Cosmetic Surgery for Treating Wounds
If you have a severe wound from an injury that limits your mobility, causes a
loss of sensation, or is cosmetically unappealing, you may be considering wound
treatments that involve plastic surgery.
Proper wound care is essential to restore function and sensation. It’s
important to be patient. Make sure you’re under the care of a board-certified
plastic surgeon, and follow his or her guidance. It’s not an easy road, but it
What are the different types of wound treatments?
To begin, if your wound is severe, you may have to undergo debriding, which
is the removal of dead tissue, prior to reconstructive surgery. Once that is
done, there are several types of wound treatments your plastic surgeon may
Skin graft: Skin grafts are used for burn patients or whenever there is a
wound that needs skin coverage to help it heal. They involve removing skin from
one area of the body and transplanting it to another. There are two types of
skin graft: split-thickness grafts in which just a few layers of deep skin are
transplanted, and full-thickness grafts, which involve all of the dermis.
During a skin graft, a special skin-cutting instrument known as a dermatone,
removes the skin from an area (the donor site) usually hidden by clothing such
as the buttocks or inner thigh. Once removed, the graft is placed on the area in
need of covering and held in place by a dressing and a few stitches. This
dressing usually needs to stay in place for five to seven days to allow the
graft to heal. It should not be removed unless directed to do so by your
physician. The donor site is also covered with a dressing to prevent infection
from occurring. Recovery time from a split-thickness skin graft is generally
fairly rapid, often less than three weeks. For full-thickness skin graft
patients, the recovery time is a few weeks longer.
Microsurgery: Simply stated, microsurgery is a procedure in which the
surgeon uses a microscope for surgical assistance in reconstructive procedures.
By using a microscope, the surgeon can actually sew tiny blood vessels or
nerves, allowing him or her to repair damaged nerves and arteries. This may used
to re-attach an amputated finger, be a method to relieve facial paralysis, or to
reconstruct breasts. Microsurgery is frequently used with other surgical
procedures such as the free-flap procedure.
Free flap procedure: A free flap procedure may be performed during breast
reconstruction or following surgery to remove head or neck cancer. During the
procedure, muscle, skin, and/or bone are transferred, along with the original
blood supply, from one area of the body (donor site) to the surgical site in
order to reconstruct the area. The procedure often involves the use of
microsurgery. Healing of the surgical site can be slow and require frequent
wound care. Total recovery may take 6 to 8 weeks or longer.
Tissue expansion: Tissue expansion is a medical procedure that enables
your body to "grow" extra skin for use in reconstructive procedures. This is
done by inserting a device known as a balloon expander under the skin near the
area in need of repair. Over time, this balloon will be gradually filled with
saline solution (salt water), slowly causing the skin to stretch , much the same
way a woman’s skin stretches during pregnancy. Once enough extra skin has been
stretched, it is then used to correct or reconstruct a damaged body part. This
procedure is especially common for breast reconstruction. Tissue expansion has
many advantages in that the skin color and texture are a perfect match for the
area in which it is needed, and there is little scarring since there is no
removal of skin from one area to another. The major drawback to tissue expansion
is that it can take three months or longer to stretch the skin. During this
period, as the balloon expander grows, the bulge under the skin grows with it.
This bulge may be desirable for a breast reconstruction patient, however, for
patients undergoing this procedure for the scalp or another part of the body,
the bulge may be uncomfortably noticeable.
What happens after surgery for wound treatment?
For any surgery involving the removal and transplantation of skin, it is
extremely important that you follow the general instructions and guidelines for
the care of your wound once you are sent home.
Easy does it! Patients often report being tired and more fatigued when at
home than while they were in the hospital. You may find it helpful to set up a
regular routine, but remember to pace yourself. If you are tired, take time to
rest. Do not overdo it.
Be patient with your healing! As you continue to heal, you will notice changes
in the color, appearance and feeling of your skin at the surgical site. You also
may notice numbness, a tingling sensation or minimal feeling around your
incisions. This is normal. These sensations will continue to improve over the
next several months.
Perfusion and circulation
It is important to monitor perfusion (passage of fluid) and circulation of the
wound site. Avoid wearing clothing that constricts or applies pressure around
your wound. Also, to help with perfusion, your physician may give you specific
instructions for taking aspirin daily for 3 to 4 weeks after surgery. Do not
take the aspirin unless specifically instructed to do so by you physician.
Signs of infection at the surgical site
The following are signs indicating that there may be an infection at the
surgical site. Notify your physician right away if you experience any of the
- White pimples or blisters around incision lines.
- An increase in redness, tenderness, or swelling of the surgical
- Drainage from the incision line. (Occasionally, a small amount of
bloody or clear yellow-tinged fluid may drain and not be a sign of infection.
Notify your physician if it persists or if it changes in consistency.)
- A marked or sudden increase in pain not relieved by the pain
You may experience some other, signs of a general infection that will require
medical treatment. If you notice any of the following symptoms of infection, it
is important that you call your health care provider as soon as possible.
- A persistent elevation of body temperature greater than 100.5
degrees Fahrenheit. (Take your temperature daily, at the same time each day).
- Sweats or chills
- Skin rash
- Sore or scratchy throat or pain when swallowing
- Sinus drainage, nasal congestion, headaches or tenderness along
the upper cheekbones
- Persistent, dry or moist cough that lasts more than two days
- White patches in your mouth or on your tongue
- Nausea, vomiting or diarrhea
- Trouble urinating: pain or burning, constant urge or frequent
- Bloody, cloudy or foul-smelling urine
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