PLASTIC, AESTHETIC AND RECONSTRUCTIVE SURGERY
The body may suffer from various deformations or tissue – organ function losses as a result of diseases, accidents, operations, tumors, burns, etc. These losses may deeply affect the human life. Plastic and reconstructive surgery is a branch of surgery aiming to repair and correct the congenital or subsequently acquired tissue and organ function losses in body. It tries to complete deficiencies, replace the required functions, and strengthen the weaknesses. Plastic and reconstructive surgery is repair and restructuring surgery.
Aesthetic and Reconstructive Breast Surgery (Mammoplasty):
Breast enlargement operation, named as augmentation mammoplasty, is a surgical operation performed in order to enlarge the size and shape of female breasts. This surgery may be applied in the following cases:
For personal reasons in women who find their breasts too small; or
In order to correct the breasts which downsize after pregnancy; or
For the sake of symmetry of breasts of different sizes; or
For breast reconstruction purposes after breast cancer surgery.
Aesthetic surgeons may increase breast circumference of women by one or several brassiere measures with breast prosthesis implanted behind breasts.
Women with large and droopy breasts may be exposed to back and neck pains, skin irritations, bone abrasion and respiratory problems because of these heavy tissues. In addition, bra straps cause notches on shoulder due to this weight. Breast reduction operation is termed as “reduction mammoplasty” in medicine. This procedure is the operation of removal of surplus fat, skin and breast tissues in order to make the breasts appear smaller, lighter and fuller. At the same time, this operation further reduces areola, i.e. the dark zone around nipples. Breast reduction operation also covers mastopexy.
With the effects of pregnancy, lactation and gravitational force, breast tissues of all women indispensably droop as time passes. In addition, loss of skin flexibility by aging also contributes to droopy appearance and structure of breasts. The operation named mastopexy aims to reshape and steepen the droopy breasts. Of course, this operation does not eliminate the effects of gravitational force. Therefore, breasts undergoing mastopexy tend to droop again by time varying from person to person. Mastopexy at the same time reduce areola, i.e. the dark zone around nipples, thereby giving a more aesthetic appearance thereto. If your breast tissue is small or its sizes are reduced due to such a reason as pregnancy, through implantation of a breast prosthesis in the same operation, in addition to steepening, it may also be possible for you to have desired breast sizes.
Facial aesthetics generally and mostly refers to correction of aging-related changes for many people. In fact, one of the important dimensions of facial aesthetics is to have an attractive and eye-catching facial appearance, in addition to correction of aging signs, if any. To this end, many known and new methods are employed in aesthetic and plastic surgery. Stem cell therapies, lasers, ultrasonography and radiofrequency instruments, special fillings and operation methods developed in the recent years have brought important advancements and have facilitated successful results in this field.
Eye and its contours are the zones where aging signs are seen first. What are these signs and changes? First of all, crows feet and clarification of forehead lines, and then, bags in eyelids, followed by sagging of upper and lower eyelids and brows. These aging signs are further accompanied by such slower changes as deepening in lines on cheek and nose intersection, sagging in cheeks and flattening of cheekbones, prolapse in neck, and wrinkles on face.
At early stages, Botox, filling, PRP and similar other medical therapies are useful for reduction of these signs. At the later stages, for slight to moderate level prolapses and wrinkles, non-surgical skin lifting and resurfacing operations which are applied by newly developed devices such as “Ulthera” and “3DEEP RF” and Palomar ICON and which allow the patient to return to her social life immediately after the operation are useful and helpful in many people.
Surgical methods are nowadays the main alternative in treatment of advanced level wrinkles and prolapses. However, in patients who do not want surgery or are not fit for surgery, the aforementioned technologies are useful in reduction of many aging signs. Surgical methods that can be used for this purpose are blepharoplasty (eyelid aesthetics), classical skin lifting, endoscopic mid-face lifting and brow lifting, and laser-supported mini face-lifting. Patients prefer especially laser-supported mini face-lift for face and neck lifting operations because it leaves a shorter scar and its healing and recovery process is relatively shorter than classical face lifting.
