Medical tourism Israel, low cost surgery
Reconstructive surgery helps
patients of all ages and types - whether it's a
child with a birth defect, a young adult injured in
an accident, or an older adult with a problem caused
The goals of reconstructive surgery differ from
those of cosmetic surgery. Reconstructive surgery is
performed on abnormal structures of the body, caused
by birth defects, developmental abnormalities,
trauma or injury, infection, tumors, or disease. It
is generally performed to improve function, but may
also be done to approximate a normal appearance.
Cosmetic surgery is performed to reshape normal
structures of the body to improve the patient's
appearance and self-esteem.
Although no amount of surgery can achieve "perfection,"
modern treatment options allow plastic surgeons to
achieve improvements in form and function thought to
be impossible 10 years ago.
This will give you a basic understanding of some
commonly-used techniques in reconstructive surgery.
It won't answer all of your questions, since each
problem is unique and a great deal depends on your
individual circumstances. Please be sure to ask your
doctor to explain anything you don't understand.
Also, ask for information that specifically details
the procedure you are considering for yourself or
has Reconstructive Surgery?
There are two basic categories of patients:
those who have congenital deformities, otherwise
known as birth defects, and those with developmental
deformities, acquired as a result of accident,
infection, disease, or in some cases, aging.
Some common examples of congenital abnormalities are
birthmarks; cleft-lip and palate deformities; hand
deformities such as syndactyly (webbed fingers), or
extra or absent fingers; and abnormal breast
Burn wounds, lacerations, growths, and aging problems are considered acquired deformities. In
some cases, patients may find that a procedure
commonly thought to be aesthetic in nature may be
performed to achieve a reconstructive goal. For
example, some older adults with redundant or
drooping eyelid skin blocking their field of vision
might have eyelid surgery. Or an adult whose face
has an asymmetrical look because of paralysis might
have a balancing facelift. Although appearance is
enhanced, the main goal of the surgery is to restore
Planning Your Surgery
In evaluating your condition, a plastic surgeon will
be guided by a set of rules known as the
reconstructive ladder. The least-complex types of
treatments-such as simple wound closure-are at the
lower part of the ladder. Any highly complex
procedure-like micro-surgery to reattach severed
limbs-would occupy one of the ladder's highest rungs.
A plastic surgeon will almost always begin at the
bottom of the reconstructive ladder in deciding how
to approach a patient's treatment, favoring the most
direct, least-complex way of achieving the desired
The size, nature and extent of the injury or
deformity will determine what treatment option is
chosen and how quickly the surgery will be performed.
Reconstructive surgery frequently demands complex
planning and may require a number of procedures done
Because it's not always possible to predict how
growth will affect outcome, a growing child may have
to plan for regular follow-up visits on a long-term
basis to allow additional surgery as the child
Everyone heals at a different rate-and plastic
surgeons cannot pinpoint an exact "back-to-normal"
date following surgery. They can, however, give you
a general idea of when you can expect to notice
Options in Wound Treatment
In deciding how to treat a wound, a plastic surgeon
must carefully assess its size, severity, and
features: Is skin missing? Have nerves or muscles
been damaged? Has skeletal support been affected?
As you and your plastic surgeon form your surgical
plan, it's important to have a clear understanding
of what will happen during the procedure. Asking
questions is key to making an informed decision.
Direct closure is usually performed on skin-surface
wounds that have straight edges, such as a simple
cut. Maximum attention is given to the aesthetic
result, taking extra care to minimize noticeable
A wound that is wide and difficult or impossible to
close directly may be treated with a skin graft. A
skin graft is basically a patch of healthy skin that
is taken from one area of the body, called the "donor
site," and used to cover another area where skin is
missing or damaged. There are three basic types of
A split-thickness skin graft, commonly used to treat
burn wounds, uses only the layers of skin closest to
the surface. When possible, your plastic surgeon
will choose a less conspicuous donor site. Location
will be determined in part by the size and color of
the skin patch needed. The skin will grow back at
the donor site, however, it may be a bit lighter in
A full-thickness skin graft might be used to treat a
burn wound that is deep and large, or to cover
jointed areas where maximum skin elasticity and
movement are needed. As its name implies, the
surgeon lifts a full-thickness (all layers) section
of skin from the donor site. A thin line scar
usually results from a direct wound closure at the
A composite graft is used when the wound to be
covered needs more underlying support, as with skin
cancer on the nose. A composite graft requires
lifting all the layers of skin, fat, and sometimes
the underlying cartilage from the donor site. A
straight-line scar will remain at the site where the
graft was taken. It will fade with time.
Tissue expansion is a procedure that enables the
body to "grow" extra skin by stretching adjacent
tissue. A balloon-like device called an expander is
inserted under the skin near the area to be repaired
and then gradually filled with salt water over time,
causing the skin to stretch and grow. The time
involved in tissue expansion depends on the
individual case and the size of the area to be
The advantages of tissue expansion are many-it
offers a near-perfect match of skin color, sensation,
and texture; the risk of tissue loss is decreased
because the skin remains connected to its original
blood and nerve supply; and scars are less apparent
than those in flaps or grafts. The expander
temporarily creates what can be an unsightly bulge,
making this option undesirable for some patients.
Advanced Wound Care:
Though success will largely depend on the extent of
a patient's injury, flap surgery and microsurgery
have vastly improved a plastic surgeon's ability to
help a severely injured or disfigured patient. Using
advanced techniques that often take many hours and
may require the use of an operating microscope,
plastic surgeons can now replant amputated fingers
or transplant large sections of tissue, muscle or
bone from one area of the body to another with the
original blood supply in tact.
