PLASTIC RECONSTRUCTIVE SURGERY

Breast Reconstruction: Reconstructive Mammoplasty
Oncological Facial and Body Surgery
Post-Traumatic Reconstruction
Congenital Defects Sindactyly
Cleft Lip
Cleft Palate
Angioma
Hand Reconstructive Surgery
Carpal Tunnel (carpal ligament release)
Z-Plasty Incision
Skin Lesions
Nasolabial Flap
Tissue Expander
Scar Revision
Maxillofacial Surgery

BREAST RECONSTRUCTION; Reconstructive Mammoplasty

Breast reconstruction is one facet of a complete treatment plan for breast cancer.
Depending on the situation, the reconstruction can be done at the same time as the amputation and in other cases it would be advisable to do this several months after completing radiation therapy.
There are different techniques utilized in breast reconstructive surgery. The techniques that use one’s own tissues recreate a breast that is more natural and will not change as much over time, even when considering changes in posture or weight, etc.  On the other hand, the use of tissue expanders or implants can lessen the possibility of complications under certain conditions.
Breast reconstruction normally requires two or three operations.
Breast reconstruction affects:

1. In fallen breasts, it may be necessary to change the other breast in order to achieve good symmetry.
2. Change out the tissue expander for a permanent implant.

Complete Areola-Nipple Reconstruction

TRAM


In a Breast Reconstruction using an abdominal flab (TRAM Flap), tissues from the abdomen are transferred from the upper body to create a new breast.
In order to avoid muscle weakness in the abdominal area it may be necessary to locate a mesh to add strength to the abdominal wall.
Patient choice is vital taking into account important risk such as necrosis or the total loss of the flap.

EXPANDER

In some scenarios reconstruction with tissue expanders and breast implants achieves excellent results.  A tissue expander is a special prosthesis that is introduced in order to allow the tissue to be filled progressively and subsequently creating space for locating a permanent implant.  There exists expanders that, once inflated, can be left in place permanently. A tissue expander needs good skin coverage of a determined density and elasticity, because tissue quality is very important under these circumstances.  For example, radiation therapy on the upper body can be contraindication for tissue expanders.

FLAP

The Latissimus Dorsi Musculocutaneous Flap technique allows the removal of tissue from the back and transferring it to the upper body for the purpose of creating a new breast. Depending on the quantity of tissue needed, it may be necessary to utilize breast implants as well in order to achieve the desired size.

ONCOLOGICAL FACIAL AND BODY SURGERY

 
Skin Tumors and Lesions

A skin lesion should be removed completely, limiting it as much as possible both on the surface of the skin and beneath, to make sure that a sufficient depth and area are extracted.  Sometimes a sample biopsy needs to be examined by a pathologist.

In certain specific cases it will be necessary for a sample to be studied mid-operation via microscope by a pathologist in order to determine if the extraction needs to be redone. 
Functional maintenance is the primary objective and must take precedence the purely aesthetic considerations that we desire.
The reconstruction resulting from the removal of a lesion can require complex techniques that target the best functional and aesthetic result possible.

POST_TRAUMATIC RECONSTRUCTION

Surgical reconstruction resulting from accidents or burns in any area of the body

CONGENITAL DEFECTS

SINDACTYLY

Sindactyly (fusion of finger or toe membranes) refers to a fusion within the hands or feet that generally means a skin-level connection of fingers or toes, although in some rare cases can include the joining together of actual bone.
The fusion can be partial, usually extending to the first joint, but can include the entire finger or toe and in some cases extra digits as well. Polysyndactyly is not just fusion of skin but includes the presence of additional fingers or toes and is just as common on hands as feet.

CLEFT LIP

Cleft lip is a congenital defect in the structures that form the mouth.  It is a fissure or separation in the lip and results when the two sides of the lip do not grow at the same time.

Cleft lip and palate can occur simultaneously or separately.  Furthermore, the opening in the lip or palate can be unilateral or bilateral.

CLEFT PALATE

Cleft palate is a congenital defect of the structures that form the upper palate and is characterized by a split or separation in the palate on the roof of the mouth.

Cleft lip and palate can occur simultaneously or separately.  Furthermore, the opening in the lip or palate can be unilateral or bilateral.

ANGIOMA

This is a benign tumor formed by blood vessels that can manifest itself anywhere on the body. Angiomas are classified according to spider veins, strawberry hemangiomas and senile angiomas among others. There also exists a type of angioma that forms from the accumulation of swollen lymphatic glands.

HAND RECONSTRUCTIVE SURGERY 

Dupuytren's contracture is an abnormal thickening and shortening of the palmar aponeurosis (fibrous tissue underneath the skin in the palm of the hand).  In the beginning this manifests itself as a nodule or thickening of the skin that is strongly adhered to the fibrous tissue on the palms of the hand.
It generally is not painful.

CARPAL TUNNEL (CARPAL LIGAMENT RELEASE)

Carpal Tunnel Syndrome occurs when the median nerve, which spans from the forearm to the hand, is trapped or under pressure in the area of the wrist.  The median nerve controls the sense of feeling and touch for the front part of the fingers (except for the little finger) as well as the impulses of some small muscles in the hand that allow movement of the fingers and thumb.