Purpose of rhinoplasty is to make changes in general appearance of nose, thereby making the nose congruent with face, and in the meantime, to resolve breathing problems, if any. By nose aesthetics operations, nose may be extended or shortened, or may be reduced or enlarged, and nares and nose dorsum or “bridge” may be reshaped. Nose tip may be changed to be more upturned or narrower or wider. In short, changes may be made to the extent permitted by anatomic features of nose and face, and nose skin.
In general, curvature of nasal bone is rather normal and is seen frequently. Degree, location and level of curvature, called deviation, may vary. If it is so heavy that it occludes airways, it may cause breathing difficulties. In this case, this curvature is corrected as a part of nose aesthetics, and this process is called “septoplasty”.
At least one of the following features is seen in a candidate fit for nose aesthetics:
Nose is too wide or long in comparison to face.
Nasal bone is broken or curved.
Shape of nose has changed due to such a reason as accident or impact.
Nose is visibly asymmetric.
Nose tip is drooping when looked from side profile.
Nares are not fit to overall shape of nose.
Angle between nose and lips is too narrow or too wide.
Nasal Aesthetics Operation:
The operation is performed in hospital under general anesthesia and takes 1 to 5 hours in average depending on the procedures applied. It generally does not require the patient to stay in hospital. A splint named “thermal splint” is used in order to stabilize the nose for 5 to 7 days after the operation. Buffer is generally not used, and if required, a silicone slotted buffer which also allows inhalation is used.
After the operation, there may be bruises and tubercles in the eye contour. In general, healing time is 3 to 5 days. Patient may return work 1 week after the operation. Patient can do sports and use glasses 1 month after. Nose takes its final shape at the end of 1 year in average, though it varies depending on the nasal structure.
The projected result of nasal aesthetics operation is to have a nose congruent with chin, eyes and cheeks. That is why the patients who know general characteristics of their face, and know specifically what they want for their nose, and accept that the operation has its own limits are the most satisfied patients. It is very important to be sure of what is desired and to establish a good dialogue with the doctor. On the other hand, it may be misleading to block out the patient’s own photograph, because changes on photograph are made bi-dimensionally in electronic media, while the changes during the operation are made on real human tissue and tri-dimensionally and by human skills. This means to say that a “perfect” nose seen on the screen may not be obtained by surgical operation.
The most important factors determining the postoperative shape of nose are the patient’s bone, cartilage, soft tissue and skin structures, and healing/recovery characteristics. Final shape of nose is determined by a combination of all these variables. Preoperative demands of patient also determine the uprightness and shape of nose. Some people prefer a more natural and flat nose, while some others prefer a more upright and attractive nose.
As a conclusion, the indicator of success in nasal aesthetics operations is to obtain a natural nasal appearance fit to face and compliant with aesthetic measures which does not have any operation scars.
Before entering into details of the abdomen lifting operation (lipoabdominoplasty), to describe the ideal abdominal anatomy is greatly important for understanding this operation. Ideal abdominal anatomy means an anatomic structure with evident side waist curves, and a slight concavity above the belly and a partial convexity under the belly, and image of abdominal muscles on both sides of umbilicus (belly-button).
Classical abdomen lifting operations aim to correct only drooping skins and slackened abdominal muscles. Therefore, creases may remain at side waist zones due to surplus fats, and even lower abdominal zone may be rather tense and flat, while upper abdominal zone may have a curved appearance. On the other hand, purposes of lipoabdominoplasty are deepening of side waist curves, and removal of surplus lipoidosis and ptosis at lower abdominal zone, and non-existence of surplus tension at the mid-line, and additionally, removal of surplus lipoidosis and flabbiness at upper abdominal zone.