A flap is a section of living tissue that carries
its own blood supply and is moved from one area of
the body to another. Flap surgery can restore form
and function to areas of the body that have lost
skin, fat, muscle movement, and/or skeletal support.
A local flap uses a piece of skin and underlying
tissue that lie adjacent to the wound. The flap
remains attached at one end so that it continues to
be nourished by its original blood supply, and is
repositioned over the wounded area.
A regional flap uses a section of tissue that is
attached by a specific blood vessel. When the flap
is lifted, it needs only a very narrow attachment to
the original site to receive its nourishing blood
supply from the tethered artery and vein.
A musculocutaneous flap, also called a muscle and
skin flap, is used when the area to be covered needs
more bulk and a more robust blood supply.
Musculocutaneous flaps are often used in breast
reconstruction to rebuild a breast after mastectomy.
This type of flap remains "tethered" to its original
In a bone/soft tissue flap, bone, along with the
overlying skin, is transferred to the wounded area,
carrying its own blood supply.
A microvascular free flap is a section of tissue and
skin that is completely detached from its original
site and reattached to its new site by hooking up
all the tiny blood vessels.
In addition to correcting cuts and other surface
wounds, plastic surgeons also regularly treat both
cancerous and non-cancerous growths and problems
with the supporting structures beneath the skin.
Tumors, both cancerous and benign, vary widely in
type, severity and recurrence. The removal method
chosen will depend largely on the type of growth,
what stage it's in, and its location on the body.
Skin cancers and growths are usually removed by
excision and closure, in which the growth is simply
removed completely with a scalpel, leaving a small
thin scar. If the cancer is large or spreading,
major surgery may be necessary, using flaps to
reconstruct the affected area.
Whether the defect is congenital or acquired,
plastic surgeons can usually restore comfort,
mobility, and normal appearance to patients with
hand problems. Acquired defects include carpal
tunnel and other painful conditions caused by
pressure on the nerves (usually at the wrist or
elbow); trigger fingers, a condition caused by
swelling of a flexor tendon in the hand; ganglion
cysts, a benign cystic growth and scar contracture
which occurs when a wound or burn on the hand heals
poorly and forms scar tissue that curls the fingers
or restricts mobility. Dupuytren's disease causes a
similar problem of hand contracture.
Children born with syndactyly (webbed fingers) can
benefit from finger separation, where a zig-zag-type
incision separates the fingers and rearranges the
tissue between them, preventing growth deformities.
If a child had polydactyly (extra fingers),
correction is often more than simply removing the
extra digits. The surgeon may also need to balance
the tendons of the hand and stabilize the remaining
finger joints so that the hand functions as normally
as possible. Plastic surgeons also reconstruct
missing digits, including the thumb, which supplies
half of the hand's function.
You're Considering Laser Surgery...
In the past decade, laser technology has
revolutionized many areas of plastic surgery. The
laser's allure comes from its ability to "blast"
away or diminish imperfections or growths with a
minimum of bleeding, bruising, and scarring.
Currently, there are many types of lasers available,
with many more under development. Therefore, it's
important to understand that not all lasers are
The yellow pulsed-dye laser uses a type of dye as
its active medium. It has a pulsing beam that is
heavily absorbed by hemoglobin, which gives blood
its red color. This laser is often used for
performing surgery on children who have pinkish
birthmarks called port-wine stains. The laser
destroys the abnormal blood vessels, lightening the
birthmark to the point of being barely noticeable.
Scarring, which was a problem with earlier laser
models, is minimal with the yellow pulsed-dye laser.
The "pigment-blasting" laser family-the Q-switch
ruby, the Q-switch YAG, and the alexandrite is a new
group of lasers effective in eliminating the black
and blue pigments of tattoos, pigmented lesions and
the brown patches and spots that often occur with
aging. Though the removal of decorative tattoos is
considered a cosmetic procedure, the removal of "traumatic
tattoos" is a reconstructive process. Traumatic
tattoos occur when material particles are forced
under the skin through an accident-as in an
explosion or a collision.
The carbon dioxide laser, sometimes called the "workhorse"
of lasers, is an invisible light absorbed by water,
the primary component of human skin. When the beam
is focused, it can cut tissue and seal blood vessels
simultaneously. When defocused, it vaporizes. These
characteristics make it the treatment of choice for
removing warts and many types of skin growths.
The YAG laser has been shown to be effective in the
surgery of various types of hemangiomas, which are
skin growths with heavy concentrations of blood
vessels. It delivers highly-focused energy
and-unlike other lasers-its tip can be placed
directly on the skin, mimicking a scalpel.
The argon laser is similar to the yellow pulsed-dye
laser. The argon laser emits a blue-green light that
is absorbed heavily by the color red. It is
particularly effective in treating abnormalities
that have a proliferation of blood vessels, such as
blood blisters, "spider" blood vessels on the face,
"strawberry" birthmarks, hemangiomas, and bulky
The copper vapor laser is a newer type of laser that
emits a yellowish light. Its uses include treating
brown or red pigmented areas.
The number of laser treatments you'll need depends
largely upon the size and severity of the defect. A
child with a large birthmark may need six to ten
laser treatments to achieve satisfactory results.
Only one treatment may be needed to remove some
small spider veins on the face.
Lasers have a number of valuable uses, but a laser
should not be viewed as a "magic wand" that improves
the results of any type of surgery. For traditional
kinds of surgery and most plastic surgery, the
scalpel is still the proven instrument of choice.