Plastic
Surgery DEFINATION AND DISCRIPTION
Plastic surgery is defined as repair or reconstruction of lost injured
or deformed parts of body chiefly by transfer of tissue. The term plastic concern moulding and reshaping of tissues and comes from Greek plastikos.
SURGICAL CONDITIONS WHERE PLASTIC
SURGERY IS HELPFUL:
1) Skin infections ( wounds, burns, injuries, after surgery)
2) Malignant and non-malignant conditions
3) Cysts
4) Cosmetic
Skin grafts:-
A skin wound as a result of surgery has a lesion which needs to be removed a lesion as in skin cancer, a severe skin infection, or from an injury or burn. If the area is small and the skin nearby is loose, the wound can be closed by bringing the edges together (direct closure). If this is not possible, then the wound can be repaired with a skin graft. Skin grafting is a surgical procedure in which a patch of skin is completely removed from another part of the body (called donor site) and used to cover the wound (called recipient site).
Types Of Skin Graft
Skin is made up of two layers: a thin outer layer called the epidermis and a thicker inner layer called the dermis.
A full
thickness skin graft is when the epidermis and all the dermis are included in the graft. No dermis is left at this donor site and the skin will not grow back. The edges of the donor site have to be stitched together to heal. For this reason, only a small patch of full thickness skin is removed. Healing usually takes seven to ten days.
A full thickness skin graft gives a better cosmetic result, and is used mainly for small defects on the face and hands. Common donor sites are the areas behind the ears, the neck, inner side of the upper arm and groin.
A partial thickness skin graft or split thickness skin is when the epidermis and only part of the dermis is included. The deeper layer of dermis is left at the donor site. This layer contains the hair follicles and other skin glands, which are capable of regenerating the skin. The donor site usually heals in ten to fourteen days. A partial thickness skin graft can be taken from any part of the body, but most commonly it is taken from the thigh or the upper arm.
Composite grafts - combinations of skin and fat; skin and cartilage; or dermis and fat, which are used in areas that require three-dimensionality, such as the nose.
Sources of skin grafts
The use of one's own skin as the source area is called an autograft. However, if there is not enough skin on the body to provide graft coverage for another area on the same body, then skin may be harvested from outside sources. Three common options:
1. Allograft : Skin taken from another human source, such as a cadaver
2. Xenograft : Skin taken from an animal source
Synthetic tissue
Reasons for Procedure
- To promote healing of:
- Large burns
- Wounds
- Varicose ulcers (venous ulcers)
- Pressure ulcers (bedsores)
- Diabetic ulcers
- To reconstruct skin removed during surgery (such as following breast cancer surgery)
Selection of donor:-
Selection of the donor site is usually based on the features wanted at the recipient site. This is more important in full-thickness grafts, because more of the characteristics of the donor site skin will be retained by the grafted material in its new location.
- Thickness, texture, pigmentation, and presence or absence of hair should be matched as closely as possible.
- When grafting in children, consider that donor sites such as the groin, axillae, thigh, and chest will grow hair at puberty, and this hair growth may be undesirable at the new location.
- Full-thickness grafts may be harvested from the upper eyelid, nasolabial fold, pre- and postauricular regions, and the supraclavicular fossa. These donor sites most often are employed to close a wound on the face or neck.
- When harvesting from the face, it is often aesthetically preferable to harvest bilaterally to maintain facial symmetry, even if the result is more skin being removed than is neessary to cover the defect. Consider the aesthetic units of the face when excising lesions and applying skin grafts.
- Less frequently used full-thickness donor sites include hairless groin skin, dorsum of the foot, wrist flexion crease, and elbow crease. Scars from skin grafts harvested from the wrist flexion crease may resemble those observed with a previous suicide attempt and probably should be avoided.
- Thick hairless glabrous skin for resurfacing the hand can be taken from the ulnar border of the hand and the sole of the foot with excellent match of colour, texture, and thickness.
- Split-thickness skin grafts may be harvested from any surface of the body, but sites should be chosen that are easily concealed in recreational clothing.
- Common sites include the upper anterior and lateral thigh. The buttocks may be used as a donor site, but the patient may complain of significant postoperative pain and will require assistance caring for the wound.
- The scalp is used for resurfacing areas of the face too large for a full-thickness graft and is especially useful in severe burns with limited donor site availability.