For children or adults who have suffered from burns, wounds, such as bedsores, or conditions and injuries that have left scars, reconstructive surgery can be just what they need to restore their bodies to good health and former appearance.

Conditions requiring reconstructive surgery for skin

Burns

  • Reconstructive surgery can improve the appearance and function of skin that has been injured and deformed by burns.
  • Goals for burn wound care procedures:
    • Improve function/appearance of skin.
    • Prevent infection of burn wounds.
    • Reduce risk of diseases which burn victims may be prone to contracting.
  • Common techniques for burn reconstruction and care:
    • Scar release for contractures.
    • Z-plasty to reposition a scar to make it less noticeable and relieve tension of a contracture.
    • Grafting to improve function of a scarred area.
    • Flap surgery to improve function of a scarred area.
    • Tissue expansion as an alternative to grafting.

 

Wounds

  • Focus on healing chronic and complex wounds to prevent limb amputations.
  • Chronic wounds: do not progress through the usual stages of healing, have not healed or improved significantly within four weeks.
  • Diabetic foot ulcers, venous leg ulcers, pressure ulcers, radiation tissue damage, osteomyelitis (chronic bone infection), non-healing surgical wounds.
  • Treatments to include: removal of dead or infected tissue, restoration of blood flow, antibiotic therapy, specialized dressings, skin grafts/skin substitute grafts, compression therapy, surgical intervention.

 

Bedsores

  • Bedsores, sometimes called pressure sores or decubitus ulcers, can develop in people who have been confined to bed for long periods of time, are unable to move for short periods of time, or who use a wheelchair or sit in one spot for long periods of time.
  • Other complications, such as aging, circulation and decreased sensation, can increase the likelihood that a person will develop bedsores.
  • Hospital patients and nursing home residents, as well as those who are being cared for at home and who are confined to bed are most at risk to develop bedsores.
  • Left untreated they can lead to dangerous medical complications like bone and blood infections or bacterial infections in a joint.
  • If the pressure sore has progressed to the point that the ulcer has gone deeper than the skin surface and is affecting bone and tendon, surgery is the best treatment.

 

Scars

  • Scar revision and treatments for hypertrophic (thick, red, raised), keloid (grow beyond the border of incision or wound), and contracture scars (loss of skin over a large area).
  • Variety of techniques to improve both new and old scars including topical creams, laser treatment, steroid application and injections, surgical scar revision.
  • Topical treatments, which include compression bandages and gels.
  • Injectable treatments, which are used with concave scars.
    • Several injections may be required over the course of time.
  • Surface treatments, which can decrease the appearance of the scar.
    • They may include dermabrasion, laser therapy, chemical peels, or skin bleaching.

 

Skin cancer

  • Skin cancer risk factors:
    • Ultraviolet radiation exposure
    • Chemical carcinogens exposure
    • Immunosuppression
    • Infections
    • Genetic susceptibility
    • Fair skin, blonde or red hair, light colored eyes
    • Chronic inflammation
  • If you have received a diagnosis of skin cancer that has been confirmed by biopsy, you may be a good candidate for treatment.
  • Skin cancer surgery:
    • Curettage: scrape away cancer cells and destroy remaining cells with electrocautery
    • Excision: remove the tumor and surrounding border of normal skin

 

Reconstruction with Integra

  • Initially developed for the primary coverage of acute burns.
  • Acts as a network for dermal reconstruction.
  • An epidermal graft overlay is necessary after 3-5 weeks to achieve the in vivo reconstruction of a full-thickness skin equivalent.
  • Many advantages: immediate availability, availability of large quantities, simplicity and reliability of the technique, pliability and cosmetic appearance of resulting cover.

 

Skin grafts

  • Assist in the following preventative and recovery measures:
    • Promotion of accelerated healing of burns and other wounds
    • Reduction of scar contracture
    • Reduction of fluid loss
    • Protection from bacterial invasion
  • Used when there is inadequate skin available to complete the treatment process.
  • Split-thickness: uses only the layers of skin closest to the surgace.
  • Full-thickness: used to treat deep/large wounds or to cover jointed areas where maximum skin elasticity and movement are needed.