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    Basic Principles of Plastic Surgery

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    RAJESH YADAV
    1. Plastic surgery focuses on principles rather than specific procedures, and aims to close wounds without tension to minimize scarring. 2. Placement of scars along relaxed skin tension lines and hidden areas helps reduce complications like abnormal scarring. 3. Wound closure techniques like simple interrupted sutures, vertical mattress sutures, and subcuticular sutures are used depending on the site and thickness of skin.

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    Basic Principles of Plastic Surgery

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    RAJESH YADAV
    160 views46 pages
    1. Plastic surgery focuses on principles rather than specific procedures, and aims to close wounds without tension to minimize scarring. 2. Placement of scars along relaxed skin tension lines and hidden areas helps reduce complications like abnormal scarring. 3. Wound closure techniques like simple interrupted sutures, vertical mattress sutures, and subcuticular sutures are used depending on the site and thickness of skin.

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    Basic principles of Plastic Surgery

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    Basic principles of Plastic Surgery

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    1. Plastic surgery focuses on principles rather than specific procedures, and aims to close wounds without tension to minimize scarring. 2. Placement of scars along relaxed skin tension lines and hidden areas helps reduce complications like abnormal scarring. 3. Wound closure techniques like simple interrupted sutures, vertical mattress sutures, and subcuticular sutures are used depending on the site and thickness of skin.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    160 views46 pages

    Basic Principles of Plastic Surgery

    Uploaded by

    RAJESH YADAV
    1. Plastic surgery focuses on principles rather than specific procedures, and aims to close wounds without tension to minimize scarring. 2. Placement of scars along relaxed skin tension lines and hidden areas helps reduce complications like abnormal scarring. 3. Wound closure techniques like simple interrupted sutures, vertical mattress sutures, and subcuticular sutures are used depending on the site and thickness of skin.

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    BASIC PRINCIPLES OF PLASTIC

    SURGERY

    Dr. Ekta Mishra

    Dept. of plastic surgery


    INTRODUCTION

    Plastic surgery is a unique speciality that


    has no organ system of its own and is
    based more on principles rather than
    details of specific procedures.
    SCAR-A FRIGHTENING TERM
    FOR PATIENTS
    FACTORS INFLUENCING
    FINAL OUTCOME OF SCARS

     Direction of scar
     Atraumatic techniques
     Wound closure techniques
     Post op management
     Infection
     Age of patient
     Site of scar
     Type of skin
     Race
    PLACEMENT OF SCAR

     Relaxed skin tension lines


     Contour lines or natural junction lines
     Hidden area – eg.inside hairline or in the
    eyebrow
    Non judicious placement of scar results in
    abnormal scarring.

     Unstable scar
     Contracted scar
     Painful scar
     Adherent scar
     Stretched scar
     Hypertrophic scar
     Keloid
    CLOSURE OF SKIN WOUNDS

     Mc method-
    sutures
    staples
    skin tapes
    wound adhesives
     MAIN AIM – approx.of skin edges without tension.
     Deeper wounds are closed in layers.
     MAIN AIM
    1. to eliminate dead space.
    2.to provide strong enough closure to
    prevent dehiscence.
    SUTURING TECHNIQUES

    Simple interrupted suture


    Vertical mattress
    Horizontal mattress
    Subcuticular suture
    Half buried horizontal mattress
    Continuous over n over suture
    CONTINOUS OVER N OVER
    SUTURES
    HORIZONTAL MATTRESS SUTURE
    VERTICAL MATTRESS
    SUTURES
    SIMPLE INTERRUPTED
    SUTURES
    SUBCUTICULAR SUTURES
    .
    SIMPLE INTERRUPTED SUTURE
    Gold standard
    Angle of exit = angle of entry.
    Approx. placed 5-7mm apart and 1-2mm from skin edges.
    VERTICAL MATRESS SUTURE
    Adv.- used when eversion of skin edges is desired.
    Disadv.-tend to produce most obvious cross hatching if not removed eariy.
    HORIZONTAL MATTRESS SUTURE
    Adv.- used in thick glabrous skin.
    Disadv.- some degree of eversion is seen.
    SUBCUTICULAR SUTURE
    Can be interrupted or in running fashion.
    CONTINUOUS OVER N OVER SUTURE
    Adv.- can be placed in locking fashion to provide haemostasis by
    compression of wound edges.eg.scalp closures.
     TIME OF SUTURE REMOVAL
     If sutures are left long common complication are
    1.Stitch abcesses
    2.Cross hatch marks

    -over vascular area like scalp,face,neck


    3-5 days.
    -over chest,abdomen
    7-8 days.
    -over extremeties
    10-12 days.
    tension n subcuticular sutures can be left for 2 weeks.
    METHOD OF EXICISION OF
    SKIN LESION.
    ELLIPTICAL EXCISION-
    mc tech.
    Disadvantage – dog ears are common complication

    WEDGE EXCISION-
    can be used for lesions located at or adjacent to free margins.

    CIRCULAR EXCISION-
    when preservation of skin is desired.eg.tip of nose.
    when length of scar should be minimum.eg.in children.

    SERIAL EXCISION- Excision in more than one stage.eg. Congenital naevus.


     ALWAYS REMEMBER THE ADAGE
    ‘The great plastic surgeon can
    boast of numerous elegant flaps n free
    tissue transfers but usually does a skin
    graft’.
     Free grafts
    ‘are tissues which are completely detached
    from the body before it is transported to other
    host bed where it develops a new blood supply
    ensuring the viability of transported tissue’

    DONOR AREA-area where grafts are harvested.