Beauty of legs is very important especially for woman body. Women having problems with their legs may be exposed to serious problems such as self-confidence and choice of dress. It may lead to some problems which seem simple, but are very important in human life, such as hiding legs by loose trousers, and looking enviously at women wearing mini skirt, and particularly, avoiding such social activities as swimming pool and sea in summer months.
Basic problems of legs are as follows: Parenthesis leg appearance, too thin or too thick legs, and asymmetric leg appearance. Basic methods employed for resolution of these problems are fat injection, use of silicone prosthesis, and liposuction.
As in all aesthetic interventions, first of all, patient is asked to express her complaints, and after determination of examination findings, the method to be applied is chosen. Surgical planning and drawing are prepared for the patient depending on the method to be applied. Drawing bears great importance in surgical planning, and it is required to work interactively with active participation of the patient. If this is done, postoperative patient satisfaction level will be very high.
All operations for buttocks, hips and waist may be collected under the heading of buttock aesthetics. The purpose is to shape and lift buttocks, to remove surplus fat in hips, and to pit and thin waist. To this end, fat is removed by liposuction at places required, while upper parts of buttocks are supported by fat injections. Silicone prosthesis may be used if fat is not sufficient. This process gives a backward hipshot and high buttock appearance. In patients who have lost too much weight and whose skin is loosened, the whole buttocks may be hung upwards by removal of a belt of skin from lower abdomen and upper buttocks.
There are many procedures applicable on buttocks. They may be applied alone or in combination, depending on the patient’s needs.
Liposhaping: Fat is removed from hips, waist and lower and outer sides of buttocks by using thin cannulas. The fat removed as above is intensified by special processes, and is given to upper side of buttocks. Thus, waist becomes hollow and thinner, and hips are narrowed. Agglomeration at the lower side of buttocks is corrected, and the lightened buttocks raise. Fat injections make the upper side of buttocks fuller, rounder and higher.
Buttock prosthesis: Silicone buttock prosthesis may be used in patients with flattened buttocks and without adequate fat tissue. These prostheses are specifically designed for buttocks. Prostheses are recently implanted inside muscles. This process has materially reduced the problems arising out of buttock prostheses. Prostheses are implanted through a short incision on the groove between buttocks, and operational scars are not visible.
Buttock lifting: Particularly after an excessive loss of weight, buttocks also prolapse downwards together with the whole leg skin. Emptied and slackened skin is removed in the form of a belt, together with abdominal lifting. These processes are called “belt lipectomy”. An all-round operational scar remains fully inside the underwear. This process tightens the buttocks and leg skin. If the lower part of buttocks is slackened, a part of skin may be removed in such manner to leave its operational scars inside the groove at the lower part of buttocks.
Suture hangers: In weak patients with a thin skin and small buttocks, small prolapses developing by time may be reduced by suture hangers. For hanger, the sutures applied in silhouette lift are used, and hanging procedure is applied in two sessions with an interval of 3 months. In the first session, sutures are implanted, and left for integration with body tissues. In the second session, hanging process is applied. Effects of hanger are weak and short-time.
Filling applications: Hyaluronic acid fillings may be used in patients with flattened buttocks and without adequate fat for fat injection, who do not want prostheses. The most known brand is Macrolane. Macrolane fillings endure for approximately 1 year.
Aesthetic and functional correction of vagina, inguinal zone and vaginal lip disorders in women constitutes the aesthetic surgery field. Other aesthetic operations include downsizing of vaginal labial minora, and restoration and downsizing of labial majora, and fat injection, or vaginal constriction.
Vaginal constriction operations, and uncontrolled episiotomy incisions in postnatal women, and multiparous women, and advanced age and structural features lead to expansion in vaginal wall. These disorders are both non-aesthetic, and may cause problems in sexual intercourse.
Shape, color and size of vaginal labial minora vary depending on race and age. Labial minora are not symmetric because one is generally larger or longer than the other. These problems may be congenital or subsequently acquired. As surplus parts of labial minora transpirate, they may emit a bad smell. Surplus parts of labial minora which have an aesthetically bad appearance or cause pain during sexual intercourse may be removed.
