The plastic surgeon is a surgical speciality which repairs or reorganizes a tegumentary structure or the shape of the human body ( or veterinary animal in surgery ). Concerning almost all the anatomical areas, excluded the interior of cranium, thorax and abdomen, its sphere of activity is vast. Its large fields of activities are: cosmetic surgery, surgery of the hand, crânio-facial surgery, surgery of the flarings, reconstructive surgery and pediatric plastic surgeon

Fields dependant on the plastic surgeon

Tumors of the skin and soft fabrics

• benign Tumors (exérèse of Naevus)

• malignant Tumors (Carcinome basocellulaire, Carcinome spinocellulaire, Mélanome…)
• intermediate Tumors (dermatofibrosarcome of Darier and Ferrand)
• Angiomas

Infections and necrose soft skin and fabrics

• acute Infections (Dermohypodermite, fasciite necrosing, Gangrène)

• chronic Infections (Hidrosadénite suppurée, Cyst pilonidal)

Resumption of scars

• unaesthetic Scars

• hypertrophic Scars (chéloïdes)

Rebuildings/Change of aspect

• Of the center in particular: following a Mastectomie, for a Hypertrophy mammaire, cure of Ptose - as the centres which fall in an unaesthetic way following an important weight loss or after several Grossesse S

• Faciale (after traumatisms for example)
• Abdominale (after pregnancies, important weight loss, malformation of the type Diastasis of the abdominal muscles)
• Comblement from losses of substance (after exérèse of tumors or dilapidating post-surgery)

Care with the flarings

• Bandages into sterile for the flarings on standby of Clerc's Office of skin

• Clerc's Offices of skin to replace that burned
• Final improvements of the grafted skin (section of the possible supports which limits the capacities of movements)

Surgery of the hand

This field is shared with the orthopedic surgery.

• Amputation
• synovial Cysts
• Treatment of the syndrome of the carpel tunnel
• Lesions of the flexor tendons * Lesions of the tendons bungee cords
• Replanting
• Revascularisation
• nervous Micrurgy
• Lesions of the pulleys
• tendineux Transfers, rehabilitation of the tétraplégies

Cosmetic surgery

The cosmetic surgery is only one of the many applications of the plastic surgeon. It represents only one small percentage of the activity of the public hospitals and academics.

• Liposuccion, Plastie mammaire, abdominal, fessière, legging…
• Surgery of the face: Face lift, separated ears, nose,…
• Rhinoplastie

Nb,

Cranio-facial surgery

Field being interested in the treatment and the rebuilding of the traumatisms and congenital malformations implying inter alia cranium, the orbits, the jawbone and the mandible. In the child, that can imply the replanning of the dome of the skull, the fronto-orbital surgery, the orthognatic surgery and the repair of labio-palatine cracks. In the adult, that implies sometimes the treatment of cancers ORL, but especially the rebuilding of the face post oncologic résection and the treatment of the facial fractures.

nonexhaustive List

Psychological dimension of the change of aspect

The Image of oneself is an important component of psychological balance. Appearance indeed conditions the first judgment which one has of a person, the glance of the other is a “reflection”.

The plastic surgeon thus has a great role in the cure of diseases or disfiguring accidents.

But it can also be not desired as a repairing care, but by will to change appearance. It is then a problem which can be complex: is a person “badly in her skin” because its appearance does not correspond to its idea, or the person it allots her discomfort to its appearance whereas it has another cause?

Surgical techniques

Directed cicatrization

The losses of substances ( pieces of flesh having disappeared) caused by the surgery are not systematically replaced for various reasons. One lets the skin then be reformed only, only facilitated by some bandages which protect the zone in the course of cicatrization against possible infections. To a small extent, these bandages can direct the cicatrization.

Cutaneous Clerc's Offices

The Clerc's Office S generally practiced are the autografts, i.e. the skin is taken on the patient and is used on this same patient. One has several thicknesses of possible cut for the skin.

• the mean Clerc's Office of skin: one takes using a kind of giant razor the skin and the surface part of the derm, because only the basal cells of the skin can survive and multiply: to carry them, it is necessary to take part of the subjacent derm. The cicatrization of the donneuse zone is done starting from the épidermiques enclaves of the derm (pilous follicules, sébacées glands and sudoripares).
• the mean Clerc's Office of skin in net: according to the same process as previously, but instead of posing the skin directly on the place to be covered, one perforates the graft of skin in order to give him an aspect of meshs which will be thus extensible.
• the Clerc's Office of total skin: all the thickness of the skin is carried, the taking away is done by section with the lancet of a certain surface of skin. Donneuse surface is then sutured (one closes again the wound created by suturing the two edges of the wound), because it cannot heal itself any more. The scrap of skin recovered is then removed from the grease of the hypoderme so that the graft is likely the most to adhere to surface usherette.

See also: cutaneous Clerc's Office

Scraps

The scraps are displacements of skin and/or soft fabric and structures vascular feeding them towards a site receiver.

• the scraps translation: the skin is divided until a certain depth so as to preserve its vascular network. Then by rotation or translation of the site donor on the site receiver, one fills a loss of substance. This technique is applicable only to scraps of skin and not to the scraps of soft parts.
• the scraps pedicles: according to the same process as previously, with the difference that the skin, the soft fabrics under unclaimed even the muscles more in depths can be moved by taking as point of rotation the vascular axis (artery + vein) feeding the scrap.
• free scraps: the scrap and its vascular pedicle are individualized and transferred onto a site receiver located remotely site donor and the scrap is connected on a vascular axis located in the area usherette.

Illustration: the Chinese scrap (or chinese flap ), used for the rebuildings of the face. It consists in taking a scrap on the front armlever, by taking the skin, fabrics subjacent, the artery and the vein feeding them, connecting them on arteries and veins of the neck. One sutures then the scraps so as to fill a loss of substance on the face. One can at the time of this operation fill the loss of substance of the front armlever by a graft of total skin coming from the belly. It results a mini from it plastie abdominal with Clerc's Office from total skin, free scrap and vascular surgery. Another example Scrap DIEP (Deep Inferior Epigastric Artery Perforator Flap), the scrap is taken on the lower part of the abdomen to generally rebuild the center: what is what scrap DIEP?

Treatment of the badly burned persons

One understands by large flaring a person having more than 50% of burned body surface in a surface way or more than 15% burned in a major way. These cases are vital urgencies for several reasons:

• These patients have hydrous losses very important because the burned skin is more impermeable, only it is for the entries or the exits of substances
• These patients are private of a barrier essential with protection vis-a-vis the pathogenic organizations (Bactérie S)

The first urgency is to restore the hydro-electrolytic balance in their avoiding the dehydration and the escape of the Rock salt.

One Clerc's Office then on the patient of the skin of animal origin, which will be rejected by the immunizing Défenses of that Ci but which will be useful, during some time, of biological Pansement. This amount of time will be exploited to make cellular culture. Indeed, of the cells of skin of the patient are taken and sent in the only laboratory able to make “industrial” culture of skin located at the United States. Once the surface of cultivated necessary skin, the patient is grafted with this skin cultivated and recognized like “self” by its immunizing defenses.

The result is of nothing miraculous, one restores only the function of barrier of the skin. The esthetic and functional aspect (capacity of movements) are less convincing.

Cutaneous burns in the child

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