Listed below is the step by step procedure of plastic surgery:
- What is Plastic Surgery ?
- Why is Plastic Surgery Required?
- Pre-operative Preparation
- Day Before Surgery
- Procedure Day
- Methods/Techniques of Plastic Surgery
- Post Procedure
- Risks and Complications
What is Plastic Surgery ?
Plastic surgery is a procedure to reconstruct or repair a damaged, abnormal or missing tissue structure or skin. This surgery is mainly recommended for patients with certain illness, abnormality, burns, injury or birth defects.
The general/primary purpose of plastic surgery is to repair and restore the function of the tissue cells and the skin. Doctor tries to retain these functionalities as close to normal. Other secondary purpose of this surgery is to improvise the appearance of the part of body where it is being performed.
Why is Plastic Surgery Required?
Plastic surgery can be required as a corrective measure for birth defects, to repair skin and tissue damage caused due to disease, infections, illness or injury.
Correcting Birth Defects
Children who are born with abnormal body structure may require plastic surgery to repair it. For example, child with cleft lip and palate is a facial birth defect that includes a gap between the palate (roof of the mouth) and upper lip. Normally, it should have been joined together properly with no possible gap in between.
Other birth defects include:
- Birthmarks: Some birthmarks look scary. These include strain like structure or haemangiomas. These birthmarks are results of problems in the blood vessels in children.
- Problems in the hands: Babies born with webbed fingers or with too many or less number of fingers on their hands.
- Ear issues: Babies born with small ears (smaller than normal size) or absent ears (microtia).
Fixing Damaged Areas
Plastic surgery can also be required to repair as well as reconstruct damaged tissue. These get damaged due to various problems that emerge later in your life (acquired issues).
Such problems are as follows:
- Cancer: People can damage their body tissues or skin due to several reasons. One of the reason can be due to the growth of cancer tissues. Such damage is visible on your face and other body parts. Plastic surgery can be a feasible method to resolve such areas of your skin.
- Serious Accidents: Major accidents like fractures can break your skin and also lead to serious damaging of your tissues. Large wounds can be a result of trauma. One can also get severe wounds out of an animal bite. For example, a snake bite can rotten up your skin cells leading to excess damage. Plastic surgery can be helpful in repairing and reconstructing such skin cells.
- Infections: One of the application of plastic surgery is to discard dead tissue cells and repair the nearby areas in order to enhance the development and growth of new cells.
- To treat extensive burns: Individuals who have had an extensive burn condition cannot undergo any other treatment to recover their skin condition. Plastic surgery is the only solution to resolve and recover the condition of their skin.
The steps followed in the preoperative part of your surgery include various diagnostic tests that help your doctor decide the schedule and type of your plastic surgery. Preoperative evaluation provides all the aspects about the patients health condition. It also verifies whether your body is healthy enough and ready for the surgical procedure.
Preoperative tests help your doctor to adapt a safer way to treat your problem. Tests are mainly conducted to check various functions of your body. For example, tests for working of liver, kidneys, and the heart.
Lab tests are conducted some days prior to your surgery. Some amount of blood is drawn from your system and used for various types of blood tests.
Following tests can be performed:
- Complete Blood Count Test: To measure your red blood cell count (RBC), white blood cell count (WBC), platelet count, haemoglobin and many other components of your blood.
- Liver Function Test (LFT): Blood test to check the functioning of your liver.
- Renal Function Test (RFT): Type of blood test to check the functioning of your kidneys.
- Blood Group: Blood group is an important point to be determined.
Electrocardiogram (ECG or EKG)
One of the important step in the preoperative follow-up is to conduct ECG. Your heart is responsible to carry many stressful functions. Stress hormone affects the heart's normal function. ECG generates your heart's electrical activities. A normal ECG ensures that your body is functioning well enough and is eligible for the surgical procedure.
Mammography is a type of X-ray mainly conducted to examine your breasts in order to determine any kind of breast disease, abnormalities or cancer condition. A screening mammography test consists of two X-ray images of each breast.
Chest X-ray is performed to monitor your heart and lungs. X-ray helps your doctor to check the size of your lungs and heart. It also gives information about other tissue body structures. In such a way, abnormalities in your heart and lungs can be detected using this scanning test.
Physical Examination is conducted to check if you have any signs of infections on your skin layers. If your donor site has a birthmark or infection or marks left from the previous wounds, doctor's will discuss with you whether to use the donor site. Donor site can be changed as per your skin conditions.