Craniofacial surgery is a plastic surgery discipline covering cranium, face and orbit (eyeball cavity). Surgeons dealing with craniofacial surgery are specialized on correction of congenital cranial deformities or subsequently acquired posttraumatic or post-tumor surgery deformities and to reconstruct the deficiencies. Plastic surgery specialists dealing with craniofacial surgery often enter into cooperation with brain surgery specialists or orthodontists.
- Craniosynostosis surgery: One or more of “suture” zones where cranial bones contact each other and which ensure growth of bones may be lacking in some cases. This is called craniosynostosis. It is seen in one of every 2200 live births. Cranium cannot grow vertically to this suture and continues its growth parallel to it. This results in various different cranial shape disorders. These disorders are publicly named as “tower head, hammer head or flattened head”. As the skull cannot grow normally, brain tissue may also be exposed to various different pressures, and vision problems and mental problems may develop. Craniofacial surgery aims not only to correct the malformations in cranium, but also to prevent the probable future vision and mental problems.
- Facial cleft surgery: Face and mouth zone is formed by combination of various bones and soft tissues during embryologic (mother’s womb) development. Non-combination of these tissues at various different stages and quantities cause clefts on face. Most common clefts are lip and palate clefts. In addition, clefts of upper lip, nose, orbit, forehead and skull, and mandibular (lower jawbone) zones containing various different degrees of skin, soft tissue and bone tissue may develop. Facial cleft surgery deals with correction of these deformities. Beside repair of skin tissue, bone tissue transplantation from another zone may also be required.
- Correction of posttraumatic deformities: Skin and/or bone losses occurring in cranial zone due to traffic accidents, firearm injuries and other traumas are repaired by various different surgical methods. Bone deficiencies may be repaired by cranial or another zone bones, or by such extracorporeal materials as titanium plates, and alloplastic materials (medpor, etc.).
- Repair of post-tumor surgery defects and deformities: Soft tissue and bone deficiencies emerging as a result of cranial and facial tumors are reconstructed by various different methods. Tissue transplantation may also be performed by microsurgery methods.
- Orthognatic surgery: Surgery discipline dealing with follow-up and treatment of lower and upper jawbone deformities. It partially deals also with aesthetic maxillary surgery. It is a treatment and surgery method applied together with orthodontist.
- Distraction osteogenesis: A surgery method applying the principle of elongation and growth of bone tissue by using an implanted tool if and when bone is not adequately developed in deformities in craniofacial bones. It has various applications on mid-face zone, mandibular, palate and cranial zones.
- Orbital hypertelorism surgery: Increase of distance between orbits (eyeball cavities) is called hypertelorism. It may be seen in various syndromic diseases, encephalocele, dermoid cysts and tumors. Craniofacial surgery deals with correction of hypertelorism.
- Surgery of craniofacial syndrome patients: In some cases such as Apert syndrome, Crouzon syndrome, Treacher Collins syndrome, Pierre Robin syndrome and craniofacial microsomy, a series of deformities may develop in the patient’s face and skull. These deformities require application of different approaches for various problems, as a part of craniofacial surgery discipline.
- Hemifacial atrophy (Romberg disease) surgery: A disease characterized by atrophy (regression and downsizing of tissues) affecting unilateral facial skin, soft tissue, muscular and rarely bone tissue in 95% of patients. Purpose of surgery is to provide a more aesthetic symmetry.
Maxillofacial Aesthetics:Maxillary structure may be changed through many operations in maxillary zone. Many surgical interventions such as maxillary filing or elongation of short chin may be applied.
Maxillary surgical interventions generally have aesthetic purposes. In addition, some mandatory processes may be applied together with orthodontists.
Maxillary filing is a maxillofacial aesthetic operation commonly applied in practice. In general, it is done to downsize too long or too wide chins. It is not correct to use it in too long chin operations. Therefore, it is a practical operation fit for tiny maxillary reduction processes.
