ache. Breast reconstruction a€” Ita€™s needed in patients of breast cancer whose disease has been cured or in some girls with congenital absence or hypoplastic breast. Gummy smile (exposure of gums while smiling): In few persons upper teeth and gums are excessively visible while smiling. Congenital black spots (nevus), moles: Excision of small nevi or moles is an outdoor procedure. Scar revision: Revision of most of the facial scars is an outdoor procedure and hospitalisation is usually not needed.


Baldness: Surgical options for correction of baldness are hair grafting, scalp flaps or tissue expansion. Lipofilling: This is used for cheek or lip augmentation or correction of facial asymmetries by fat injections. Gynecomastia (Breast enlargement in males) : Liposuction is the best way to manage this problem if there is no glandular tissue.
Plastic Surgery is basically reconstructive surgery and covers almost every external organ of the body.
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Vitamin D3 Vegetarian vitamin D3 maximizes the bone, immune and overall health benefits beyond all other multis. Organic B Vitamins – Innovative new methods of concentrating the water soluble vitamins within organic holy basil, lemon, and guava yields a B-complex blend of unprecedented potency. A Juice Drink loaded with 7 potent antioxidants that work synergistically to richarge your body instantly. MANGOSTEEN, CRANBERRY, BARLEY GRASS, SYLIMARIN (Milk Thistle), PROMEGRANATE, GOJI BERRY and BLUEBERRY. The word a€?plastic surgerya€? has been taken from Greek word a€?Plastikosa€? meaning a€?fit for mouldinga€?. Reconstruction of damaged or lost structures is better done by principles & techniques of plastic surgery. Healing by primary intention means that after injury, wound is repaired by surgical means so as to close the gap between damaged tissue margins.
Goal of management is not only restoration of appearance but also of function, which is so much important for day to day activities. Suturing of simple facial wounds is not a job to be done in outdoor clinics with relatives holding a crying child and doctor putting stitches with local or even only vocal anesthesia. At times in badly contaminated wounds, repair may need a stage of debridement before final skin cover. CT scan especially 3D CT gives a very good view of facial skeleton and is the best tool to map out bony injuries. In cases of congenital absence of ear {microtia} there is also atresia of external auditory canal. In many situations injured person is the sole earning member of the family and any such incapacitating injury may deprive the family of its livelihood.
In case of fingertip amputations every effort is made to restore or at least preserve the remaining finger length that is so much necessary for optimum hand functioning.
Plasma proteins and other large molecules that cana€™t be taken back by venous capillaries, seek its way through lymphatics. It may be apparent in early childhood, after puberty or even in adulthood depending on severity of blockage.
The superficial burns almost always (unless infected) heal without any significant scarring in two to three weeks time.
However in case of large scars which cana€™t be removed under local anesthesia, hospitalisation for a day may be needed. Small facial spots may be excised and defect repaired by suitable plastic surgery procedure.
Fat is retrieved by liposuction and is injected in desired areas under strict aseptic and anaerobic conditions. Together with this process, skin cells from the periphery of wound margin migrate toward center of wound to cover the granulation tissue.
In cases of polytrauma priority of management depends on general condition of patient and other associated injuries.
Correction of lacerations may be simple straight line closure or may need some plastic surgery procedure like Z a€“ plasty, W a€“ plasty etc so as to give final scar line parallel to skin creases.
Open reduction and fixation of facial bones by miniplates and screws obviates the need of keeping mouth closed by inter maxillary fixation in majority of cases. Reimplantation of avulsed scalp skin is possible in selected cases and hence it should be preserved (as described in Microsurgery- reimplantation surgery) and brought to hospital with patient as early as possible.
These children may have problem in binaural hearing and in recognition of direction of sound {if deficiency in hearing is more than 15 decibel}. Goal of treatment should be restoration of a functional hand in least possible time and not just wound healing. Most often these types of injuries are caused by door hinges and children are the usual victims. Single stage repair is possible in distal penile or selected cases of mid penile varieties. Main role of these is to carry away proteins and other substances that cana€™t be reabsorbed in venous capillaries. Deep burns need specialised management so as to avoid the menace of fibrosis, scarring, disfigurement and joint contractures. We should remember that a€?once scar, always scar; ita€™s quality can definitely be improveda€?. Besides removal of excess fat and loose sagging skin, abdominal muscles are tightened also so as to restore their tone. Both types of procedures are performed by same surgeon and basic principles are also the same.


