Recent developments in plastic surgery

doi:10.1136/bmj.325.7359.319

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D Johnson, specialist registrar (davidjohnson_plastic@lycos.co.uk),
I H Whitworth, consultant

Department of Plastic and Reconstructive Surgery, Salisbury District Hospital, Salisbury SP2 8JB

Correspondence to: D Johnson

Accepted 31 May 2002

Misconceptions still abound that plastic surgeons are predominantly cosmetic surgeons. Plastic surgery is a technique based specialty with the aim of reconstructing tissue so that patients gain normal function and appearance. As a result plastic surgery encompasses a vast range (see box and bmj.com). Our review focuses on advances in surgical techniques, technical and biological advances (see also bmj.com), and changes in the organisation of plastic surgery, with its intergration with other specialties.

Conditions treated by plastic surgeons

Congenital abnormalities
Breast surgery
Trauma
Oculoplastic conditions
Hand surgery
Malignancy
Reanimation for facial palsy
Burns
Aesthetic surgery
Laser surgery
Chronic wound management
Vascular malformations

Methods

We selected topics for review by searching Medline from 1 January 1998 and by reviewing abstracts from the past four annual meetings of the British and American Associations of Plastic Surgeons, the Congress of the International Confederation of Plastic, Reconstructive and Aesthetic Surgery, and the International Society of Craniofacial Surgeons.

Surgical advances

Microvascular free tissue transfer

The development of microsurgical techniques has made it possible to replant severed body parts, ranging from whole limbs to fingertips, by anastomosing the divided blood vessels along with nerves and other injured structures. Success depends on the mechanism of injury (clean cuts do better than crush injuries), the correct management of the amputated part (keeping it cool but not frozen), prompt surgery (ideally within a few hours of injury), and the skill of the microsurgeon.