Reconstructive surgery is a surgical speciality that deals with restoring bodily form, function and aesthetic appearance following or due to a disease process. The aim is to do this with as little discomfort and most pleasing outcomes for the individual.
The areas in which we offer reconstructive surgery are:
Skin cancer is an increasing concern especially in our society where sunbathing and the outdoor life style’s expose us to dangerous UV rays of the sun. As with all cancers they start small and inconspicuous but can be locally destructive to tissue and surrounding structures if neglected. Early detection allows sound oncological excision and minimal yet visually pleasing results. Prevention is the key, we offer a thorough evaluation and treatment plan tailored to your individual needs.
Skin cancer can be categorised into non-pigmented and pigmented lesions. Non-pigmented make up the larger group with basal cell carcinoma (BCC) most prevalent followed by squamous cell carcinoma. The pigmented group makes up less than 4% but is led most ominously by the melanoma. This is more related to severities of sun burns obtained in our youth as well as familial predilection. This is also one of the most aggressive skin cancers, with early detection being most crucial.
The typical basal cell carcinoma presents itself in sun exposed areas as a small itchy pimple that develops into a pearly coloured nodule with small capillaries dispersed within.
The melanoma presents as asymmetrically shaped, irregular borders, variegated colour, usually greater than 0.6cm in diameter and elevated.
Finally between benign and cancerous growths we can get pre-malignant lesions. This means they have a higher potential to convert to a cancerous lesions and removal may be advised.
Breast cancer has justifiably received intense research due to its prevalence and mortality rate amongst female patients. Owing to active awareness programs, modern screening tools and guidelines, breast cancer is more frequently detected in its earlier stages resulting in a better prognosis for the patient.
Following oncological resection of tumours, volumetric and symmetrical defects become apparent. Reconstructive surgery in these settings allows for an improved long term appearance.
Reconstructive options can be under one of the following three:
Autologous: This only uses the persons own tissue to reconstruct, which can be in the area (pedicled flap) or from a distant site of the body (free flap).
Combined: Autologous & prosthesis, where body tissue is combined with a synthetic prosthetic (e.g expander or implant).
Prosthetic: Where only a prosthetic device is used e.g expander or implant.
Any tissue that is damaged will form scar tissue(except foetal)to some degree or other. The severity of the scar formation depends on the mechanism of injury, location, skin type, treatment offered, genetics and external factors. Scars can be visibly or physically debilitating, leading to social anxiety or impaired daily activities.
Scar formation takes about a year to completely mature, during which time modulation can be implemented to improve the final outcome. The key to optimising the outcome is pristine closure of the wound, maintenance of its integrity and modulating the scar as it matures. Wound healing takes about 12 months to complete (mature) and its colour reflects these phases
The four phases are:
Haemostasis – clotting (bright red)
Acute Inflammatory – recruitment of cells (red - cyanidin)
Chronic inflammatory (proliferative) – growth of new blood vessels, structural elements of the skin (Pink)
Scar modulatory (remodelling) – architectural organisation of collagen into final type and orientation (pink-surrounding tissue colour)