Plastic and reconstructive surgeon
Valdas Mačionis
Valdas Mačionis
Over 20 years experience in various areas of plastic and reconstructive surgery:
Peripheral nerve and vascular microsurgery
Dermatoplasty
Bone reconstruction
Transplantation and plasty of other tissues
Operations on the hand
Treatment of complex injuries of the upper and lower extremity
Experience from internationally recognized clinics
Publications in journals included in Index Medicus (Medline)
Peripheral nerve and vascular microsurgery
Dermatoplasty
Bone reconstruction
Transplantation and plasty of other tissues
Operations on the hand
Treatment of complex injuries of the upper and lower extremity
Experience from internationally recognized clinics
Publications in journals included in Index Medicus (Medline)
What is plastic surgery? Why is this title frequently accompanied by words "reconstruction", "microsurgery", and "hand surgery"? What does surgical plasty mean?
Often plastic surgery is referred to as only esthetic (cosmetic, beauty) surgery, i.e. removal of facial creases, excision of nevi, breast augmentation and so on. In fact plastic surgery is a much wider area. The term "reconstructive" has been incorporated into the title of this specialty not by chance, but in an attempt to emphasize that the object of plastic surgery includes not only the form but also the inner structure of the human body.
From the historical point of view, surgical meaning of the terms "plasty" and "reconstruction" is identical. Restoration of mutilated parts of the face (nose, ear) by transferring tissue of the same individual has been performed for more than 2.5 thousand years [1, 2]. But only in 1818 the root of the Greek words plassein (to mold, to shape) and plastikos (fit to mold, e.g. clay, wax) established itself in the surgical vocabulary in the term "rhinoplasty" (reconstruction of the nose) [3, 4]. Twenty years later the combination of "plastic" and "surgery" appeared as a specialty title [5]. Interestingly, a much more informative and long-used term of "reconstruction" (rebuilding, recreating; from Latin struo - to build) was adopted to define this field of surgery much later [1, 6, 7, 8, 9]. Despite the academic appropriateness of the latter term, the artistic title is generally preferred. One of the most distinguished contemporary publications of restorative surgery is entitled briefly, Plastic Surgery. However, it suffice to look through the contents of this 8-volume and over 8400-page book to make certain that to the greater extent plastic surgery deals with reconstruction of various parts of the body and their tissue [10].
Modern plastic surgery is unimaginable without microsurgery - operative surgery employing microscopes, special instruments and materials. Microsurgery dramatically expanded possibilities for human tissue reconstruction and revealed functional and aesthetic significance of precise restoration of delicate anatomical entities. E.g., traumatic lesions of the facial nerve are accompanied by disappearance of function (paralysis) of mimic muscles, which, in its turn, results in unsightly inanimate facial expression. By performing microsurgical repair of the facial nerve, one may expect a better recovery of function of the facial muscles than it would be without the precision technique. But even more significant is the fact, that microsurgery enables repair of tiny blood vessels and thus restoration of viability of amputated or transplanted parts of the human body. Microsurgical tissue transfer provides numerous choices for the treatment of defects of various parts of the body. E.g. irreversible facial palsy can be treated by transferring a functioning muscle. Donor areas (places from which tissue is harvested) may be chosen distant from recipient areas (places to which the tissue is to be transferred), and thus better functional and esthetic results may be achieved. E.g. breast defects can be reconstructed by taking skin flaps from the hidden buttock areas instead of using tissue from more conspicuous regions near the breast.
Today's advances in plastic surgery would also have not been attained without the development of hand surgery. The hand as an object of plastic surgery holds a special place. First of all, the hand is very important from the functional point of view. When talking about the function of the hand, professionals mean not only complex hand motion, but also the ability of the hand to sense. Not everyone appreciates the significance of the latter function. If the nerves of the upper extremity are damaged, the hand looses sensation and becomes "blind". With insensate hand, it is impossible to pick up a desired object from several other items in ones pocket; such a hand looses its natural protection, when touching sharp, hot and other hazardous objects. Beauty is also an important function of the hand, since the hands, just like the face, are usually conspicuous. Taking into account that the hand is the most frequently traumatized part of the body and that the anatomical entities of the hand are very tiny, it is not surprising that many injuries and disorders of the hand require attention of a plastic and reconstructive surgeon. Traumas, burns, infections, and diseases may disrupt the subtle anatomical structure of the hand, restoration of which necessitates complex surgery - skin, bone, tendon, muscle, nerve, blood vessel or even composite tissue plasty (a reconstructive procedure). When treating conditions of the hand one must be knowledgeable in the surgery of the entire upper extremity, since the hand is its organic part. Practical knowledge of surgery of the other parts of the body is also required, because a clinical situation may require tissue transfer from other regions. For instance, microsurgical toe-to-hand transplantation requires knowledge of anatomy and function of the foot. It is therefore not surprising that hand surgery comprises nearly a quarter of the subject of plastic surgery in the book mentioned above [10]. In most of the advanced countries there is an established notion that the hand should be operated only by a specialist proficient in reconstructive surgery.
