1. An Introduction to Reconstructive Plastic Surgery Hannah Dobson

2. What is Plastic Surgery  From the Greek ‘plastikos’  Reshaping the tissues of the body to restore form and function  Encompasses both cosmetic (aesthetic) and reconstructive surgery

3. Ancient Plastic Surgery  First performed by Indian potters ~3000 BCE  Ritual amputation of the nose as punishment to thieves and adulterers  Flap of tissue turned down from the forehead to cover the defect  Indian physicians used skin grafts ~800 BCE

4. Modern Plastic Surgery Cosmetic Surgery Reconstructive Surgery  Facelifts  Injectable fillers  Nose surgery  Hair replacement surgery  Breast augmentation / lift  Arm lift  Tummy tuck  Sclerotherapy  Body contouring  Liposuction  Chemical peel  Cancer  Skin, head & neck, breast and soft tissue sarcoma  Congenital  Craniofacial surgery  Cleft lip & Palate  Skin, giant naevi, vascular malformations  Urogenital  Hand and limb malformations  Trauma  Soft-tissue loss (skin, tendons, nerves, muscle)  Hand and lower limb injury  Faciomaxillary  Burns  Breast reconstruction / reduction

5. Primary Wound Closure  Clean the wound  Anaestheic  Injectable lignocaine or bupivacaine  Adrenaline to decrease bleeding  Do not use on the fingers, nose, toes or penis  Allow 5-10 minutes for the anaesthetic to take effect  Suture the wound  Face: 5/0 or 6/0  Other areas: 4/0 or 4/0  Non-absorbable sutures cause less noticeable scarring

6. Key principles  Optimise wound by adequate debridement or resection  Wound or flap must have a good blood supply to heal  Place scars carefully – lines of minimal tension  Replace defect with similar tissue – ‘like with like’  Observe meticulous surgical technique  Remember donor site ‘cost’

7. Split-thickness Skin Grafts  Epidermis and part of the dermis  Commonly from anterior or lateral aspect of the thigh  Graft obtained with a Zimmer dermatome or Humby knife

8. Split-thickness Skin Graft

10. Full-thickness Skin Graft  Epidermis and entire dermis  Palmar surface of hand  Commonly from above the inguinal crease

11. Full-thickness Skin Graft

12. Flaps Transposition flap Advancement flap

13. Bilobed flap Intraop and at 6-weeks post-transfer

14. Pedicled Myocutaneous Flap

15. Myocutaneous free flap

16. Common causes of flap failure  Poor anatomical knowledge when raising the flap (such that the blood supply is deficient from the start)  Flap inset with too much tension;  Local sepsis or a septicaemic patient;  Dressing applied too tightly around the pedicle;  Microsurgical failure in free flap surgery (usually caused by problems with surgical technique).

17. Sagittal Craniosynostosis

18. Apert Syndrome  Mutation in FGFR2 on chromosome 10  Classic features  Complex, symmetrical syndactyly of hands & feet  Multi-suture synostosis  Small mid-face  Relative exorbitism

19. Indications for fronto-orbital advancement  To release the synostosed suture and decompress the cranial vault  To reshape the cranial vault and advance the frontal bone  To advance the retruded supraorbital bar, providing improved globe protection and an improved aesthetic appearance

20. Scalp is retracted

21. Frontal Advacement

22. Calvarial remodel

23. Postoperative results

24. Post-operative Results

25. Thanks!