If you consume antibiotics like aspirin, or vitamin supplements, etc., tell your doctor about it. Your doctor will ask you to discontinue these medications for nearly about one to two weeks prior to your plastic surgery date.
After all the necessary tests and examination, your doctor will discuss and select a suitable and convenient date for your plastic surgery. However, you will have to visit your doctor a day before your surgery for some hospital formalities as well as to note down all the instructions you need to follow on the day of surgery.
Schedule for extensive burn cases is immediately decided after the patient is brought to the hospital because such patient's require urgent medical assistance before any other problem occurs for the patient.
Day Before Surgery
An appointment is fixed with your doctor and team of nurses to carry out some important points required for the surgery. Your doctor will narrate out all the steps of plastic surgery procedure that will be performed. At this time, if you have any questions or doubt, discuss them with your doctor.
Once clear about the procedure, next step will be the schedule of the surgery day. Points for the time schedule cover the following aspects:
- Time you must fast for the surgery
- Time you must arrive at the hospital
- Time slots required just before the surgery to make certain arrangements
- Time duration of the surgery
- Other necessary schedules
Your skin surgeon will also talk to you about sedation method and how it works. If in case you are allergic to such chemicals, let your doctor know about it. After covering all the necessary points with you and your family, you are asked to sign a consent form as an approval for performing the surgery. Other hospital formalities and paper work will also be discussed with you.
For extensive burn cases, there is no preparations done a day before as cases of extensive burns needs emergent medical care.
Get proper rest and sleep before you arrive at the hospital for your plastic surgery. It is advisable to arrive a little earlier on your surgery day. Nurses will guide you to your surgical room. A surgical gown will be provided. Arrangements can be done just before the main surgery procedure. Creating intravenous lines (IV) is a part of these arrangements. It is necessary for administering anesthesia drugs in your system. Other connections can be done on your body to monitor your vitals regularly while the surgery is under process.
Nurses will monitor all these connections to check if your vitals are running normal. All these steps are important as they imply that your body is ready for the surgery. When anesthesia starts taking effect on your body, it indicates your surgeons to begin with the surgical procedure.
As patient's with extensive burns require immediate surgery, doctor's start with the preparations of the surgery. Nurses may collect blood samples of patients for various medical reasons. However, surgery procedure is carried out within few hours without making the patient wait any longer, as it can even cost the patient's life.
For plastic surgery or any kind of skin surgery, it is mandatory to clean your skin area with an antiseptic solution to avoid any sort of infection. Plastic surgery can be performed using various techniques that can be studied further.
Methods/Techniques of Plastic Surgery
There are many methods and techniques to repair, reconstruct and correct your skin using plastic surgery. Surgeon can use one or multiple methods to relocate and manipulate the tissues of your body this surgery.
Following are the various methodologies and techniques used in a plastic surgery:
Skin grafting refers to transplantation of part of the skin. The transplanted skin is known as a skin graft. The area of skin transplant is often referred to as recipient site. This procedure involves taking healthy layer of the skin to transplant it on the areas where skin is either lost or damaged. If your own skin is utilized for transplantation, the skin graft is termed as an autograft and the site from where the autograft was collected from is often referred as donor's site. If the skin graft is collected from any other external source or donor, it is termed as an allograft. Allografts can be required for patients who have had maximum area of their skin burnt. Skin grafting is mainly used as a treatment measure for patients who have extensive wounds or burns.
Skin grafting procedure begins by infusing general anesthesia or local anesthesia into the patient's body. The type of anesthesia used in this approach may vary on the size and section of the affected part of your body.
Your doctors will hold the skin graft on the required location of your body. In order to join it, your doctor will stitch, staple or clip this graft in its required place. This surgical area will be cleaned with cotton and secured with sterile bandages. The donor's site is also secured with sterile dressing to avoid the risk of infection.
There can be two types of skin grafts used in this method based on the requirements of the patient. These two types are as follows:
Full thickness skin graft
Your skin is made up of two layers where the upper layer is called as the epidermis and the layers under the epidermis are called as dermis. A full thickness graft includes removal of both these layers of skin. After collecting this type of skin graft, the donor's site is closed by suturing it. A full thickness skin graft involves only a small section of skin removal. Such skin grafts are mainly collected from the neck, back area of your ear or inner side of upper arm.
