DONATERECONSTRUCTIVE SURGERIES
Overview
Reconstructive surgery is a sub specialty of Plastic surgery and is often regarded as an art of replacing what is ‘lost’. It deals with restoring the form, contour and most importantly function of the part of body that is removed as a part of oncosurgical resection. Most Patients requiring reconstructive services are of Head and Neck cancer and Breast cancer. Unlike most other cancers impact of the surgical management of the head and neck cancers is immediately noticeable in social settings. Moreover the patient suffers from facial disfigurement, altered speech, salivation, inability to swallow and deviation of airway.
All these mutilating surgeries leave a psychological impact on these patients. Their quality of life is impaired. They are depressed. Removal of breast for cancer is also known to be associated with major depression amongst women. But now it is proven that with the help of plastic and reconstructive surgery, especially micro-vascular reconstructive surgery quality of life of the patients can be improved. We can provide good functional and cosmetic result in most of the patient with the disease. They can lead normal life with little or no limitations.
What is Reconstructive Surgery?
Reconstructive surgery often uses tissue from one area of body to repair another area. Reconstructive surgeons repair and restore physical appearance that could be external or internal. Surgeons may insert implants, graft an area, transplant tissues for ushering a new lease of life.
Reconstructive Surgery after Resection of Cancer Includes:
Reconstruction of head & neck defects
Reconstruction of breast –augmentation or reduction.
Reconstruction of soft tissues ,bones of different parts of body.
Reconstruction of bladder, bowel
Some of the cosmetic surgeries
Screening and Diagnosis of Reconstructive Surgery
Type of reconstruction depends on the defect created by removal of cancer. Choice of reconstruction depends on area to be repaired, condition of donor area and comorbidities. Always assess:
- Extent of surgical defect in consultation with resection team.
- General condition of patient
- Comorbidities—Diabetes, Coronary Artery Disease, Peripheral vascular disease, Kidney diseases, Cirrhosis , Anemia, Hypoproteinemia
- Condition of Donor area
Treatment of Reconstructive Surgery
Breast cancer surgery
Several techniques are used for reshaping the breast and achieving symmetry. Breast implants, revision of scars , reduction of size of breast etc are some of the procedures for desired outcome. Reconstructive surgeon should consider size and location of cancer, availability of tissue and size of other breast.
Breast Implants
Breast implantation is usually done as two stage procedure. In first stage tissue expander is put and implant is inserted later after few months.
Tissue Reconstruction
autologous tissue is taken from your own body and pedicled or free placed in recipient area. Nipple areola can also be reconstructed.
Reconstruction after Head and Neck cancer treatment
It includes primary closure by moving the sides of affected areas or transferring tissues from another region for repair. In certain situations bones, muscles, skin along with arteries and veins are transferred to remote area of the body (Free Flap).
Reconstruction after Bladder cancer treatment
A neobladder is reconstructed by using part of intestine. It is done after removing urinary bladder or cystectomy in patients diagnosed with bladder cancer. Neobladder function like original urinary bladder by storing urine without any external bags or devices.
Bone reconstructions
sarcomas of long bones (Osteosarcoma) are treated with chemotherapy first and then limb saving surgery is done. Joints and bones can be replaced with modular prosthesis. Person with replaced bone or prosthesis can walk, sit and climb stairs.
Soft tissue repair
Defects of large areas of skin, underlying tissues and muscles can be repaired by transferring tissues from remote areas of the bodies
How is RGCIRC Different
With the team efforts of Plastic surgeons, Oncosurgeons, Anaesthetists & dedicated Nursing staff, RGCIRC is emerging as biggest centre for Cancer Reconstruction especially micro-vascular reconstruction in northern part of India. We have performed more than 4000 cases of cancer reconstruction with good functional and cosmetic results in last 6 years.
We are preserving a lot of limbs in limb salvage surgeries for bone tumors. Reconstruction of soft tissue defect is also required after removal of large muscle or skin tumors by orthopaedic surgeon. We are also working to reduce the problem of lymphedema (swelling of arms and legs) both surgical and non surgical, after breast cancer and groin surgery.
Risk Factors of Reconstructive Surgery
Any surgery especially reconstructive surgery will carry high risk of complications or flap failure in presence of following factors
- Obesity
- Age
- Smoking
- Sleep apnoea
- Diabetes
- Coronary artery disease
- Peripheral vascular disease
- Previous surgeries or scars especially at donor areas
- Chronic kidney disease, liver disorders
- Anemia, hypoproteinemia
- Irradiated area
- Immunocompromised patient
Prevention & Cure of Reconstructive Surgeries
Aim is to inform the patients about preventing bad reconstructive surgery. Reconstruction is unavoidable but bad reconstruction can be averted if proper precautions are taken.
- Choose a qualified and experienced plastic surgeon
- Discuss with him various options and complications of reconstructive surgery.
- Have your surgery at high volume center
- Ensure that all facilities exist under one roof and team of doctors is available who will look after you in postoperative phase?
DO’s after Surgery
- Do keep an eye on any infection. Maintain body hygiene.
- Do take your medications( especially antibiotics) as advised.
- Physical activity to be restricted as advised by your plastic surgeon.
- Balanced diet as advised by your surgeon
- Maintain good oral hygiene
- Learn to take care of drains, wound etc
DON'Ts after Surgery
- Smoking, indulge in alcohol or drug abuse
- Get constipated , repeated bouts of coughing
- Lifting heavy weights, Gym
- Driving too early
- Too spicy, too oily junk food from market
If you follow simple do’s and don’t’s, you can avoid turning a simple surgical procedure into major medical crisis.
Patient may ask to doctor
- Who performs my reconstructive surgery?
- How long after chemotherapy can I have plastic surgery?
- How long does it take to undergo and recover from reconstructive surgery?
- What are the risk and benefits of plastic surgery?
- Are there any alternatives or other options for this procedures?
- What is the complete recovery time and when can I resume my routine activity?
- Will I have ugly scars of plastic surgery?
- Are reconstructive surgeries safe in presence of diabetes and cholesterol disorders?
- How will reconstructive surgery improve my image and function?
- What are the complications of this reconstruction?
- Whom should I meet during follow up – My oncosurgeon or my plastic surgeon