Maxillary filing operations are performed through an intraoral incision. Operation is done under general anesthesia. It is required to be done in an operating room. It should be applied in a full-fledged hospital. The patient must take care in eating and drinking for some time after the operation. The patient should be kept under control for 1 month. As a conclusion, the patient may have a smaller chin 1 month after the operation.
These gonion operations may apply different techniques. For example, if the jawbone of a person is backward caved in, that zone may be filled in by fillings and silicones. If it is too short, it may be extended frontward by using surgical screws, or if it has protruded too much, it may be corrected by filing operations.
Gonion operation is not a standard type of operation. Type of operation is determined by the patient’s maxillary structure. The operation should be designed fit to the facial structure, Patients wishing facial aesthetics or a reduced nose do not generally know that the problem is in jawbone. In general, maxillary interventions are applied for a patient wishing facial aesthetics. The type of operation should be determined according to gonion problem.
Original name of maxillary operations which are publicly known as “jawbone surgery” is orthognatic surgery. Applied to correct the physical problems in face. Warps and deformities may be corrected through interventions to submaxilla and intermaxilla.
Another problem dealt with by orthognatic surgery is intermatching of teeth on submaxilla and intermaxilla. To put it differently, maxillary surgery may be used both aesthetically and for resolution of a physical problem. It is required to apply an orthodontic therapy before dental therapy. As publicly known, it is “dental braces”.
An x-ray must absolutely be taken before orthognatic surgeries. Skeletal deformity is determined by x-ray results, and surgery is planned accordingly. In general, the problem is related to being in the forefront or at the back for intermaxilla or submaxilla or both. In reliance upon this orthodontic and skeletal analysis, the surgery is planned.
Maxillary surgeries are performed under general anesthesia. As it is done intraorally, it leaves no operational scars. Surgery takes 1.5 hours if it is related to only one jawbone. If it is required to intervene with both jawbones, surgery takes more than 3 hours. During surgery, patient does not feel any pain.
Skin Tumors Surgery:
Skin wounds, rigidity and incrustation which do not recover for a long time may be a sign of skin tumors. Great majority of these tumors are harmless and simple masses named as benign tumors. Besides nevi associated with pigment cells of skin, such simple tumoral structures as fatty tissues, connective tissues or muscular tissues originating from tissues inside or close to skin stay in the body by slowly growing in a long time. Sometimes, they cause pain, sensitivity and similar other disturbances due to mass effect. From time to time, they may get inflamed, grow up and cause a discharge.
Nevi: Almost everyone has a great many nevi. Large nevi with a diameter of more than 1 cm are highly probable to develop a tumor. Patients with a history of malign skin tumor in their family and who continue to produce nevi with side irregularities and pigment irregularities may specifically be under risk. Sudden changes in small nevi are also important medically. In the case of sudden growth, itching, bleeding or pigment changes, you have to take medical help as soon as possible. An extremely bad tumor named malign melanoma may develop on nevi. At early stages, it may be fully treated, but at delayed stages, it may be helpless.
Do not ever have your nevi scorched by laser, cautery or chemical agents. Appropriate surgical interventions will give the most reliable and best aesthetic results with not much disturbance to you.
Benign masses: The existing masses must be examined and followed up or surgically excised by a specialist.
Malign masses: The most common type of malign masses is sun-related ones. A person with a light skin color must be protected from sun all his life. Some skin tumors develop insidiously. All kinds of wounds which do not heal within a few weeks must absolutely be assessed in terms of skin tumor. Malign skin tumors may develop through transformation of existing nevi, on burn zones, in non-healing wounds and on zones exposed to friction at all times. A pathologic examination must be performed thereon without delay. If deemed necessary, a surgical excision is applied. For some tumor types, it may be required to clean lymph nodes. To this end, lymph nodes may be marked by special methods. This is called “sentinel lymph-node marking”.
