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Planning is of the essence: a summary of reconstructive surgery techniques (Part 3)
Take a trip through the centuries and the evolution of surgical techniques to the life-giving work of today’s plastic and reconstructive surgeons (Part 3).
Read Part 1 of a summary of reconstructive surgery techniques here.
Read Part 2 of a summary of reconstructive surgery techniques here.
Tube pedicle flaps
During and after World War I, tube pedicle flaps were developed to move large areas of skin and subcutaneous tissue to areas requiring repair.
A tube pedicle is a reconstructive technique in which the skin and soft tissue to be used for the flap is formed into a tubular pedicle and moved from the source to the target site by anchoring at both ends, periodically severing one end and anchoring it closer to the flap target.
The use of a tube pedicle flap is usually a multistage procedure requiring careful planning before the actual surgery. The classical abdominal tube pedicle flap for the transfer of large areas of skin and subcutaneous tissue is raised on the abdomen and lateral aspect of the thorax. It involves two parallel incisions. The tissue between these is raised and the donor site repaired with a split skin graft. The flap is tubed to eliminate any raw surface, and this was critical before the use of antibiotics. After four weeks, one end of the flap is divided and sutured to a prepared site on the forearm.
After a further four weeks the other end of the flap can be transferred to its planned recipient site. This is a multi-stage procedure and requires the patient to be in hospital for long periods of time up to six months.
Cross leg flap
This flap repair utilises a flap of skin and subcutaneous tissue raised on the calf of the uninjured leg and sutured to a complex tissue loss on the injured leg. The raised flap donor site is repaired with a split thickness skin graft.
It requires fixation of the legs together using either plaster casts or orthopaedic pins. A second stage of the reconstruction is done after three weeks when the base of the flap is partially divided. At a third procedure the flap is completely separated at its base. The remaining wounds are sutured. Nursing a patient with this flap is vitally important, as the patient is confined to bed until the third stage is completed.
These pedicle flaps have been largely superseded by many newer flaps not requiring lengthy stays in hospital.
Free flaps
These are flaps based on a known blood supply. The vessels are isolated and reattached to blood vessels in the recipient site. Because of the small calibre of these vessels, repair requires an operating microscope.
Conclusion
Plastic and reconstructive surgery has an ancient and colourful history. Today it covers the whole of the human lifespan. Newborns require corrective surgery for congenital facial and other defects. In the middle years burns and trauma require plastic surgical attention. In our later years skin cancers require careful plastic surgical management. The gains in quality of life for these groups is inestimable.
Read part 1 of this article here.
Read Part 2 of this article here.
Dr Earle Brown FRACS FRCS is a well-known plastic surgeon who, before retiring from practice in Aotearoa New Zealand, played a role in the development of plastic surgery in our country.
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Find out more about the history of plastic surgery.
Read about New Zealand’s contribution to plastic surgery and the origins of the word ‘Plastic’.
Read about Sir William Manchester’s role in the establishment of plastic surgery in New Zealand.
Discover the work of Sister Joyce Walters in the establishment of the New Zealand plastic surgical nursing service.
Skin deep: unveil the secret superpowers of your body’s largest organ.
Read about the pioneers of plastic surgery: the story of Kiwi innovation over the war years - Part 1, Part 2, and Part 3.
Plastic and reconstructive surgery has an ancient and colourful history. Today it covers the whole of the human lifespan. Newborns require corrective surgery for congenital facial and other defects. In the middle years burns and trauma require plastic surgical attention. In our later years skin cancers require careful plastic surgical management.