    RECEPIENT AREA-area where grafts are
    transferred.
     Skin graft consists of epidermis n variable thickness of
    dermis.

     TYPES OF SKIN GRAFTS-


    Depending on the donor

    1.Autograft
    2.Homograft
    3.Xenograft
    4.Isograft
     Depending on thickness of dermis
    A. Split thickness skin graft – THIERSCH
    GRAFT
    B. Full thickness skin graft – WOLFE
    GRAFT
    PARTIAL THICKNESS SKIN
    GRAFT
    Indication for skin grafting
    1.SKIN LOSS-
    post traumatic-eg.avulsion n degloving injury.
    post surgical- eg.excision of benign or malignant
    lesion.
    as a result of pathological process.eg.venous ulcer.

    2.MUCOSA LOSS-
    after excision of leuco plakic patch in oral cavity.
     CONTRAINDICATION-
    Avascular recepient area-
    bare bone,bare cartilage,bare tendon
    Infection – particularly heavily infected wound i.e
    bacteria in the concentration of greater than
    10^5/gram tissue.
    IN NUTSHELL,skin grafts are generally
    considered as standard option for closing
    defects that cannot be closed primarily.
    FLAPS
    Unlike grafts,flaps are vascularised tissue
    possessing its own network of arterial n
    venous system.
    -. BROADLY CLASSIFIED AS –
    Free flaps
    Pedicled flaps.
     FREE FLAPS-
    Are completely detached from the donor
    area before being transferre to the recepient
    area.

     PEDICLED FLAPS-
    Have a pedicle or base which remain
    attached to one or the other part of the body
    during its transfer to the recepient area.
     Pedicled flaps are classified as-

    SKIN FLAFS
    MUSCLE FLAPS
    FASCIAL FLAPS
    ADIPOFASCIAL FLAPS
    COMPOUND FLAPS-
    fasciocutanious flaps
    myocutaneous flaps
    osteocutaneous flaps
    osteomyocutaneous flaps
     CLASSIFICATION BASED ON BLOOD SUPPLY –
    Random pattern flap
    does not have cutaneous vessels running
    along.It is based on subcutaneous ,dermal and
    subdermal plexus.
    Axial pattern flap
    based on direct cutaneous vascular
    system which run along the length of the flap.
    RANDOM PATTERN FLAP
     Classification based on location of donor site –
     LOCAL FLAPS-
    a.flaps that rotate about a pivot point.
    -rotation flap
    -transposition flap e.g.Z-plasty
    -bilobed flap
    -interpolation flap
    b.advancement flap
    -single pedicled
    -bipedicled
    -v-y n y-v advancement flap
    DISTANT FLAPS
    Z- PLASTY
    :\
    -Involves transposition of two
    interdigitating triangular flaps
    -has three limbs n two angles
    -all three limbs should be equal n the angle
    may vary from 30-90 degree.(standard is
    60 degree.)
     EFFECTS PRODUCED AFTER Z-PLASTY
    -gain in length along the direction of
    common limb of z.
    -direction of common limb of z is changed.
    angle gain in length
    30-30 degree 25%
    45-45 degree 50%
    60-60 degree 75% (IDEAL)
    75-75 degree 100%
    90-90 degree 125%
    MULTIPLE Z-PLASTY
    Replacing the single z with multiple z with
    smaller limbs,the tension on transverse
    closure for almost equal gain in length is
    evenly distributed.
    CLINICAL USES OF Z-PLASTY

    -lengthening of linear contracture- linear


    PBC,congenital
    -correcting notching at free borders of lip,ala of
    nose,ear lobe etc.
    -changing direction of scar to make it parallel to
    RSTL.
    -correcting constriction bands of extremities.
    -breaking a scar.
    V-Y ADVANCEMENT
    Incision is made as V and closed as Y,tissue
    is advanced in the direction of stem of Y.

    Y-V ADVANCEMENT
    Incision is given as Y and closed as V.
    INDICATION OF V-Y TECHNIQUE
    -used to lengthen structure as nasal
    columella.
    -eliminate minor notches of lip.
    -sometimes for closing circular defects.
    RECONSTRUCTIVE LADDER
    PLANNING CLOSURE OF DEFECT
    free tissue transfer
    |
    regional tissue transfer
    |
    local tissue transfer
    |
    skin graft
    |
    direct tissue transfer
    |
    allow to heal by sec. intention
    TAKE HOME MESSAGES

    -plastic surgery is a constant battle b\n


    blood supply n beauty.
    -observation is the basis of surgical
    diagnosis.
    -diagnose before you treat.
    -make a plan n a pattern for this plan.
    -make a record – sketches n photographs.
    -the lifeboat FLAP or GRAFT.
    -a good style will get you through dexterity
    & gentleness.
    -replace what is normal in normal position
    & retain it there.
    -treat the primary defect first.
    -losses must be replaced in kind.
    -do something positive- start with a
    landmark or two pieces that definitely fit.
    -Never throw anything away.
    -never let routine methods be your masters.
    -consult other specialists.
    -speed in surgery consists of not doing the same
    thing twice.
    -never do today what can honourly be put off till
    tomorrow.
    WHEN IN DOUBT, DON’T
    -the aftercare is as important as the planning!!!!!

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