Burn Injury Treatment:
Burn injuries and scars are treated in plastic surgery clinics. Burn impairs both appearance and function of organs. For instance, in hand burn injuries, besides appearance, the abilities of hand to open, close and grasp may also be impaired, or a burn scar on gill or neck may pull submaxilla downwards, thereby preventing the patient to close his mouth. Thus, burn injury treatment has both reconstructive (repair) and aesthetic purposes in plastic surgery. Treatments at early stage and late stage are different:
At early stage:
Refers to the first aid intervention performed immediately upon burning, and subsequent dressings. It is intended to cure the burn injury with the least possible skin loss, and wound should be dressed appropriately by a doctor, and wound should be kept clean and hygienic. In the case of burning, the first things to do are washing the burned zone by cold water, and keeping it cold, and stripping the patient named, and examining the burned zones, and cleaning the burned tissues. Then, appropriate dressings are applied. Wound should not be allowed to go into sepsis. Dressing is very important at this stage as well. There are many different pomades and drugs used for burn dressing. If appropriate pomade is not used in dressing, the patient loses time, and his burn injury may worsen, rather than healing. There are many pomades such as Madecasol, Silverdin, Kenakort and Furacin, but each is indicated in a different area. In general, we start dressing with one of them, and continue with another one sometime after. Therefore, in case of a burn injury, patient must absolutely go to a specialized doctor and must not try dress the wound himself.
At late stage:
In the case of skin loss due to burn (third degree burns), the area should be repaired in accordance with plastic surgery principles. Skin defects are repaired either by using skin in areas neighboring the wound or by using skin patches taken from leg, buttocks or inguen, and they are termed as “graft” in medicine.
Sometimes, the patient’s burn injuries heal without a skin loss (first and second degrees of burns), but the patient has burn-associated functional problems. For example, if patient’s palm burns and then heals by itself, a contracture may develop. Contracture means a permanent shortening of affected skin due to a burn injury. In this case, patient’s fingers close by time, and patient cannot open his fingers. There are many different methods for opening the fingers.
As an another example, if armpit burns and then heals by itself, contracture may develop, and it may become very difficult and painful for the patient to lift his arm sideward. Many different surgical techniques are applied to correct such constrictions and contractures in plastic surgery. For burn injury treatment, the patient must absolutely be examined.
Chronic Wound Care (Pressure Sores, Venous Ulcers and Diabetic Feet):
Chronic wound care requires a multi-disciplinary approach. In Chronic Wound Care Polyclinic, doctors and other medical professionals examine and assess the patient’s wounds and decide the most appropriate way of treatment. Not only care and dressings are arranged according to the wound characteristics, but also Plastic Surgery and General Surgery divisions closely follow up the patient again according to the wound characteristics. For wound care, imported “Wound Care and Dressing Materials” are used. Our specialized doctors determine the control periods and take necessary actions according to situation and needs of the patient.
What is chronic wound?
Wounds which heal late or difficultly or do not heal at all are called “chronic wounds”. Differently from acute wounds, chronic wounds have their specific characteristics. Ischemia, hypoxia or infection are basic characteristics of chronic wounds. If a wound does not heal in three months, it is termed as chronic wound. Included among chronic wounds are diabetic foot wounds, pressure sores, venous ulcers, ischemic ulcers and wounds associated with various vasculitis. Chronic wounds may develop also due to soft tissue radionecrosis developing as a result of radiotherapy to soft tissue areas, and due to extravasation (leakage or discharge of fluid from a vessel into tissue spaces) of some chemotherapy drugs.
General factors leading to chronic wounds are obesity, smoking, malnutrition, advanced age, vitamin and trace element deficiencies, malignity, chemotherapy and radiotherapy, use of immunosuppressive drugs, use of steroids and anticoagulants. However, a wound may become chronic even without general factors. In this case, we rather mention about local factors affecting the wound site. Insufficient blood flow, excessive tension of skin, inappropriate closure of surgical wounds, insufficient venous drainage, presence of a foreign object, presence of infection, mobility of wound site and similar other local factors may delay the wound healing.
