What's new in surgery. Plastic surgery and burns.
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Plastic surgery is all too often thought of as an indulgence of the rich and famous with little attention paid to the repair of bodies and limbs disfigured or deformed by accident or illness. Surgeons look to management to address those issues that create an insecure base for planning the service and for its organisation nationwide.
Plastic surgery has always been a technique- and technology-driven surgical discipline, given that there is no regional anatomic focus. There has been a remarkable evolution in technique over the last 25 years with an increased understanding of anatomy leading to a whole host of new and more reliable flaps, which has transformed reconstructive surgery, breast reconstruction being one notable example. The development and maturation of microsurgery has led to the full fruition of anatomic principles. With better understanding of blood supply to the skin, fascia, muscle, and bone, many traditional reconstructive procedures are constantly being superseded by the new, ingenious use of various tissue flaps. Advances in technology will accomplish another transformation of the specialty, notably the recent advances in tissue engineering, the potential of gene therapy, new alloplastic materials, and computer-assisted imaging technology. It would be impossible to address all of the recent advances in this rapidly expanding field of surgery in a short article. We have selected a few topics that we thought would be the most interesting to all surgeons to give a wide view of a variety of challenges addressed by the modern plastic surgeon. Major advances in surgery often come from cross-fertilization between specialties, and plastic surgeons have frequently been involved in this process.
Now that endoscopic techniques have been established in visceral and trauma surgery under the concept of minimal invasive surgery, plastic surgery has also begun to accept these techniques since minimal invasive surgery is very important in this field. In contrast to abdominal and thoracic surgery, plastic surgery cannot be done in preformed cavities. Therefore, it was necessary to develop new techniques and instruments. We present the most important operations in the field of plastic surgery that can so far be carried out endoscopically. The development phase is only at the beginning, and new indications are being added daily since the technical equipment can also only be gradually adapted to the needs that arise.
Plastics are not only the proverbial everyday commodity, but they also permeate almost every aspect of medical devices, from technology to clinical application. This article addresses some of the confusing features of plasticity as they relate to the materials called plastics, to the phenomena of material plasticity, and to the clinical and biological usage of the word.
The spectrum of plastic surgery is wide. It covers constructive, reconstructive and anaplastic surgery. A considerable portion of the operations can be carried out ambulatorily. Several examples show the practicability and limits. They are different according to the orientation of the surgeon and the equipment in his practice. Unfortunately also economic problems must be pointed out.
Plastic and reconstructive surgery is benefiting from the ideas and achievements of its innovators, while at the same time exploiting collaborative efforts with private industry and with other surgical specialties. The result is better and faster problem-solving for patients with physical impairments.
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Plastic surgery has acquired an important place in primary breast cancer treatment (conservative or radical) and in the treatment of sequelae. The authors have tried to define, based on their experience, the contraindications for breast reconstruction. They are rare from a technical point of view. The carcinologic contraindications are relative: highly aggressive cancers, locally advanced cancers, cancers with metastases or recurrences. Radionecrosis and radio-induced sarcomas, treatment sequelae are also contraindications for breast reconstruction. General contraindications are relative (major obesity, smoking, diabetes, general weakness). Psychological contraindications must be taken into consideration. The authors conclude that contraindications for breast reconstruction are mainly carcinologic and the decision for reconstruction is usually taken by the patient after complete medical information.
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