Reconstructive Procedures
BreastBreast AsymmetryAlthough breasts are often not the same in terms of size and shape significant differences in both size and shape can be distressing for patients. Correction of asymmetry can involve a variety of techniques such as breast augmentation, tissue expansion, mastopexy (breast lift), breast reduction and liposuction. Breast ReductionLarge breasts can lead to both functional and aesthetic concerns. Breast reduction aims to both reduce the breast tissue volume and also recreate and improved breast shape. Different techniques are available and can be combined with liposuction. Breast AugmentationThis is the most commonly performed aesthetic operation and involves the placement of either ones own tissue into the breast (autologous fat), breast implants (silicone) or hyaluronic acid (macrolane). The commonest of these techniques is the use of silicone breast augments and involves placement of the implant s in a pocket either above or under the muscle or a combination of these (dual plane). The incisions for the insertion of silicone breast implants can be in the fold: most commonly armpit, areola or through the tummy button. Nipple/Areola ReconstructionWhere a nipple has been removed due to previous surgery a new nipple can be created using the remaining tissue of the breast. Flaps of skin may be used to create the nipple. This usually results in scars that are 1-2 cm in length at the side of the new nipple. Areola reconstruction is often performed following nipple reconstruction to provide more natural areola coloring. Both nipple and areola reconstructions can be performed as day case local anesthetic procedures Breast ReconstructionFollowing mastectomy various techniques are available to improve cosmesis. These include tissue expansion/implants, autologous fat transfer and the use of flaps – either with or without implants. The use of the latissimus dorsi muscle can be brought from the back into the new breast leaving a scar on the back. The abdominal tissue from the tummy can also be used. It can be taken with its blood vessels and then moved onto the chest. The small vessels within the chest can be dissected and the blood vessels joined using a microscope. This form of free tissue transfer does not require the need for an implant and thus ages with the patient giving a long lasting result. Free flaps can also be harvested from both the thighs and the buttocks. Revisionary Breast ReconstructionPatients undergoing breast reconstructions especially those undergoing an implant-based reconstruction may require corrective surgery as a result of age related changes associated with implants. Correction of these deformities often requires revision of the implant pocket, the overlying skin and replacement of the implant in a different position. Where there are irregularities within the breast reconstruction autologous fat transfer can help to give a better contour and overall result GynaecomastiaJust as female breast can over develop so can male breast tissue. This can give significant aesthetic concerns to patients. Removal may require a combination of liposuction and direct excision and is dependent on the amount of tissue needing to be removed. |
Face, Head and NeckTumor ExcisionThe commonest head and neck tumors are Basal Cell and Squamous cell carcinomas. Although the majority of lesions can be removed through excision and direct closure one may require reconstruction with local flaps and/or skin grafts. The majority of these can be removed under local anesthetic as an outpatient. Occasionally tumours may spread to the neck and a lymph node dissection may be required to remove tumor that has spread to the lymph nodes. This requires a general anesthetic and a stay in hospital of a few days. RhinophymaThe presence of sebaceous hyperplasia can lead to an unsightly growth of the nasal skin. Removal of this either by laser surgery or direct excision may be required to improve both aesthetic and functional problems RhinoplastyThe different components of the nose can develop in an unusual fashion or can be damaged through trauma. The different components namely the bones and the cartilage can be reshaped to improve both function and cosmesis. OtoplastyProminent ears can lead to significant aesthetic concerns. Different techniques are available to reduce the projection of the ears, the ear lobule and recreate the normal cartilaginous appearance of the ear. These can often be performed under local anesthetic. Following otoplasty patients will require to were a head bandage for at least a week following surgery Face-liftDifferent techniques of face lifting allow one to individualize results. The use of the layer under the skin can be used to enhance the contour of the face. The neck may also be improved either by the same incision located around the ear or via a direct incision under the chin. Face lifting can also be combined with other rejuvenation techniques such as autologous fat transfer, laser resurfacing, chemical peels and chin/cheek implants. BlepharoplastyBoth the upper and lower eyelids can age resulting in an excess of skin and also a weakening of the layer under the muscles. Removal of excess skin and tightening the layers under the muscle with redistribution/removal of fat can help to improve contour. Lifting of