Plastic surgery does not relate to any specifically defined organ or anatomical area but consists essentially of corrective, restorative surgery.
A plastic surgeon is often part of a multiprofessional treatment team.
Conditions such as acute infections or injuries may require emergency plastic surgery. Check local availability of 24-hour emergency plastic surgery services.
Purely aesthetic surgery is usually not provided in public health care.
Consult also local policies concerning indications and organization of care.
Acute infections
Each specialty is responsible for infections in its patients. The most severe infections can be treated in cooperation with a plastic surgeon, particularly at the reconstruction stage.
The superficial epidermis or superficial dermis is detached due to abrasive forces.
There is often plenty of sand, dirt and foreign material on the wound surface.
After applying superficial or infiltration anaesthesia, all foreign material should be carefully removed from the wound because otherwise the foreign material and dirt will be stuck underneath or inside the epithelial layer as the wound is epithelized. Subsequent removal will be practically impossible.
The debrided wound should be covered with a non-adhesive foam dressing or other type of non-adhesive dressing.
Deep injuries may require a skin graft.
Dermatoporotic ulcers
Low-energy rupture or haematoma of fragile dermatoporotic skin; the ruptured fragile skin cannot be sutured
Often leads to slowly healing tissue defects.
E.g. a pretibial ulcer next to the anterior tibial surface
Haematomas
Smaller, non-taut haematomas not jeopardizing blood circulation in the skin can be treated by supportive bandage.
Extensive haematomas may detach the skin from the fat beneath, which may even lead to extensive necrosis of the skin. Such haematomas should be urgently drained.
Skin rupture/laceration
Ruptured fragile skin may in some cases be thinned and an attempt made after debridement to use it as a skin graft.
An evident skin defect should be repaired by using a skin graft.
Surgical treatment can be considered in individual cases where conservative treatment is being very well implemented but the ulcer is so extensive that it would take a very long time to close conservatively.
For other burdensome scars, a plastic surgeon should be consulted in cases such as the following:
scars clearly impairing function, such as tight scars preventing the full range of joint movement or associated with other harm
large or deforming scars.
Lymphoedema
Lymphoedema means accumulation of fluid containing protein in the subcutaneous tissue due to deficient lymph circulation.
Lymph circulation may be impaired by surgery, radiotherapy, an injury or an infection (secondary lymphoedema).
Primary lymphoedemas with congenital causes are rarer.
The diagnosis of lymphoedema is based on clinical examination (detection of pitting oedema).
Differential diagnosis: other causes of oedema, such as venous, cardiac or renal failure, venous occlusion, tumours, vascular developmental anomalies
Imaging should be used to exclude recurrent tumour / lymph node metastases in patients with cancer (including patients with history of cancer) and recently developed lymphoedema.
Compression therapy with supportive garments is the cornerstone of treating lymphoedema.
At first, the aim is to remove superfluous tissue fluid, which can usually most easily be done by using a slightly elastic supportive bandage. Measures involving supportive garments should be taken only after pitting oedema has been treated.
In mild oedema, treatment with supportive garments can be started right away.
Supportive garments must be replaced often enough to ensure sufficient compression.
For lower limbs every 3-6 months
For upper limbs about every 6 months
Surgical treatment
Surgical treatment is divided into mass removal surgery and microsurgery to restore the function of the lymph system.
The choice of surgical method depends on factors such as the duration of oedema, the development of fibrotic/fatty tissue, the cause of lymphoedema, the volume of the fluid component, whether and how often the patient has had erysipelas, as well as on the patient's other conditions and functional capacity.
Mass removal surgery
Liposuction (requires extremely good compression therapy before surgery and permanently thereafter)
Excision of damaged tissue and repair by skin grafting is very rarely used today.
Surgery to restore the function of the lymph system
Patients with gender dysphoria are usually diagnosed at specialized units Transgenderism.
Patients are referred for assessment of surgical treatment from these units.
Restorative surgery and genital surgery are available in public health care.
Depending on individual consideration and the patient's wishes, restorative surgery may include masculinization or feminization of the chest area, or genital surgery, for example. Check local policies.
Cleft lip and palate
The treatment of cleft lip and palate as part of a multiprofessional team Cleft Lip and Palate
Complications and sequelae of aesthetic surgery
Aesthetic surgery means surgical modification of normal structures or features purely for looks or shape.
Any complications or sequelae of aesthetic surgery should primarily be treated in the private sector.
Exceptions are emergency situations requiring immediate treatment, such as
infection
bleeding
significant rupture/dehiscence of a wound
pulmonary thrombosis/embolism, an allergic reaction or other condition requiring immediate treatment.
Late oedema following breast implant surgery may signify breast implant lymphoma Breast Augmentation, requiring urgent examination at a breast unit.