Reconstructive Surgery

Reconstructive surgery is the branch of plastic surgery concerned with restoring the form and function of areas of the body affected by injury, burns, previous surgery, tumours, infections or malformations. Unlike aesthetic surgery, whose main aim is to improve appearance, reconstructive surgery primarily seeks to restore function and an appearance as close to normal as possible.

The procedures usually use the patient's own tissues: skin, fat, fascia or muscle, moved locally or from another region. At Detalii Med, in Baia Mare, the assessment and procedures are carried out by the clinic's plastic surgeons.

Reconstructive surgery may be suitable for people who have:

• tissue defects left after removal of skin tumours or other growths;
• after-effects of injuries, wounds or burns, including contracture scars;
• deformities following previous surgery;
• certain congenital malformations of the skin and soft tissues;
• slow-healing wounds, after the underlying cause has been treated and a medical assessment made.

The indication is set individually, taking into account general health and any associated conditions.

Reconstructive surgery can cover tissue defects, release scars that limit movement, restore the contour of an area and improve both its function and its appearance.

It cannot always restore the appearance and function that existed before the injury or illness. Transferred tissue may differ in colour, texture or sensation from the surrounding area, and scars remain, both in the treated area and in the donor area. Sometimes several stages are needed for a satisfactory result.

At the consultation, the plastic surgeon examines the affected area and assesses the quality of the surrounding tissues and the function of the region. The medical history, previous operations and treatments, associated conditions such as diabetes or circulatory disorders, medication and smoking, which can affect healing, are discussed.

The doctor explains the reconstruction options, the likely number of stages, the area from which tissue would be taken, recovery and risks. Blood tests, imaging or collaboration with other specialists may be needed. The plan is agreed together with the patient.

The technique is chosen according to the size, depth and location of the defect. Commonly used methods are:

• direct closure, when the surrounding skin allows the wound to be closed without tension;
• local flaps, in which neighbouring tissue is moved to cover the defect;
• skin grafts, taken from a donor area and applied to the defect;
• fat transfer, to restore volume and contour;
• plasty techniques to release contracture scars.

Some complex cases may require more extensive techniques or several operations. The duration varies widely, from under an hour to several hours.

The type of anaesthesia depends on the extent of the procedure. Small procedures can be done under local anaesthesia, and more extensive ones under regional or general anaesthesia, following a pre-anaesthetic assessment. The appropriate option is decided at the consultation.

Recovery depends on the type and size of the procedure. After small procedures, the patient usually goes home the same day, and stitches are removed after 7 to 14 days. After more extensive grafts or flaps, a hospital stay, immobilisation of the area and repeated dressings may be needed.

During healing, pressure and tension on the operated area are avoided, and smoking must be stopped. For areas around the joints or the hand, rehabilitation may be recommended. Regular check-ups are important for monitoring progress.

The risks vary with the technique and the area and are discussed at the consultation:

• bleeding, haematoma or infection;
• partial failure of the graft to take or compromise of the flap;
• delayed healing, especially in smokers, patients with diabetes or after radiotherapy;
• thickened or contracture scars, in the treated or donor area;
• differences in colour, texture or sensation of the transferred tissue;
• the need for further procedures;
• the risks of anaesthesia, when general anaesthesia is used.

Initial healing usually takes a few weeks, and the result improves gradually over several months as swelling disappears and the scars mature. The final appearance is usually assessed after 6 to 12 months. Reconstructions in several stages extend over a longer period.

Reconstructive surgery helps restore the form and function of areas affected by injury, surgery or illness. Every case is different, and the right technique is chosen after a careful assessment. The aim is a functional and as natural as possible result, with realistic expectations discussed at the consultation.