Trauma and Plastic Surgery

About The Treatment

Plastic surgeons play a vital role in trauma management for Road Traffic Accidents, Factory/ Industrial mishaps, paediatric injury due to fall etc. Trauma may involve Face, Hands, Lower Limbs, Scalp, Private part or any other critical areas. Plastic surgeons are capable to manage soft tissue, tendons, muscles, nerve or bony injuries efficiently.

Initial Trauma Assessment and Stabilization

Primary Survey (ABCDE Approach)

• Airway:

  • Ensure the airway is clear and protected.

    
    

• Breathing:

  • Assess and support breathing; provide oxygen if needed.

    
    

• Circulation:

  • Control bleeding, and support circulation with IV fluids and blood products.

    
    

• Disability:

  • Perform a quick neurological assessment.

    
    

• Exposure:

  • Fully expose the patient to identify all injuries while preventing hypothermia.

    
    

Secondary Survey

• Detailed Examination:

  • Thoroughly assess the extent of injuries, including fractures, lacerations, and soft tissue damage.

    
    

• Imaging:

  • Use X-rays, CT scans, and MRIs to evaluate the injuries further.

Wound Management

• Debridement

  • Initial Cleaning: Remove dirt, debris, and non-viable tissue to prevent infection.

  • Definitive Debridement: Surgical removal of necrotic tissue to prepare the wound for closure or reconstruction.

    
    

Fracture Management

• Stabilization:

  • Temporary stabilization using splints or external fixation.

    
    

• Definitive Fixation:

  • Internal fixation using plates, screws, or rods, often in collaboration with orthopedic surgeons.

  
  

Soft Tissue Reconstruction

• Laceration Repair

  • Primary Closure: Direct suturing of the wound edges.

  • Layered Closure: Suturing multiple tissue layers to ensure strength and minimize tension.

    
    

Skin Grafting

• Split-thickness Grafts:

  • Used for large surface areas; includes only the epidermis and part of the dermis.

    
    

• Full-thickness Grafts:

  • Includes both epidermis and full dermis, used for smaller, critical areas.

    
    

Flap Surgery

• Local Flaps:

  • Tissue is moved from an adjacent area to cover the defect.

  
  

• Regional Flaps:

  • Tissue moved from a nearby region, maintaining its own blood supply.

  
  

• Free Flaps:

  • Tissue transplanted from one part of the body to another, reconnecting the blood vessels Microsurgically.

Facial Trauma Management

• Facial Fractures

  • Reduction and Fixation: Realignment of bones and fixation using plates and screws to restore facial structure and function.

  • Orbital Fractures: Special attention to the orbital floor and walls to prevent complications like enophthalmos or diplopia.

    
    

• Soft Tissue Injuries

  • Precise Closure: Meticulous suturing to align skin, muscle, and mucosa for optimal aesthetic and functional results.

  • Scar Management: Early interventions like silicone gel sheets and steroid injections to minimize scarring.

    
    

Hand Trauma Management

Tendon and Nerve Repair

• Tendon Repair:

  • Primary or delayed repair of severed tendons, often requiring splinting and rehabilitation.

    
    

• Nerve Repair:

  • Microsurgical techniques to repair damaged nerves and restore function.

    
    

Replantation

• Digit and Limb Replantation:

  • Microsurgical reattachment of amputated parts, restoring blood flow and function.

    
    

Rehabilitation

• Physical Therapy:

  • Essential for restoring function, strength, and dexterity.

    
    

Psychological Support

• Counselling and Support:

  • Addressing the emotional and psychological impacts of trauma through counselling, support groups, and psychiatric care.

    
    

Long-Term Follow-Up

Monitoring:

• Regular check-ups to assess healing and identify complications.

  
  

Revisions:

• Secondary surgeries to improve function and appearance as needed.

  
  

Multidisciplinary Collaboration

• Coordination: Working closely with trauma surgeons, orthopaedic surgeons, neurosurgeons, and other specialists to provide comprehensive care.

Plastic surgeons' expertise in both acute and reconstructive phases ensures optimal recovery, functionality, and aesthetic outcomes for trauma patients.