Reconstructive plastic surgery is a distinct area of plastic surgery which differs from cosmetic surgery. While the goal of cosmetic surgery is to enhance or alter the normal appearance, the goal of reconstructive surgery is to reconstruct something abnormal to achieve a more normal appearance. Such abnormalities can be congenital or acquired. Examples of congenital deformities include cleft lip and palate, extra fingers and toes, webbed fingers, and skin growths, for example, strawberry patches or giant hairy nevi (moles). Acquired deformities span a broad range of abnormalities which have developed due to trauma, cancer, or other disease. Some examples of these deformities include breast cancer, skin tumors, burn scars, facial injuries, hand injuries, and amputations. Plastic surgeons perform a wide variety of surgeries to restore function and to correct the appearance of deformity. This is accomplished in a number of ways. Common procedures include skin grafting, flap surgery, microsurgery, and various other procedures.
Skin grafting is a technique performed to replace damaged or unhealthy skin. It involves moving a section of skin from one part of the body to another part. This technique is commonly used to cover large open wounds or to replace skin damaged because of a burn injury. The place where the skin was taken from is allowed to heal spontaneously on its own.
Flap surgery is a step up and substantially more complex and sophisticated than skin grafting. Flap surgery involves moving layers of tissue (usually skin, fat, muscle, and even bone) and its associated blood supply from one area of the body to another. This can be in the same region, utilizing a regional flap, or it can be done from a distant part of the body; anywhere from head to toe. If the tissue or “flap” is brought from a distance, the blood supply usually has to be divided and reconnected by use of the operating microscope. Hence, plastic surgeons also perform microsurgery.
Microsurgery is a special area of plastic surgery which describes any surgery involving techniques performed under the magnification of an operating microscope. Microsurgery is used, as described above, for transfer of tissue from one part of the body to another distant part of the body; but it also has many other applications. Plastic surgeons use the assistance of the microscope to repair severed nerves and to reattach amputated body parts including fingers and toes, even entire limbs. Any surgery which requires magnification to help define the anatomy could be amenable to microsurgery.
The use of artificial materials is often used in reconstructive surgery. The specialty of plastic surgery does not derive its name because plastic surgeons use plastic materials when performing surgery; rather, it comes from the Greek word plastikos, which means “form.” In order for plastic surgeons to change shape or form, we sometimes use materials other than living tissue for reconstruction. A common example is reconstructive breast surgery. When a woman requires breast reconstruction, she has the option of using her own tissue or having implant surgery. Breast implants enhance the size and shape of the breast. Both flap surgery and implant surgery allow the opportunity for an excellent aesthetic breast reconstruction. By drawing from a wide armamentarium of procedures and choices, Vanderbilt plastic surgeons bring together form and function to achieve the goals of reconstructive plastic surgery.