Intended for healthcare professionals

Clinical Review Recent advances

Plastic surgery

BMJ 1998; 317 doi: (Published 08 August 1998) Cite this as: BMJ 1998;317:397
  1. Rajiv Grove, specialist registrar in plastic surgery,
  2. Roy Sanders, director
  1. RAFT Institute of Plastic Surgery, Mount Vernon Hospital, Northwood, Middlesex HA6 2RN
  1. Correspondence to: Mr R Grover
  • Accepted 27 May 1998

The primary aims of plastic surgery are the restoration of appearance and function. This includes reconstruction after traumatic defects, congenital anomalies, and ablative surgery for malignancy, as well as surgery of the hand, breast surgery, and the field of aesthetic surgery. Considerable advances are being made as we begin to understand the biological basis for tissue regeneration, malignant neoplasia, and wound healing. The tools of the plastic surgeon now encompass the means of cellular manipulation of these biological processes.


Topics for this article were selected by reviewing the conference proceedings of the European Association of Plastic Surgeons and the American Society for Plastic and Reconstructive Surgery over the past four years. After a search of Medline, key articles relating to these topics were included.

Reconstructive flap surgery

Tissue used in reconstruction requires oxygen and nutrition to ensure its survival. A split thickness skin graft with low metabolic demands adheres to the wound bed and is initially nourished by diffusion, after which ingrowth of capillaries establishes a permanent blood supply. In wounds that are not able to support a graft by diffusion and many others that require tissues of better aesthetic and mechanical properties, reconstruction with tissue supported by its own blood supply is required. Such tissues transferred from one place to another are referred to as flaps. In the 1970s and 1980s anatomical research identified tissue units with an arterial and venous axis that allows them to be isolated or transferred. Advanced optical systems and microinstrumentation have permitted the transfer of these isolated tissue units with anastomosis of the axial blood supply at the recipient site for reconstruction.

Microsurgical free tissue transfer has become commonplace, and advances have been made in improving the benefit-risk ratio for free tissue transfer. The golden rule remains to achieve the maximum gain with the minimum risk and …

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