the muscle may also be used in the face to give a lift to the mid face. Brow liftingFacial Palsy often leads to a paralysis of the eyebrow leading to asymmetry between the two sides. A brow lift can help to improve cosmesis and can be performed by either an incision above the eyebrow, a small incision on the forehead or endoscopically. Mid Face-LiftFacial Palsy often affects the position of the corner of the mouth. The descent of the face leads to an obvious difference that can also cause patients functional problems such as speech, eating and drinking. Lifting techniques can involve a number of different techniques using incisions in the hairline, the nasolabial fold, an incision underneath the lower eye or an incision around the nose and cheek. BotoxOften facial paralysis leads to an asymmetry between the normal and abnormal sides. Although lifting techniques can be applied to the abnormal side weakening the normal side can improve cosmesis. One can target the injection of individual muscle groups to individualize treatments. Hand and WristDupuytren’s contractureDupuytren’s contracture is a condition that causes lumps and cords to form in the palm of the hand and fingers. It can lead to the fingers bending down into the palm with loss of ability to straighten the fingers. The condition can be treated and helped, though not cured, by surgery. Depending on the severity of the condition the following operations can be performed: fasciotomy, selective fasciectomy, dermofasciectomy using skin graft. GanglionA ganglion presents as a fluid-filled cyst or swelling around the hand and wrist. Those on the back of the wrist joint may become quite large and can be sore. These can be removed but may recur. Ganglions can also occur on the back of the joint of the finger tip. These can also be removed in a similar way. Trigger finger releaseThe flexor tendon that bends the finger runs in a tight sheath or tunnel. Constriction of the tendon in the tunnel produces a swelling on the tendon which then flicks in and out of the sheath producing snapping of the finger from a bent to the straight position. This is painful and inconvenient. The sheath can be released and the triggering cured. Carpal tunnel releaseCarpal tunnel syndrome (entrapment of the median nerve at wrist level) is a common condition that typically causes intermittent tingling and feelings of altered sensation in the thumb, index, middle and ring fingers of the hand. These feelings are often described as ‘pins and needles.’ Pain is also a feature of the condition and localises to the base of palm and front of wrist area. Carpal tunnel syndrome can be relieved by division of the thick ligament under which the nerve runs leaving a small discrete scar on the base of the palm. Other nerve compressionsThere are a variety of other nerves in the arm that can become trapped or pinched in specific anatomical sites. Cubital tunnel syndrome is the most common of these and produces pain around the inner aspect of the elbow. It is relieved either by the use of night splints with a need to undertake surgical decompression in some cases. Tendon transfersFollowing irreparable damage to one or more nerves in the arm it is possible to replace lost movement with muscles that can be spared from another part of the arm. The tendon is moved from its normal position to a new site to replace the missing movement. This can help the hand to function more normally. Wrist stabilization operationsWrist instability is caused by injury to the small ligaments that normally bind together the small bones of the wrist. Torn or partially torn ligaments produce painful clunking and a feeling of the wrist ‘giving way.’ This group of conditions can be treated by replacing the ligaments using tendon slings, for example modified Brunelli procedure for scapholunate instability, and Adams ligament for reconstruction of distal radioulnar ligaments. Where osteoarthritis has already occurred, partial wrist fusion operations are the best treatment option. Ulna shorteningUlna impaction is caused by one of the two bones of the forearm known as the ulna being slightly long compared to the other bone known as the radius. As a result the end of the ulna tends to collide with the side of the wrist and cause pain, for example in a hammering type movement. This can be treated by an operation known as ulna shortening where a sliver of the ulna bone is taken out (effectively breaking the bone) and the bone ends joined together and fixed with a permanent metal plate. TrapeziectomyOsteoarthritis at the base of the thumb prodcues pain and loss of function with loss of pinch grip and key pinch. Pain is aggravated by heavy use of the hand and in later stage disease causes pain at night and sleep disturbance. Where conservative treatment fails the condition can be treated by removing one half of the joint (trapezium bone) and the thumb base is suspended using a tendon sling. Wrist arthroscopyWrist pain can be difficult to diagnose and using a ‘telescope’ (arthroscope) to look inside the wrist can help with this diagnosis. Conditions such as torn cartilages (TFCC tear) can be treated through the scope at the time. Wrist fusionOsteoarthritis of the wrist can be treated by partial or full wrist fusion which relieves pain and stiffens the wrist. Wrist joint replacement