Split or partial thickness skin graft
Here, only the epidermis and a smaller section of the dermis is collected. The donor's site is left unstitched, allowing it to heal naturally. Such skin grafts are collected from the thighs, upper arm or buttocks.
Tissue expansion is an approach that revitalizes your body to grow and develop extra skin by expanding the neighboring tissues. This extra skin layer can later be useful to reconstruct the surrounding areas.
The process begins by administering general anesthesia into the patients body. Tissue expansion procedure involves insertion of a balloon-like equipment under your skin. The equipment is called as an expander. The placement is done near the area to be reconstructed or repaired. The expander is filled with salt water so that skin is fed regularly as required. This encourages the skin to gradually grow and expand.
The entire tissue expansion process may differ in its time of execution. Time required for tissue expansion is directly proportional to the size of the area of skin to be repaired. For larger sections of skin, it could take nearly around three to four months for the growth and development of skin. Until then, the expander under your skin looks like a bulge in your skin.
Once your skin has grown well enough and successfully expanded as required, it shows that the expander is no more required. At this time, you may need a second surgery for the removal of expander placed under your skin as well as to reposition the newly formed tissues.
The advantage of this surgical method is that it ensures that the reconstructed and the repaired area of skin has almost the same texture and color. This reduces the risks of repair failure as the blood supply to this skin stays connected.
Tissue expansion technique can be used for breast reconstruction. It is also useful for patients having large wounds.
The flap surgery procedure includes reposting a living piece of tissue from one body part to another. The piece of tissue is taken along with the corresponding blood vessels that supply blood to this section and is responsible to keep it alive.
Most of the times, the surgeon cuts a skin section in such a way that the skin partially stays attached to your body, which creates a flap. This flap is then transferred and stitched over the injured area.
One of the uncommon approach of a flap surgery is the free flap method. In this approach, a piece of your skin, the blood vessels supplying this skin, are entirely detached from the main blood supply. It is then re-attached at a new location.
A similar approach of a free flap performed using a microscope is called as a microsurgery. In this method, microscope is specially used to connect the tiny blood vessels onto the new location where flap is being placed.
Flap surgery is performed by sedating the patient's body with general anesthesia or local anesthesia. The type of anesthesia usually depends on the size and location of the flap.
Flap surgery carries a benefit that lets your repaired section of skin get enough blood supply and also maintain it. This lowers the chance of repair failure which gives patients an advantage over skin grafting approach.
Breast reconstruction can also be done using flap surgery approach. Other applications of flap surgery are also included in large wound fixation, improvement of cleft lip and palate and open fractures.
During the post-operative period, your doctors evaluate your body's response to injury and your rate of recovery. Rate of improvement with medications is also evaluated.
The post procedure measures of plastic surgery are similar for skin grafting and flap surgery. However, post procedure care for tissue expansion method is different.
For Skin Grafting and Flap Surgery
After successful implementation of skin grafts, most of the times it is necessary to cover the surgical areas by dressing to avoid infections and bleeding. A traditional method for dressing your surgical areas involves using cotton gauze soaked in saline or vaseline gauze as primary dressings. This is mainly performed if the surgical skin areas are independent of structural integrity. However, this dressing technique cannot be used for larger wounds. Also, it is very painful and traumatic when the fibrous material of your wounds begins to shed.
Other dressing approach involves using a mepitel (a soft silicone dressing) that can be often replaced with a newer one to avoid bacteria and infection. It can also be slightly painful. It provides structural support for the skin graft. Therefore, need for staples or sutures may not be always required. It is highly used for convex and concave structure of wounds. However, this type of dressing is very expensive.
An advanced method for dressing a skin graft contains a non-woven, semi-porous adhesive bandage. This bandage is called as hypafix. It is made up of polyester material that prevents allergy. If such types of dressings are used over your surgical areas, one may not require stitches or staples on those areas. Also, it reduces immobilization of your skin graft.
The type of dressing also depends on the type of your wounds and its location. Although, it is very important to prevent your dressing from getting exposed to water. Also, try to keep those areas clean and free from sweat or any kind or dirt. Avoid any contact with the dressing.
After skin grafting, it is very essential that you take a follow up with your surgeon to inspect your surgical sites. This inspection can be performed after two to five days post surgery. Although, if a hypafix is used, your inspection can be scheduled after a week or more. This is because hypafix secures the skin graft in place.
The chances of infections or graft slippage is around 1% for most surgeries. However, it is mandatory for your doctors to conduct an inspection just to verify these conditions.
