Reconstructive Plastic Surgery
Reconstructive plastic surgery deals with rectifying bodily abnormalities caused by birth defects, injuries, disease, ageing or infections.
Trauma
Lacerations
This is common injury where an open wound is sustained in the course of an accident. Sometimes the underlying bone may be affected.
A tidy repair under antibiotic prophylaxis affords the best chance of a fine scar.
Most facial lacerations can be safely closed within a 24 hour time period.
Depending on the site of the laceration, sutures are removed at 7 days (face) or at 14 days (extremities). Where possible, external sutures are avoided.
Post operative scar care is essential for an optimal outcome.
Burns
Another common injury from any heat source (fire, hot water, contact with hot objects) needs early treatment to reduce pain, hasten healing, prevent scar formation and to optimise the outcome.
Small burns can be treated on an outpatient basis with regular wound dressings in the clinic and commencement of scar care immediately on wound re-epithelialisation to avoid thick red hypertrophic or keloid scars
Less severe issues after a burn as Post Inflammatory Hyperpigmentation can be treated with pigment reduction modalities.
More severe late stage issues as scar contractures may require surgical reconstruction.
Please note that large burns are usually evacuated to tertiary hospitals in Singapore with specialised facilities as the National Burns Centre at the Singapore General Hospital campus.
Facial Fractures
Facial fractures can profoundly affect facial shape and function.
These range from simple nasal fractures to more complex fractures as orbitozygomatic fractures.
Repair can range from simple manipulation and reduction to fixation with plates and screws.
All have the ultimate objective of restoring the facial bones to its normal position.
Scars
These firm, lumpy reminders of a previous skin break from surgery or trauma can become problematic when they take on autonomous growth characteristics and become tumour-like (keloid scars), become red and raised (hypertrophic scars) or start to cause pain, restrict movement or distort anatomy when the scar is tethered or contracted.
Keloid Scar Treatment
Keloid scars are raised, thickened, and often itchy or painful scars that extend beyond the boundaries of the original wound.
Most can be treated with regular steroid injections. Botox may be added to the injection as it appears to decrease scar contraction.
Only in situations where they arise on the face or ears, judicious excision may be an option with regular review and steroid injections as required.
Scar Revision Surgery
Skin Lesion Excision and Reconstruction
Skin lesions may be benign or malignant.
It is important that a tissue diagnosis be obtained in the first instance to ascertain the pathological identity of the lesion in question. Benign and malignant lesions may look very similar.
In either case, excision of a lesion must be thoughtful with a correctly aligned incision for a fine scar and optimal cosmetic outcome.
Tumour Excision and Reconstruction
Subcutaneous tumours may also be benign or malignant.
Once again, excision of a tumour must be thoughtful with a correctly aligned incision for a fine scar and optimal cosmetic outcome.
Tumour excision should also be complete to prevent recurrence.
Where tumour involvement is extensive and includes the overlying skin, closure after complete excision may necessitate flap cover.