Options in Wound Treatment
In deciding how to treat a wound, a plastic surgeon must carefully assess its size, severity, and features: Is skin missing? Have nerves or muscles been damaged? Has skeletal support been affected? As you and your plastic surgeon form your surgical plan, it's important to have a clear understanding of what will happen during the procedure.
Asking questions is key to making an informed decision. Direct closure is usually performed on skin-surface wounds that have straight edges, such as a simple cut. Maximum attention is given to the aesthetic result, taking extra care to minimize noticeable stitch marks.
Tissue expansion is a procedure that enables the body to "grow" extra skin by stretching adjacent tissue. A balloon-like device called an expander is inserted under the skin near the area to be repaired and then gradually filled with salt water over time, causing the skin to stretch and grow. The time involved in tissue expansion depends on the individual case and the size of the area to be repaired.
The advantages of tissue expansion are many-it offers a near-perfect match of skin color, sensation, and texture; the risk of tissue loss is decreased because the skin remains connected to its original blood and nerve supply, and scars are less apparent than those in flaps or grafts. The expander temporarily creates what can be an unsightly bulge, making this option undesirable for some patients.
Other Reconstructive Procedures
In addition to correcting cuts and other surface wounds, plastic surgeons also regularly treat both cancerous and non-cancerous growths and problems with the supporting structures beneath the skin.
Tumors, both cancerous and benign, vary widely in type, severity, and recurrence. The removal method chosen will depend largely on the type of growth, what stage it's in, and its location on the body.
Skin cancers and growths are usually removed by excision and closure, in which the growth is simply removed completely with a scalpel, leaving a small thin scar. If the cancer is large or spreading, major surgery may be necessary, using flaps to reconstruct the affected area.
A wound that is wide and difficult or impossible to close directly may be treated with a skin graft. A skin graft is basically a patch of healthy skin that is taken from one area of the body, called the "donor site," and used to cover another area where skin is missing or damaged. There are three basic types of skin grafts.
A split-thickness skin graft, commonly used to treat burn wounds, uses only the layers of skin closest to the surface. When possible, your plastic surgeon will choose a less conspicuous donor site. Location will be determined in part by the size and color of the skin patch needed. The skin will grow back at the donor site, however, it may be a bit lighter in color.
A full-thickness skin graft might be used to treat a burn wound that is deep and large, or to cover jointed areas where maximum skin elasticity and movement are needed. As its name implies, the surgeon lifts a full-thickness (all layers) section of skin from the donor site. A thin line scar usually results from a direct wound closure at the donor site.
A composite graft is used when the wound to be covered needs more underlying support, as with skin cancer on the nose. A composite graft requires lifting all the layers of skin, fat, and sometimes the underlying cartilage from the donor site. A straight-line scar will remain at the site where the graft was taken. It will fade with time.
Whether the defect is congenital or acquired, plastic surgeons can usually restore comfort, mobility, and normal appearance to patients with hand problems.
Acquired defects include carpal tunnel and other painful conditions caused by pressure on the nerves (usually at the wrist or elbow); trigger fingers, a condition caused by swelling of a flexor tendon in the hand; ganglion cysts, a benign cystic growth, and scar contracture which occurs when a wound or burn on the hand heals poorly and forms scar tissue that curls the fingers or restricts mobility. Dupuytren's disease causes a similar problem of hand contracture.
Children born with syndactyly (webbed fingers) can benefit from finger separation, where a zig-zag-type incision separates the fingers and rearranges the tissue between them, preventing growth deformities.
If a child had polydactyly (extra fingers), correction is often more than simply removing the extra digits. The surgeon may also need to balance the tendons of the hand and stabilize the remaining finger joints so that the hand functions as normally as possible. Plastic surgeons also reconstruct missing digits, including the thumb, which supplies half of the hand's function.