The carpal tunnel – a narrow and rigid passage from the ligament and the bones in the base of the hand – contains the median nerves and tendons.  Sometimes, the enlargement of those irritated and inflamed tendons narrow the tunnel and compress the median nerve.  The result can be pain, weakness and numbness of the hands and wrist that radiates throughout the entire arm.

Although the sensations of pain can indicate other conditions, Carpal Tunnel Syndrome is one of the most common compression neuropathologies and well-known by those who compress or traumatize the peripheral nerves of the body.

Z-PLASTY INCISION

Z-plasty is a surgical technique done by repositioning the incision such that the new location remains more in accordance with the natural folds of the skin, making it less noticeable.

In this procedure the old scar is removed and replaced with incisions on each side that create small triangular skin flaps.  These flaps are then utilized to cover the wound at a different angle, making the scar resemble a Z.  The wound is closed with fine sutures and removed after a few days.  The Z-Plasty is an outpatient procedure that is done with local anesthetic.
It is important to emphasize that this procedure does not eliminate the scars, but rather makes them as imperceptible as possible.  A part of the scar will always remain outside the area involved.

POST-TUMORAL RECONSTRUCTION

Skin Lesions

NASOLABIAL FLAP

Through the use of local flaps, we are able to utilize the adjacent areas that have the same texture, color and hair, which in turn allows us to achieve results that are more aesthetically pleasing.

TISSUE EXPANDER

Tissue expansion is a procedure that allows the body to form extra skin that can be utilized for the reconstruction of any part of the body. A silicon ball expander is inserted under the skin near the area to be repaired and is gradually filled with a saline solution that is progressively shaped and filled until the skin distends. 

This technique is used frequently in post-mastectomy breast reconstruction. However, it can also be used after accidents or surgery or to repair congenital skin damage or even in certain cosmetic procedures.

SCAR REVISION

There exist a wide variety of techniques for correcting an unattractive scar. For example, the Z-Plasty eliminates band or cord-shaped scar tissue that crosses the folds one’s joints (elbow, finger, etc.) and limits flexibility and proper movement.

DEFINITIONS:

Hypertrophic Scar:  Welt.

Distatic Scar:  A scar that is wide and flat. 

The borders of a wound separated by scar tissue can sometimes rise to a height of several centimeters.
Cicatriz QUELOIDE: Tumoración o bulto que sobrepasa los limites de la cicatriz
Keloid Scar:  Mass and shape that extends beyond normal boundaries.

MAXILLOFACIAL SURGERY

What is maxillofacial surgery?  It involves trauma, tumors, congenital defects and cranio-mandibular dysfunction (TMJ) 
Traumatology of the Mouth and Face:

This refers to accidents that cause damage in these areas.  In actuality, it can be said statisticially that the injuries most common for children occur when they begin to walk and hit their chin.  This is a high risk, because the energy from the trauma transfer to the condyles of the jaw bones which is where jaw development occurs.
Inadequate treatment of children in this situation will eventually result in stunted facial growth and possibly the ability to open their mouth.  In adults the most frequent causes of trauma in the face are automobile accidents, social violence and accidents in the home.  All of these are able to bring about injuries on the face, the mouth, the tongue and often fractures of the jaw and maxillar and should be attended to immediately.

Whenever you have received a blow to the face, you should always be examined by a Maxillofacial surgeon, who will evaluate the necessity of radiological work to find possible fractures that are not obvious to the naked eye. The treatment will always be the most appropriate and the idea of turning to other specialties that simply do not have adequate training for the management of these kind of injuries should not be even be considered.
Congenital Facial Defects:  From the moment that a human being is inside the womb there exists the possibility that the mouth and face will not form in the normal manner, as is the case with the children that are born with Cleft Lip and Palate, the most well-known congenital facial defects.  However, there exist many other syndromes (groupings of signs and symptoms), such as the second and third branchial arch syndrome that manifests itself by a lack of development on one side of the face resulting in small ears and difficulty opening the mouth along with decreased auditory capacity (and in some cases with both sides of the face undeveloped).

The medical specialty of Genetics now knows of hundreds of alterations that can manifest in malformations of the mouth and face.  If one of these shows up in your newborn in the shape or function of the facial area, do not hesitate in asking the immediate advice of your Maxillofacial surgeon.
Orthognathic Surgery

This is the part of the specialty that treats modifications in the proportion of the mandible relative to the maxillars. Here we treat conditions such as prognathism (an oversized mandible), apertognathia (inability to close the mouth due to premature molar contact or malformations of the maxillar or mandible).  Some dentists and orthodontists think that they can restore some of these conditions with braces, when in reality these cases require surgery.  Furthermore, they do not explain this to their patients leading them to believe that they can have a well-proportioned face and mouth through non-invasive methods. 

Always remember that if you or your children run into an orthodontial dilemma that you should be evaluated previously by a Maxillofacial surgeon.
Craniomandibular Articulation:
Also known as the temporomandular joint, it is the part of your anatomy that allow the mandible to open and close, having the base of the skull as its base of support.

The majority of the suffering in this area manifest themselves as loud or unusual noises in the ears, pain in the ear, half in the skull and half in the neck.
These conditions generally afflict females - 90% of the patients are women - and in the early stages are related with emotional manifestations, but also can later manifest itself in grave illnesses such as rheumatoid arthritis or lupus that can be a manifestation of de-calcification (osteoporosis) resulting from premenopause. 
Children that suffer a trauma on the chin often develop serious craniomandibular issues in adulthood.