Consider plastic surgery. What comes to mind? Probably images of women with breast implants, or maybe Michael Jackson's ever-changing looks.
Many people use the terms "plastic surgery" and "cosmetic surgery" interchangeably -- when we do that, however, we're forgetting about another type of plastic surgery: reconstructive surgery. There's a difference here because it's not all about bigger breasts and tummy tucks. Common cosmetic surgeries include procedures such as breast enlargement, liposuction, face-lifts and rhinoplasty (nose jobs), and there were about 12.5 million performed in 2009 [source: American Society of Plastic Surgeons]. Reconstructive surgeries are performed to correct abnormalities caused by congenital defects and damage caused by major trauma as well as disease, infection and tumors. Reconstructive surgery is plastic surgery that can improve how the body functions, not solely how it looks.
In 2009, 5.2 million reconstructive procedures were performed in the U.S., with tumor removal, laceration repair, scar revision, hand surgery and maxillofacial surgery rounding out the top five [source: American Society of Plastic Surgeons]. Let's look at these and other common post-trauma reconstructive surgeries, beginning with breast reduction.
Breast augmentation (implants) is the number one cosmetic surgical procedure for women [source: American Society of Plastic Surgeons]. But despite many women's desire for larger, fuller breasts, large breasts can sometimes cause problems such as chronic neck, shoulder and back pain; poor posture; and pressure on the shoulders from bra straps. Breast reduction surgery, also called reduction mammaplasty, can reduce these symptoms by reducing the size and shape of the breasts.
During the procedure, a plastic surgeon removes fat, glandular tissue and skin from the breasts. It's major surgery, and the results are permanent -- well, as permanent as gravity will allow. Like all surgeries, there are risks. Patients undergoing breast reduction surgery have a chance of developing infection, scarring, loss of sensation, asymmetrical appearance and an inability to breast-feed [source: Mayo Clinic].
Nearly 490,000 tumor removal surgeries were performed in 2009, making it one of the most common reconstructive surgeries [source: American Society of Plastic Surgeons]. Both benign (noncancerous) and malignant (cancerous) tumors can be removed with reconstructive surgical techniques, depending on the tumor's size, its type and where it's located. While small tumors may be removed with a scalpel and stitches, large tumors and skin cancers often require procedures that leave behind significant tissue or result in bone loss. With reconstructive techniques such as skin grafts or skin flaps, surgeons can restore functionality -- like swallowing in the case of throat tumors -- while minimizing scarring.
Trauma from burns often requires a combination of emergency care, reconstructive surgery, physical therapy and rehabilitation [source: Wake Forest University Baptist Medical Center]. Reconstructive surgery for burn survivors can help reduce physical disfigurement and relieve disabilities caused by skin grafts and scarring. Third-degree burns, also known as full thickness burns, cause damage so severe the wound can't heal without surgery. These surgical procedures often include debriding -- cleaning all dead tissue from the wound -- and skin grafts -- when skin from a donor site on the body is used to replace the skin injured by the burn -- among other necessary treatments.
For example, after removing all the dead tissue from within the burn site, surgeons may determine that tissue is needed to fill out the injured part of the body before skin grafts can be done. One new treatment is Integra, an artificial skin that contains shark cartilage. It's applied to burn wounds to help with tissue regeneration. Integra acts in two ways: The top layer works like skin, protecting the wound, while the bottom layer helps to regenerate skin tissue. When ready, the top layer of Integra is removed from the wound and replaced with a skin graft.
Reconstructive burn surgeries usually target the scarring left behind from the trauma, and for some patients, the process can span several years. Integra is also used in surgeries to reduce the scar tissue that results from severe burns.
Trauma, whether accidental or part of recovery from surgery, can cause scars to form. Scars are the body's way of protecting itself when the skin becomes injured. There are a few different types of scars: Hypertrophic, keloids and contractures are often severe enough to qualify as candidates for scar revision because they're typically thick, uncomfortable or reduce mobility. Minor scars that don't affect mobility or functionality (such as scarring from acne) aren't usually candidates for reconstructive surgeries, but rather could be minimized with cosmetic surgery.
Depending on scar tissue's type and location, scar revision surgery may help. Scar revision surgeries include procedures that can remove excess scar tissue, reposition the scar and minimize the scar's appearance, including the following treatments:
- Z-plasty for repositioning scars
- Skin flap closure for repositioning
- Tissue expansion for stretching the skin, making way for the scar to be removed and replaced with new skin
- Skin grafts, which leave behind a scar that's not as thick or impairing
Treatments won't make scars disappear, but they can help to reduce their appearance, make the scarred area smoother, and restore muscle and tendon functionality.
