All Cancer surgery that are performed over face or over the head & neck lead to defects that make appearance grotesque, Immediate reconstruction by plastic Surgery can restore the appearance and help provide a socially presentable appearance. Reconstruction of facial defects following Cancer surgery has been a challenge to plastic surgeons since the beginning of this century. Old-fashioned reconstructions were done in multiple stages and use to take several months to complete. Till recently Reconstructions were done using skin and muscle (most commonly Pectoralis, the chest muscle) from the fore head or from the chest wall. These are called pedicled flap reconstruction. Such reconstructions are staged and are far from acceptable, as they appear very bulky.
Reconstructive surgery and use of Free Flaps for reconstruction of defects is the recent advance in cancer reconstruction of face and other parts of the body. These are single stage reconstructions can be combined with surgery for cancer and are called primary reconstructions. These can be performed any time from 6 weeks to several years after cancer surgery and are called Secondary Reconstructions.
The basic concept is to reconstruct a defect in all the three dimensions and all the tissues. If bone is missing bone is transferred along with skin fat muscle etc. The total material required for reconstruction is taken from the body of the same person, Most commonly from the forearm or from the legs or trunk and then it is transferred to the face, to make it survive and function the blood supply has to be restarted and this requires the skills of microvascular surgery.
Hand is the biggest gift to man kind, Life is possible without eyes but not without hands. Hand is the most commonly involved body part in accidents both at home & at place of work. Reconstruction of the hand defects and injuries to hand have to be of superlative degree and are best performed by Plastic surgeons trained in Hand surgery and microsurgery . Hand is often injured at home or at place of work. Even a simple looking cut over the hand may have damaged important structures in the depth.This is because of the complex nature of hand anatomy therefore a proper examination & repair of all the divided structures is very important for good recovery of hand function.
Injuries may be as trivial as child getting a finger in the door to complex crushing in machinery or some times complete amputation of the hand or parts of hand. Repair and restoration of all divided and damaged structures need to be done care fully under magnification for best functional recovery. Fractures of the Hand that are associated with wound needs attention of Plastic Surgeon trained in hand & microsurgery. The use of microsurgery and use of muscle flaps in the early period of injury has improved recovery and made even very severely injured limbs salvageable.
Reconstruction of hand deformities is performed keeping hand function in hand. It is possible to repair and reconstruct almost every component of hand. A missing thumb in an adult folloing injury is reconstructed by transferring the Second toe or parts of great toe to construct the thumb by microsurgery. Thumb so reconstructed has normal function.
Acid assault burns are a particularly vicious form of attack where the motive is not to kill but to cause permanent disfigurement. The priority of the acute care is to limit the damage while the priority of the reconstructive care is to restore as much as possible the patient to optimum form and function. Post-burn reconstruction is provided based on functional and aesthetic demands. Priority is always given to eye closure, oral continence, neck and limb movement. Surgery is also offered for resurfacing, hair transplantation and aesthetic nasal reconstruction.
The reconstructive sequelae for each patient group have been categorised into minor or major. Minor procedures include simple grafts for eyelid contractures, hair transplants and z-plasties. Major procedures include free tissue transfer, tissue expansion and major facial resurfacing procedures.
