Plastic surgery is a diverse, comprehensive surgical field that involves treatment of almost all aspects of the human body from the newborn to elderly. The field includes reconstructive surgery, aesthetic surgery, microsurgery, craniofacial surgery, and hand surgery. Plastic surgery tackles a variety of surgical problems through problem solving and use of a comprehensive surgical toolbox that continually expands.
Plastic surgeons routinely collaborate with other subspecialties given the broad range of plastic surgery reconstructive techniques. Reconstruction of wounds after oncologic resection, radiation, trauma, wound breakdown, or infectious processes often requires assistance with plastic surgery reconstruction. For example, neurosurgery collaborates with plastic surgery in cranioplasty, craniosynostosis, spinal surgery requiring flap coverage, and oncologic resection of brain tumors in radiated fields requiring complex reconstruction. Orthopedic surgery frequently collaborates with plastic surgery in the setting of traumatic injuries with soft tissue damage, prosthetic joint complications requiring soft tissue and bone reconstruction, and oncologic excision of sarcoma, chordoma, or bone tumors requiring reconstruction. General surgery collaborates with plastic surgery for abdominal wall reconstruction, ventral hernia repair, reconstruction after abdominoperineal resection, oncologic reconstruction such as breast reconstruction after mastectomy, necrotizing soft tissue infections requiring subsequent soft tissue coverage, or traumatic degloving injuries requiring coverage of vital structures. Cardiac surgery collaborates with plastic surgery for sternal nonunion requiring sternal fixation and sternal wounds requiring flap coverage. Thoracic surgery collaborates with plastic surgery in chest wall reconstruction after oncologic resection, reconstruction after lobectomy or pneumonectomy with filling of pleural cavity with flaps, and soft tissue coverage after infection with empyema or sternum or rib osteomyelitis. Pediatric surgery collaborates with plastic surgery for esophageal reconstruction in tracheoesophageal fistula with supercharged jejunal flaps, hypospadias repair, and myelomeningocele repair. Urology collaborates with plastic surgery in phalloplasty, urethroplasty, and penile transplant. Gynecology collaborates with plastic surgery in perineal reconstruction after oncologic resection of the vagina, vulva, uterus, and pelvic floor.
Given the field encompasses most of the human body, knowledge of anatomy is essential in plastic surgery. Detailed knowledge of anatomy of vessels, nerves, muscles, tendons, bone, and perforator zones of soft tissue allows for the complex reconstruction, aesthetic procedures, craniofacial surgery, and hand surgery. The hand is one of the most anatomically intricate areas of the body, with complex relationships that allow for the unique and precise mechanics of hand function. Microsurgery requires comprehensive knowledge of vascular and microvascular anatomy. Angiosomes, a concept first described by Dr. Ian Taylor in 1987, are vascular regions perfused by a single artery. The more recently described perforator zones are regions perfused by small branches, or perforators, of larger vessels. Both angiosomes and perforator zones are critical to consider when designing a flap for reconstruction to ensure flap perfusion and survival.
Innovation has long been an essential component of plastic surgery. Dr. Joseph Murray, a plastic surgeon, was instrumental to the field of transplant surgery, for both his clinical work in transplantation and basic science research in immunology. ...