The scope of plastic surgery

Plastic Surgery techniques are used to deal with a wide range of conditions and every part of the body from the toes to the top of the head 

Common reconstructive procedures are the closure of wounds following accidents or after the removal of tumours, contracture surgery for burns survivors, breast reconstruction for women following mastectomies, cleft lip and palate surgery and attachment of severed body parts. The conservation of upper and lower limbs after severe trauma, aimed at restoring function, is a better option than amputation. 

Only four hospitals in the country have plastic surgery units – Middlemore, Waikato, Hutt and Christchurch – however plastic surgeons are routinely called upon to operate in most large public hospitals. While each unit does the full scope of procedures, the care of patients in secondary centres who present with complex problems requiring tertiary-level Plastic surgery may be compromised because of inadequate access to appropriate expertise. 

Plastic and reconstructive procedures are very time consuming with many operations taking more than four hours. These tie up operating theatres for long periods of time, both for acute and elective cases. Some conditions - like burns - require multiple operations for several years. 

There is a desperate need for more theatre time for plastic and reconstructive surgery. 

 

The main areas of work are: 

 

Combining skills

Plastic Surgeons work closely with other specialist surgeons - Orthopaedic, maxillofacial, Vascular, Paediatric, Ophthalmic or Neurosurgeons to help in the treatment of complex problems. 

 

For instance, hand surgery is often shared between orthopaedic and plastic surgeons; surgery to the head or neck between ear, nose and throat surgeons and plastic surgeons. Cases of hypospadias (congenital defects to the genital areas) will probably involve a paediatrician, urologist and plastic surgeon; craniofacial surgery, a neurosurgeon and plastic surgeon. In all-too-frequent motor vehicle accidents which leave someone with mangled lower limbs, an orthopaedic surgeon will deal with broken bones and damaged joints, while plastic surgeon will deal with the open wounds and provide soft tissue cover. 

 

Treatment may be staged over many months or years, involving specialists from many modalities. In the case of congenital cleft lip and palate, for instance, surgery in stages is combined with dental work and speech therapy: repair of the lip and anterior palate is followed by repair of the posterior palate, orthodontics, management of hearing and glue ear, speech therapy, orthognathic surgery, revisional surgery and rhinoplasty.