Plastic and Reconstructive Surgery

Lesson Objectives

By the end of this topic, learners should be able to:

1. Identify common plastic and reconstructive surgical procedures and indications.

2. Understand the principles of tissue repair, flap surgery, and grafting.

3. Recognize post-operative complications and nursing priorities.

4. Apply perioperative care principles for plastic and reconstructive surgery patients.

 Key Glossary Terms

1. Flap Surgery

• Definition: Transfer of tissue with its blood supply from one area of the body to another

• Types:

  • Local flap – adjacent tissue

  • Regional flap – tissue from nearby region

  • Free flap – tissue transferred with microvascular anastomosis

• Indications: Trauma, tumor excision, chronic wounds

2. Skin Grafting

• Definition: Transplantation of skin from a donor site to cover a defect

• Types:

  • Split-thickness graft – epidermis + part of dermis

  • Full-thickness graft – epidermis + entire dermis

• Indications: Burns, chronic ulcers, post-excisional defects

3. Burn Management

• Definition: Surgical and supportive care for thermal, chemical, or electrical burns

• Classification:

  • Superficial (1st degree) – epidermis only

  • Partial-thickness (2nd degree) – epidermis + part of dermis

  • Full-thickness (3rd degree) – epidermis + dermis + underlying tissue

• Surgical Interventions: Debridement, grafting, escharotomy

4. Microsurgery

• Definition: Surgery under a microscope to repair small vessels and nerves

• Indications: Replantation, free flap transfer, complex hand surgery

• Post-Op Considerations: Perfusion monitoring, anticoagulation, infection prevention

5. Cosmetic Surgery

• Definition: Elective procedures to enhance appearance

• Common Procedures: Rhinoplasty, liposuction, facelifts, breast augmentation

• Post-Op Considerations: Swelling, bruising, infection prevention, patient counseling

6. Post-Operative Considerations

• Monitor flap/graft viability (color, temperature, capillary refill)

• Pain management and infection prevention

• Wound dressing and early mobilization

• Psychological support for cosmetic and reconstructive patients

7. Nursing & Medical Student Focus

• Nursing: Monitor perfusion, manage dressings, educate patients, pain control, psychological support

• Medical Students: Understand flap and graft principles, surgical indications, post-op monitoring, wound healing, complications

8. Plastic Surgery Mnemonics

• “FLAP” for flap assessment:

  • F – Flap color

  • L – Look for bleeding / perfusion

  • A – Assess capillary refill

  • P – Pulse in underlying vessels

• “BURN” for burn management priorities:

  • B – Breathing / airway

  • U – Urine output

  • R – Resuscitation (fluid therapy)

  • N – Nutrition / wound care

 Tables

Table 1: Common Plastic & Reconstructive Surgeries

Table 2: Post-Operative Nursing Care in Plastic & Reconstructive Surgery