Reattachment surgery is probably not going to be high on anyone's plastic surgery wish list. And who can forget one of the most famous reattachment surgeries: John Bobbitt's penis reattachment after the infamous domestic dispute with his wife in the early 1990s.
Reattachment surgery commonly involves reconnecting appendages -- fingers, toes, hands, feet, arms, legs -- to the body, while treating damaged tendons and nerves, arteries and veins, blood vessels and even bone. Timing is key with reattachments -- a severed body part has the best chance of successful replantation if surgery is performed within four to six hours from when it was amputated [source: U.S. National Library of Medicine].
While a breast lift or breast enlargement would be considered cosmetic surgery, breast reconstruction can be an important part of treatment and recovery for women who have undergone a partial or complete mastectomy.
With this type of breast surgery, breast size, shape and appearance can be restored to something close to natural. Breast reconstruction can require several surgeries, depending on what the woman desires and how much tissue is left at the removal site. One of the most common procedures in the process is skin expansion, a technique that helps the skin expand to the new breast shape, followed by the placement of implants. If there isn't enough tissue for skin expansion, surgeons may choose to use another procedure, called tissue flap surgery. This type of surgery uses donor tissue (skin, fat and muscle) from the lower abdomen, back or buttocks to rebuild breasts. Nipple and areola reconstructive surgeries may also be needed.
Congenital anomalies can happen because of malnutrition, infection, alcohol and drug use (including some prescription drugs) during pregnancy, genetic mutations or a combination of factors. The March of Dimes estimates that 60 percent of birth defects happen for no discernible reason. About three babies out of every 100 will be born with a major birth defect [source: Nemours]. Some congenital defects require reconstructive surgery not only to correct outward appearance, but also to repair or restore day-to-day functionality.
Cedars-Sinai Medical Center cites some common cranio/maxillofacial abnormalities as examples of birth defects that result from genetic mutation or folic acid deficiency during pregnancy. Some congenital anomalies that they can repair include the following:
Surgery to correct a cleft lip not only helps to boost a child's self-confidence and remove the associated social stigma, but it's also important for correcting issues with basic functions such as eating, talking, hearing and breathing. Otoplasty, surgery to fix misshapen ears, is another common reconstructive surgery performed to correct a congenital problem.
Of the roughly 5 million reconstructive procedures done in 2009, more than 90,000 were maxillofacial surgeries [source: American Society of Plastic Surgeons]. Maxillofacial injuries are those to the head and neck region of the body.
Craniofacial injuries due to trauma or diseases such as cancer, as well as deformities such as vascular and congenital anomalies, can affect the head, face, jaw and neck. Additionally, patients with severe facial injuries are more than 60 percent likely to have concurrent trauma to the head, chest or abdomen. Such injuries may adversely affect brain, eye and spinal cord function, as well as breathing and swallowing [source: Online Surgery].
These types of injuries are often treated with soft tissue and skeletal surgeries, including presurgery 3-D modeling, bone grafting and surgery to repair damaged skin, gums, nerves and salivary glands.
Hand surgeries are one of the most common types of reconstructive surgeries; about 100,000 were performed in 2008. These surgeries may be required to repair tendons, relieve nerve problems (such as carpal tunnel syndrome) and treat joint problems, including degenerative disorders like osteoarthritis and inflammatory disease such as rheumatoid arthritis [source: Consumer Guide to Plastic Surgery]. Most often, though, surgeons are called to repair traumatic injuries that have severed tendons or nerves, to repair fractures and to reattach missing fingers. Other common hand surgeries include skin grafts, tissue regeneration and tissue transplantation.
In addition to reconstructive surgeries for repairing hand function that's compromised by trauma or degeneration, they're also performed to correct birth defects such as webbed fingers and toes, extra digits (as well as missing or duplicate digits), cleft hand and other congenital problems.
Lacerations are cuts, but when cuts are deep and jagged, they can't be healed with ointment and bandages. Lacerations can damage more than just the skin. Mild or moderate lacerations may be treated with sutures, but if the wound is severe, reconstructive surgery may be needed to repair deep tissue injuries. These range from severed tendons and nerves to damaged muscle and bone.
Most commonly, severe lacerations happen on the face, scalp and hands, and if you're young and male, you have an increased risk for this type of wound. There were more than 100,000 laceration repair surgeries performed in the U.S. in 2009. It's estimated that more than 50 percent of laceration injuries are caused by blunt trauma, with the remaining 50 percent caused by sharp objects (including metal and glass) [source: American Society of Plastic Surgeons; Singer].
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