Nasal bones, mandible and zygoma are the most commonly affected bones followed by maxilla and frontal bones in decreasing order of incidence. Scarring depends on many factors such as magnitude of trauma, type of wound, type of skin, age of patient, genetic predisposition of person for scaring etc.
If laceration is repaired by ordinary suturing there may develop cross hatch marks of sutures as shown in photo. However any scar at the site of external auditory meatus may have its adverse impact on reconstructive ear surgery hence no surgery should be done for meatus or atretic canal before ear reconstruction. Seemingly minor looking lacerations may have underlying tendon, vascular or nerve injuries.
In case of finger amputations every effort is made to restore or at least preserve the remaining finger length that is so much necessary for optimum hand functioning.
With the help of microsurgery we can not only do reimplantation but also we can transfer certain body tissues (free flap) along with their blood and nerve supply (optional) to other parts of the body according to requirement. This may be congenital (absence of development or insufficiency) or acquired due to trauma, burn, infection, malignancy, radiotherapy etc. One of the main aims of cosmetic surgery is to restore the mental health of the person thus permitting return to social participation. Plastic surgeons are better trained for management of skin, nerve, vascular, tendon and muscle injuries.
Restoration of facial bony framework is always given priority over treatment of facial wounds.
In second stage this framework covered with skin, is elevated from the site where it was implanted and the defect (thus created a€“ on posterior aspect of reconstructed ear and the site from where the framework has been elevated) is covered with split skin graft. This is more so important in cases of multiple finger tip amputations, commonly seen in factory workers. Substances that cana€™t be taken back because of this blockage or insufficiency, get pooled up in subcutaneous tissues and lead to swelling. Now days ita€™s done with special syringes (tumescent liposculpture technique) that offers better results with negligible complication rate.
Plastic surgery is basically reconstructive surgery that may be related to any part of body from head to toe; be it loss of scalp, cranium, facial fracture, hand injuries, avulsion injuries or compound fractures. They must have patience and must realize that treatment is not like magic and recovery and scar maturation take time.
Facial scars can be managed at a later date but ita€™s difficult to treat a malunited fracture. Crush injuries (combined soft tissue and bony injuries) are best managed by a team of plastic surgeon & orthopaedician.
Lymph nodes are clustered in certain parts of the body in the path of lymphatics and act as filter for lymph. Ita€™s rich in plasma protein that forms coagulum, may act as substrate for thriving of bacteria and itself may lead to chronic tissue inflammation. Injuries may be in form of abrasions, lacerations, contusions, incised wounds, maxillofacial fractures, partial or total loss of parts of face (nose, ear, lip, eyelid) or burns. Management in such cases is wound debridement, skeletal fixation followed by skin cover as early as possible.
Person gets repeated infections due to increased susceptibility that further accelerates lymphatic blockage and it may become a vicious cycle. Deep lacerations may be associated with facial nerve, salivary duct or even salivary gland injury. In cases of complete clefts (cleft lip & palate) lip, alveolus and part of hard palate is repaired in first stage (after age of ten weeks). Avulsion injuries are best managed by wound debridement and provision of skin cover as early as possible.
Surgical repair of cleft lip and anterior part of palate is done at about 3 months of age provided childa€™s weight is appropriate to its age. In most of the cases of avulsion and crush injuries ita€™s possible to provide skin cover in 3 a€“ 5 days. Delay in provision of skin cover increases the chances of infection, fibrosis, scarring leading ultimately to restriction of joint movement and poor results. Orthopaedician does the skeletal fixation and plastic surgeon does wound debridement and provides skin cover. Gone are the days when these injuries were treated by dressings and dressingsa€¦ till granulation tissue was fit to accept skin graft.
In most of the cases ita€™s now possible to provide skin cover with in a week after injury, which not only improves results but also saves time and ultimately money of the patient. With proper management and follow up till the age of about 15 years child can attain normal facial development Absence, hypoplasia or other deformities of nose, eyelids or other parts. Delay in provision of skin cover increases the chances of infection, fibrosis, scarring leading ultimately to restriction of joint movement.
Once the skin cover has matured, next step is surgery for tendon or nerve repair or even tendon transfer in selected cases.



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