Your doctor will prescribe medicines to enhance your skin to heal properly. Antibiotics and pain killers will also be given to you to prevent pain and infections. However, if you do not experience any pain, you can stop the consumption of pain killers.
Try to elevate your wounds above your heart and maintain it. This is a simple method used to lower the swelling around your surgical areas. However, one may not require to follow this while you are sitting or asleep. Patients can also use a ice pack (if suggested by your doctor) to reduce swelling. Your doctor will advise you on how often to use an ice pack.
Avoid any motion or activity that can stretch your graft or flap. Such movement can also cause an injury to your surgical site. Avoid thumping or hitting that area.
Patients are advised to avoid any rigorous form of exercise until your doctor suggests. If you have a vacuum dressing, there will be a tube connected to your dressing. If by any chance the tube falls off, consult your doctor right away.
Change your bandages or dressing regularly. Consume your medicines as scheduled. As your wounds begin to heal, you experience itchiness in those areas. Avoid scratching those areas. Scratching can loosen or re-open your wounds. Doctor can prescribe your with certain ointments to prevent this itchiness. Avoid your wounds from getting exposed to the sun.
The following measures are required to be carried out for the donor's site:
- Keep it dry
- Cover wounds with proper dressing
- Change the dressing regularly
- Keep wounds and the surrounding area clean to prevent infection
- After removal of dressing, leave the wound uncovered. However, do not rub or scratch it. Cover it with a piece of cloth before going out in the sun.
- Do not apply any lotion or powder to those areas of skin unless doctor allows
Let your doctor know if the following situations occur:
- If pain increases and does not go away even after the consumption of pain relief medicine
- Growing infection
- Medicinal reactions or reactions seen on your surgical areas
- Abnormalities around your surgical areas
- Unusual bleeding
- Unstoppable bleeding from your surgical sites
- Dislocation of your flap or graft
- Edge of the flap or graft starts to loosen up and comes out
- Abnormal bulge seen on the site of your flap or graft
- Excess draining from your wounds
- Formation of pus inside or around your wounds
For Tissue Expansion
For patients having a tissue expander placed under their skin, they are advised to take shower or bath by using a bacto-shield. One can perform routine activities. Do not lift any objects heavier than 10 pounds for minimum 6 weeks.
Person with a tissue expander implant cannot have any kind of scanning procedure. For example, tissue expanders get detected using security scanners at malls and airports. One may require to carry surgeon's note to provide it at the security counter to prove that it is a tissue expander and not any other metallic substance.
Avoid sun exposure to your wounds. Maintain hygiene of your wound and surrounding areas. One can resume usage of creams and lotions after three weeks of surgery.
If your find any other abnormal condition like allergy, infection, blood clots or pus formation, make sure you consult your doctor in time.
You can be unable to wear tight fitting clothes on the tissue expansion skin area. One must wear over sized clothes for a few days until the second surgery is performed. The tissue expander is usually taken off within eight weeks. However, individuals should continue to follow certain proprietary measures until their wounds from the second surgery heal and recover completely.
Risks and Complications
As the tissue expansion mechanism involves implanting of an expander, followed by a second plastic surgery, the risks and complications or this type of surgery vary from that of skin grafting and flap surgery.
For Flap Surgery and Skin Grafting
Following are the common risks and complications caused when a skin grafting or flap surgery is performed.
- Itching and Irritation
- Bacterial Infections
- Fluid formation inside and/or around your flap or graft
- Formation of pus
- Dirt formation
- Dislocation of flap or graft
- Opening of your flap or graft from its edges
- Flap or graft failure
- Burning sensation
- Blood clots
- Abnormal scab formation around your wounds
- Slower healing
For Tissue Expansion
The common risks and complications occurring out of a tissue expansion surgery are as follows:
- Discomfort and pain
- Immobilization of tissue expander
- Loosening of the implant
- Skin blisters
- Leakage from the blood vessels
- Excess bleeding
- Unusual drainage from the tubes of tissue expander
- Slow growth of tissues
- Numbness in the implanted area
- Swollen surgical sites
- Collection of fluids in and around the surgical sites
- Blood clots
- Pus formation
- Loosening of stitches or staples
- Accumulation of air or water in the tissue expanding area
- Dirt or bacteria formation in the tissue expanding area
- Abnormal supply or no supply of blood
- Tissue expansion failure
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