Types of chronic wounds:
Wounds which do not heal in a certain period of time and generally recur are called “chronic wounds”. These wounds may be defined as a visual proof of such an underlying cause as a pressure on tissues, weak blood circulation or poor nutrition. Pressure sores, venous leg ulcers and diabetic foot may be shown as examples of chronic wounds. For a successful treatment of chronic wounds, the patient must be examined as a whole. In addition, very careful wound care, understanding of wound healing process, knowledge about modern wound dresses and intervention with and control of underlying causes of wound are also required.
Diabetic Wounds (Wounds in diabetic patients):
Diabetes, being a chronic disease, causes damages to vascular and nerve tissues by time. Circulation disorders in vessels cause wounds particularly in feet. As the wounds are recognized late, wound care takes a long time. For treatment of wound, it is required to keep blood glucose under control, and to hold the wounded foot above the heart elevation, and to perform appropriate wound care and dressing depending on wound characteristics such as infection and necrotic tissues. Treatment takes a long time and requires patience. Sometimes, regression may be reported in the course of wound healing in spite of application of the required wound care.
Wounds Due to Circulation Disorders:
Circulation disorder diseases such as Burger disease and arteriosclerosis associated with smoking cause occlusion of vessels. Vascular occlusion leads to leg wounds, and in advanced cases, loss of foot and leg. In this type of diseases, wounds are generally deep and require a long-time therapy.
These wounds are mostly seen in front of leg and in ankles, and basic reason thereof is blood circulation problems caused by advanced varicose. Treatment of varicose wounds is difficult, and requires consultation of patient to a specialized doctor. These wounds should be followed up under control of a doctor, and should be treated in accordance with the wound. It should be kept under doctor control, and dressing fit to wound should be applied, and if deemed necessary, surgical intervention should be applied.
Wounds caused by pressure on points of contact with bed or wheelchair due to use of wheelchair or due to long-time lying on the same position for bed-ridden / paralytic patients. The pressure emerges as redness and if not treated, may turn into enlarging wounds.
Wounds Caused by Physical Traumas:
Damages in tissues or nerves due to such external factors as falling, hitting and sticking are physical traumas. Immediately after trauma, first intervention is done to the patient by the emergency service doctor and if deemed necessary, depending on the severity of and the damages caused by trauma and in consultation with other specialized doctors, a surgical intervention may also be performed. Also if and when the specialized doctor deems it fit to treat the wound by dressing and care after surgical intervention or without any surgical intervention, the wound must again be cared and dressed under supervision of a doctor.
In first and second degrees of burns, depending on the situation of burns, dressing is applied daily or for 2 – 3 days. Healing is directly proportional to age of patient and situation of wound.
Postoperative Festering Sores:
For wounds and sores associated with surgical operations, if appropriate wound care and dressing is applied, wound heals in 3 to 6 weeks in average. Dressing is applied every day or every other day depending on the situation of wound.
Wounds Treated in Chronic Wound Care Unit:
In chronic wounds, as mostly patients and wounds do not conform to the care standards, some auxiliary treatment methods have been developed for healing of wound, and for shortening the healing process, and for prevention of losses. Hyperbaric Oxygen Therapy is one of these auxiliary treatment methods.
Hyperbaric Oxygen Therapy (HBO):
Hyperbaric oxygen therapy is a medical application where 100% oxygen is supplied at a pressure equal to 2-3 times the atmospheric pressure (generally 2.5 – 2.6 times) at sea level. To put it differently, in hyperbaric oxygen therapy, oxygen is supplied under 2.5 ATA pressure in a closed environment in order to enable blood hemoglobin to carry more oxygen molecules to tissues for survival purposes.
It is demonstrated by studies that when 100% oxygen is inhaled under high pressure, oxygen in clean blood fed into tissues increases by up to 20 times. Increase of oxygen pressure in tissues leads to the following results:
Cells which cannot function due to lack of oxygen are supported.