Plastic and reconstructive surgeons must be competent in orthopedics, traumatology, vascular surgery, neurology and other areas. The best example here is replantation (reattachment) of an amputated extremity, when one has to reestablish continuity of all structural elements of the extremity taking into account their function and the perspective of further treatment. Therefore, it is often asked, where the boundaries of plastic surgery in respect of other surgical specialties are. Indeed, unlike other surgical specialties, plastic surgery is not limited to a certain anatomical unit, and there are plastic procedures (e.g. excision of a disfiguring scar and suture of the resulting wound) which can be performed by other specialty surgeons. There are, however, distinctive features of plastic surgery, the most important of which is delicate manipulation of tissue so that its viability (blood circulation) is minimally disturbed. In bringing this principle to life, one is assisted by tradition of plastic surgery, special instruments, and various operative methods. Adequate tissue circulation is most important to the postoperative results, because nonviable tissue turns into scars and might cause other severe complications. E.g. scars may produce pressure on nerve trunks and thus impair their circulation, which leads to compression neuropathies (syndromes manifesting itself as pain, abnormal sensation, muscle weakness etc). Knowing methods of tissue plasty proves useful not only in complicated situations, when one needs to transfer tissue for reconstruction of defects due to traumas, tumor (abnormal growth) removal etc. Even excision of a hypertrophic scar may require a plastic procedure so that the excessive scarring does not recur. Incisions of certain direction may result in scars hindering movement. E.g. in operative treatment of a common condition of the hand - Dupuytern's contracture (bent fingers), zigzag incision (or zigzag plasty of a straight incision) is a must, because straight wound over the palmar surface of the finger tends to turn into a scar pulling the finger back to the palm. It is also noteworthy that plastic surgeons who have mastered microsurgical technique are able to restore innervation and blood circulation of tiny segments of the human body.
References
Often plastic surgery is referred to as only esthetic (cosmetic, beauty) surgery, i.e. removal of facial creases, excision of nevi, breast augmentation and so on. In fact plastic surgery is a much wider area. The term "reconstructive" has been incorporated into the title of this specialty not by chance, but in an attempt to emphasize that the object of plastic surgery includes not only the form but also the inner structure of the human body.
From the historical point of view, surgical meaning of the terms "plasty" and "reconstruction" is identical. Restoration of mutilated parts of the face (nose, ear) by transferring tissue of the same individual has been performed for more than 2.5 thousand years [1, 2]. But only in 1818 the root of the Greek words plassein (to mold, to shape) and plastikos (fit to mold, e.g. clay, wax) established itself in the surgical vocabulary in the term "rhinoplasty" (reconstruction of the nose) [3, 4]. Twenty years later the combination of "plastic" and "surgery" appeared as a specialty title [5]. Interestingly, a much more informative and long-used term of "reconstruction" (rebuilding, recreating; from Latin struo - to build) was adopted to define this field of surgery much later [1, 6, 7, 8, 9]. Despite the academic appropriateness of the latter term, the artistic title is generally preferred. One of the most distinguished contemporary publications of restorative surgery is entitled briefly, Plastic Surgery. However, it suffice to look through the contents of this 8-volume and over 8400-page book to make certain that to the greater extent plastic surgery deals with reconstruction of various parts of the body and their tissue [10].
