Dr. Konstantinos Seretis, MD, MSc, EBOPRAS
Aesthetic and Reconstructive
"Reconstructive surgery is an attempt to return to normal whereas cosmetic surgery is an attempt to surpass the normal.
No man is a plastic surgeon unless he is adept at both."
Harold Gillies 1882-1960, Ralph Millard 1919-2011
The surgical treatment of skin tumors was always dealed by plastic surgeons and helped significantly to the evolution of plastic surgery principles and techniques. The skin tumors or lesions are divided into benign and malignant.
The most common benign skin lesions are: nevi (moles), cysts, lentigines, papillomas, hyperkeratosis, fibroids, hemangiomas, etc. Subcutaneous tumors such are lipomas, cysts and ganglia are very common too.
The malignant skin tumors are the basal cell carcinoma (the most common cancer affecting humans), the squamous cell carcinoma and the melanoma (one of the most aggressive cancers in humans).
Many factors such as skin features, inheritance, sun exposure, lifestyle and a range of chemical substances increase the risk of a malignant skin lesion.
Although the vast majority of people have only benign skin lesions, vigilance is important not only for the prevention but the treatment of malignant lesions, too. Careful regular skin examination for early detection and treatment of suspected lesions is recommended.
Benign lesions require only check, unless aesthetic issues are caused. A variety of techniques (excision, Laser, cautery etc) are available, depending on the nature, size and location of the lesion. However, in case of a malignant tumor, surgical excision and histological examination (biopsy) is always necessary.
A scar is always the final result of the normal healing process after an injury (trauma, surgery, burns, acne, etc.). A scar can be detected throughout the body and remains forever, despite its gradual improvement with time.
Plastic surgery, using various methods, offers the possibility of a remarkable scar improvement.
The use of LASER can improve the texture and color of scars, so as to reduce its intensity. However, if the scars are deep, large or contracted, leading to serious aesthetic and/or functional problems, one of the sophisticated techniques of plastic surgery is required.
Scar removal and the suitable skin arrangement with a local flap plasty is the typical surgical option to correct a scar, usually under local anesthesia.
The expansion of skin is a relatively new technique which is appropriate in case of extensive scarring, such as after burns. The tissue expanders are special silicone "balloons" (like breast implants), which are placed surgically under the skin adjacent to the scars. They are filled, gradually, with saline, so as their inflation to cause expansion of the overlying skin. Once satisfactory expansion is completed, the expanders are removed and the excess skin is used to cover the area after the large and unsightly scar removal.
Skin grafts, flaps and synthetic skin substitutes offer solutions to specific difficult cases ( eg restoration of contracted postburn scars, hand).
A burn is a type of injury to the skin caused by heat, electricity, chemicals or radiation. This skin injury has specific features and treatment. Burns are classified, according to the depth of skin injury, in 3 stages / degrees:
- First, superficial thickness, like sunburn.
- Second, partial thickness, such as thermal burn from hot water, oil, etc.
- Third, full thickness, as after self-inflicted, electric etc.
A burn, which extends beyond the skin (fat, muscle, bone) is called fourth degree.
The severity of burn injury is determined mainly by the extent and thickness, but also from the cause, the age, gender and general condition of the patient.
Critical is the initial management of each burn, starting from the accident site. The burned patient must be immediately removed from the area, then the burned surface is washed with plenty of water for at least 10 minutes and wrapped in clean material. The patient should seek for specialized medical care in order to receive further treatment. Although 95% of burns in the United States, that present to the emergency department are treated and discharged; 5% require hospital admission.
The plastic surgeon is the specialist of burn management, who evaluates and treats the burn, applying a conservative or surgical treatment. Severe burns are always hospitalized in special burn units.
Following a burn, body disfigurement and/or scar contracture may be caused, with functional and/or aesthetic implications. The management of the burn complications is also responsibility of a Plastic Surgeon.
Plastic Surgery offers treatment options to every single problem, simple or complex, which is related to the skin and its underlying tissues.
Skin flaps, grafts, artificial skin substitutes, implants, tissue expanders etc can be applied to cover any deficit, following:
congenital anomalies (aplasia, hypoplasia, asymmetries etc)
paralysis of the facial nerve
malformations of the face and body