may be possible in some cases. Rheumatoid arthritisRheumatoid arthritis is one of the forms of inflammatory arthritis that is normally treated in conjunction with a medical Rheumatology consultant. The disease can affect many parts of upper limb function and a detailed individual assessment needs to be made to establish treatment priorities. Some of the commoner operations include fusions (permanent stiffening) for painful joints, replacement of damaged joints by joint replacement arthroplasty (artificial joints) including knuckle replacement, and stabilization of collapsing joints using ligament reconstructions (swan neck and Boutonnière deformity of the fingers). Congenital hand conditionsChildren can be born with a variety of anomalies of the hand, wrist and arm. These include webbing of the fingers (syndactyly), extra fingers and double thumbs (duplication, polydactyly) and bent fingers (clinodactyly) to name some of the commoner problems. There is much that can be done for many of these conditions and many of the operations are best done earlier in childhood. |
SkinDue to a combination of ageing and environmental influences such as sun damage and UV exposure our skin is susceptible to a number of skin tumors & general damage. Basal Cell CarcinomaBasal Cell Carcinomas (BCCs) or rodent ulcers are the commonest of all cancers in the BCCs are usually found on sun exposed areas such as the face and neck although can occur all over the body. They are slow growing and are often present for months or years. They do spread around the rest of the body and surgical excision remains the most effective way of removing these common skin tumors. Squamous Cell CarcinomaSquamous Cell Carcinomas (SCCs) also occur most commonly in sun-exposed areas. Although they are less common than BCC’s they can be more aggressive and occasionally spread to the lymph glands. Like BCC’s surgery remains the most effective means of removing these lesions. Malignant MelanomaMalignant Melanoma is a cancer of the cells that help to tan the skin. In contrast to BCC and SCC, melanoma can affect younger patients. The main signs are of a mole that is growing, changing shape, changing color, itching and bleeding. It can spread elsewhere around the body and an early detection can lead to improved outcomes. The treatment may involve both surgical removal of the melanoma but also staging of the lymph node basin in the form of a technique called sentinel node biopsy Removal of skin lesionsFrequently skin lesions can be removed and closed directly with a scar that can be placed in a place that will give a good cosmetic result. Other methods of wound closure include the use of skin grafts and/or local flaps. Skin GraftsSkin Grafts are one of the most common methods for closing a wound after injury, or removal of tissue (for example after surgery for skin cancer). A skin graft is the technique of removing skin from one area of the body and placing it on another. The blood supply to the graft develops over a number of days to weeks. Depending upon what is involved, skin grafts take the form of either full-thickness grafts or split-thickness. Full-thickness Skin Grafts are whole pieces of skin and the site from where the graft is taken is closed directly leaving a scar in this area. They are commonly taken from behind the ear, the neck, the groin and the arm. Split-thickness skin grafts are usually taken from the thighs and are thin shavings of skin that leave behind them an area similar to a graze. This area heals by itself although can take a number of weeks. Skin FlapA flap is a piece of tissue that carries with it its own blood supply. One can utilize an area with excess skin and use it to move into the area needing to be reconstructed. The area where the flap is taken from is stitched and the resultant scar can be placed in a place that will allow the resultant scar to be less visible. Sentinel node biopsyThis is technique that can be used (particularly in melanoma) to determine whether there has been any spread to the lymph nodes. It requires a small scar in the lymph node basin. The lymph node is assessed pathologically and if negative can provide significant reassurance to patients. BodyArm LiftsExcess skin and soft tissue in the arms can be reduced through a combination of excision and/or liposuction. Different incisions can be used to individualize treatments Thigh liftsExcess skin and soft tissue in the thighs can be reduced through a combination of excision and/or liposuction. Different incisions can be used to individualize treatments Total body liftFollowing excessive weight loss both skin/soft tissue may need to be removed in order to improve body contour. This requires a team of surgeons in order to minimize surgical time and enhance outcomes AbdominoplastyFollowing weight loss or pregnancy changes to the tissues of the abdomen may lead to excess tissue and/or weakening of the abdominal muscles. Removal of the tissue and strengthening the abdominal muscles improves shape and contour. It can be combined with liposuction and may involve a variety of techniques and incisions. LiposuctionFat deposits in a variety of different areas around the body can be unsightly. Removal of these is possible using liposuction techniques. The technique can be utilized in almost every area of the body |