Production of substances ensuring new vessel development and wound healing increases.
Growth of bacteria in oxygen-free environment is prevented, and effects of some toxins released by them to environment are reduced.
Cells in charge of defense of body are supported.
Has anti-edema effect.
Reduces cellular intoxication in carbon dioxide intoxications.
Points to Consider in Wound Healing Process:
Cause of wound should be determined, prevented or treated.
All kinds of injuries, diseases and disorders affecting skin, subcutaneous, muscles, tendons (muscle ligaments), nerves, vessels, joints and bones at the zone from finger tips to shoulder constitute the basic subjects of Hand Surgery. All types of open wounds and sores, deformities and burns of this zone from fractures and dislocations, tearing of muscles and tendons, or skin incisions without any open wound to very heavy injuries or ruptures of extremities (also including foot and leg) are covered by treatments of Hand Surgery. The target diseases may be listed as all and any congenital deficiencies, impairments and adhesions on hand, wrist and upper arm, and paralyses caused by trauma in childbirth, and rheumatic diseases, infections, tumors, and posttraumatic sequellae on hands and wrists (paralyses developed due to a nerve ruptured as a result of an accident or losses of function due to circulation disorders, correction of fractures and dislocations that are bad-knitted or wrong-knitted, deformities developing by time after burns, various non-infectious nail impairments, etc.). Arthroscopic (operations performed by closed techniques) treatment of some diseases and injuries of small joints and intra-articular structures on hands, wrists, elbows and upper arm are also covered by Hand Surgery discipline.
Due to width of treatment scope, hand surgery has a multi-disciplinary field covering Orthopedics, Plastic Surgery and General Surgery as well. Hand surgeons become competent by a long and self-sacrificing secondary branch training after completion of training for these primary branches. Successful clinic results can be obtained only through a teamwork conducted especially together with Physical Therapy and Rehabilitation.
Post-obesity Aesthetic Surgery:
Obesity, simply defined as excessive bodyweight, is very risky. Treatment of obesity should be multi-disciplinary, i.e. treatment team must contain general surgeon, dietician, endocrinologist, psychiatrist and plastic surgeon. Plastic surgeon plays a role after loss of weight in the treatment process of obese patients. Plastic surgery operations are performed in order to correct deformities on the body of patient losing weight through sports, diet, psychiatric support and weakening surgical interventions. Prolapses develop in obese patients losing weight. These prolapses focus on abdominal zone, breasts, arms, legs, buttocks and back. As the patient loses weight, surplus tissues should be removed and skin should be lifted. Skin prolapses and sags impairing the life quality of patient are corrected by multi-step operations.
Therefore, operations are planned and priorities are decided together with the patient. Skin prolapses on abdominal zone may cover genital zone, thereby causing difficulties in hygiene and preventing mobility of patient. Excessive sags on arms and legs cause frictions during movements of patient, thereby creating difficulties by massive effect, and causing diaper rashes and wounds. Both males and females may suffer from excessive sags in breasts after weight loss. This negatively affects the patient in psychosocial terms. As a result of excessive weight loss, sags may develop in face and neck zone as well, which also require lifting operations. Purpose of these operations is to improve the life quality of patient.
“Reconstruction” means rebuilding and reforming. Reconstructive microsurgery operations aim to reconstruct an integrally, anatomically and functionally impaired body tissue by using tissues removed from another zone together with vessels and nerves under microscope.
Reconstructive Microsurgery Operations:
Grafting of ruptured organs (hand, arm, fingers, ears, scalp).
Nerve and vessel repairs.
Repair of all kinds of tissue defects and completion of deficiencies.
Breast reconstruction after cancer.
Reconstruction of leg – arm bones after tumor surgery.
Treatment of facial palsy.
Finger transplant from foot to hand.
Lymph edema treatment.
Closure of open wounds.
Closure of chronic wounds.