Modern plastic surgery is unimaginable without microsurgery - operative surgery employing microscopes, special instruments and materials. Microsurgery dramatically expanded possibilities for human tissue reconstruction and revealed functional and aesthetic significance of precise restoration of delicate anatomical entities. E.g., traumatic lesions of the facial nerve are accompanied by disappearance of function (paralysis) of mimic muscles, which, in its turn, results in unsightly inanimate facial expression. By performing microsurgical repair of the facial nerve, one may expect a better recovery of function of the facial muscles than it would be without the precision technique. But even more significant is the fact, that microsurgery enables repair of tiny blood vessels and thus restoration of viability of amputated or transplanted parts of the human body. Microsurgical tissue transfer provides numerous choices for the treatment of defects of various parts of the body. E.g. irreversible facial palsy can be treated by transferring a functioning muscle. Donor areas (places from which tissue is harvested) may be chosen distant from recipient areas (places to which the tissue is to be transferred), and thus better functional and esthetic results may be achieved. E.g. breast defects can be reconstructed by taking skin flaps from the hidden buttock areas instead of using tissue from more conspicuous regions near the breast.
Today's advances in plastic surgery would also have not been attained without the development of hand surgery. The hand as an object of plastic surgery holds a special place. First of all, the hand is very important from the functional point of view. When talking about the function of the hand, professionals mean not only complex hand motion, but also the ability of the hand to sense. Not everyone appreciates the significance of the latter function. If the nerves of the upper extremity are damaged, the hand looses sensation and becomes "blind". With insensate hand, it is impossible to pick up a desired object from several other items in ones pocket; such a hand looses its natural protection, when touching sharp, hot and other hazardous objects. Beauty is also an important function of the hand, since the hands, just like the face, are usually conspicuous. Taking into account that the hand is the most frequently traumatized part of the body and that the anatomical entities of the hand are very tiny, it is not surprising that many injuries and disorders of the hand require attention of a plastic and reconstructive surgeon. Traumas, burns, infections, and diseases may disrupt the subtle anatomical structure of the hand, restoration of which necessitates complex surgery - skin, bone, tendon, muscle, nerve, blood vessel or even composite tissue plasty (a reconstructive procedure). When treating conditions of the hand one must be knowledgeable in the surgery of the entire upper extremity, since the hand is its organic part. Practical knowledge of surgery of the other parts of the body is also required, because a clinical situation may require tissue transfer from other regions. For instance, microsurgical toe-to-hand transplantation requires knowledge of anatomy and function of the foot. It is therefore not surprising that hand surgery comprises nearly a quarter of the subject of plastic surgery in the book mentioned above [10]. In most of the advanced countries there is an established notion that the hand should be operated only by a specialist proficient in reconstructive surgery.
Plastic and reconstructive surgeons must be competent in orthopedics, traumatology, vascular surgery, neurology and other areas. The best example here is replantation (reattachment) of an amputated extremity, when one has to reestablish continuity of all structural elements of the extremity taking into account their function and the perspective of further treatment. Therefore, it is often asked, where the boundaries of plastic surgery in respect of other surgical specialties are. Indeed, unlike other surgical specialties, plastic surgery is not limited to a certain anatomical unit, and there are plastic procedures (e.g. excision of a disfiguring scar and suture of the resulting wound) which can be performed by other specialty surgeons. There are, however, distinctive features of plastic surgery, the most important of which is delicate manipulation of tissue so that its viability (blood circulation) is minimally disturbed. In bringing this principle to life, one is assisted by tradition of plastic surgery, special instruments, and various operative methods. Adequate tissue circulation is most important to the postoperative results, because nonviable tissue turns into scars and might cause other severe complications. E.g. scars may produce pressure on nerve trunks and thus impair their circulation, which leads to compression neuropathies (syndromes manifesting itself as pain, abnormal sensation, muscle weakness etc). Knowing methods of tissue plasty proves useful not only in complicated situations, when one needs to transfer tissue for reconstruction of defects due to traumas, tumor (abnormal growth) removal etc. Even excision of a hypertrophic scar may require a plastic procedure so that the excessive scarring does not recur. Incisions of certain direction may result in scars hindering movement. E.g. in operative treatment of a common condition of the hand - Dupuytern's contracture (bent fingers), zigzag incision (or zigzag plasty of a straight incision) is a must, because straight wound over the palmar surface of the finger tends to turn into a scar pulling the finger back to the palm. It is also noteworthy that plastic surgeons who have mastered microsurgical technique are able to restore innervation and blood circulation of tiny segments of the human body.
References
1. History of Plastic Surgery, ASPS and PSEF. Available at http://www.plasticsurgery.org/about_asps/history/History.cfm
Accessed March 18, 2007
2. Saraf S, Parihar RS. Sushruta: The first Plastic Surgeon in 600 B.C. The Internet Journal of Plastic Surgery; 2007, 4 (2). Available at http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijps/vol4n2/sushruta.xml
Accessed March 18, 2008.
3. von Graefe CF: Rhinoplastik, oder die Kunst den Verlust der Nase organisch zu ersetzen. Berlin, G Reimer: 1818.
4. Carl von Gräfe. De rhinoplastice. 1818. - LaneConnex - Lane Medical Library & Knowledge Management Center, Stanford University Medical Center. Available at http://lane.stanford.edu/portals/history/graefe.html?proxy-links=false
Accessed March 18, 2008.
5. Zeis E. Handbuch der Plastischen Chirurgie. Berlin, 1838.
6. Blair VP. Reconstructive Surgery of the Face. Surgery, Gynecology and Obstetrics; 1922, 34:701.
7. The Legacy of Vilray Blair. Available at http://www.plasticsurgery.wustl.edu/Overview/VilrayBlair.asp
Accessed March 18, 2008.
8. Smith F. Nelson loose-leaf system; reconstructive surgery of the head and neck. New York: Nelson, 1928.
9. Vrebos J. Regards sur la Revue de Chirurgie Plastique (1931-34) et la Revue de Chirurgie Structive (1935-38). Annales de Chirurgie Plastique Esthétique; 2007, 52: 265-75. Abstract available at
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6W8M-4NT93YW-1&_user=5677593&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000049866&
_version=1&_urlVersion=0&_userid=5677593&md5=a5f8db429e7154878bc837cacc201f65
Accessed March 18, 2008.
10. Mathes SJ, Hentz VR, eds. Plastic Surgery. 2nd. ed. Philadelphia: Saunders, 2006. Contents available at
http://www.saundersplasticsurgery.com/toc.cfm
and
http://www.elsevier.eu/wps/find/bookdescription.cws_home/690887/description#description
Accessed March 18, 2008
Accessed March 18, 2007
2. Saraf S, Parihar RS. Sushruta: The first Plastic Surgeon in 600 B.C. The Internet Journal of Plastic Surgery; 2007, 4 (2). Available at http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijps/vol4n2/sushruta.xml
Accessed March 18, 2008.
3. von Graefe CF: Rhinoplastik, oder die Kunst den Verlust der Nase organisch zu ersetzen. Berlin, G Reimer: 1818.
4. Carl von Gräfe. De rhinoplastice. 1818. - LaneConnex - Lane Medical Library & Knowledge Management Center, Stanford University Medical Center. Available at http://lane.stanford.edu/portals/history/graefe.html?proxy-links=false
Accessed March 18, 2008.
5. Zeis E. Handbuch der Plastischen Chirurgie. Berlin, 1838.
6. Blair VP. Reconstructive Surgery of the Face. Surgery, Gynecology and Obstetrics; 1922, 34:701.
7. The Legacy of Vilray Blair. Available at http://www.plasticsurgery.wustl.edu/Overview/VilrayBlair.asp
Accessed March 18, 2008.
8. Smith F. Nelson loose-leaf system; reconstructive surgery of the head and neck. New York: Nelson, 1928.
9. Vrebos J. Regards sur la Revue de Chirurgie Plastique (1931-34) et la Revue de Chirurgie Structive (1935-38). Annales de Chirurgie Plastique Esthétique; 2007, 52: 265-75. Abstract available at
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6W8M-4NT93YW-1&_user=5677593&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000049866&
_version=1&_urlVersion=0&_userid=5677593&md5=a5f8db429e7154878bc837cacc201f65
Accessed March 18, 2008.
10. Mathes SJ, Hentz VR, eds. Plastic Surgery. 2nd. ed. Philadelphia: Saunders, 2006. Contents available at
http://www.saundersplasticsurgery.com/toc.cfm
and
http://www.elsevier.eu/wps/find/bookdescription.cws_home/690887/description#description
Accessed March 18, 2008
Updated June 5, 2008
© V. Mačionis 2008