Reconstructive surgery

Abstract

Appropriate excision of malignant tumours commonly leaves defects that cannot be repaired by direct closure of the tissues. This may apply to the skin, to deeper soft tissues and to bone. Modern surgical treatment is aimed at reconstructing such defects with a variety of autologous tissues or synthetic materials. Key advantages of reconstruction of defects include: the potential for early post operative radiotherapy or chemotherapy after rapid healing has been achieved by reconstruction of a defect with vascularised tissues; restoration of function; and optimum psychosocial rehabilitation. Most often, reconstruction of a large tumour excision defect that cannot be directly repaired requires vascularised tissue (a “flap”) because the bed of the defect is non-vascularised, and/or a large volume defect is present. Many other reconstructive options are available for a variety of different indications, including skin grafts, tissue expansion, integrated prosthetics and biosynthetic or wholly synthetic tissue substitutes. Where possible, a dedicated multidisciplinary team should be available to support the patient and family through the process of excision and reconstruction and to guide decision making in treatment of the patient and disease. It is vital that optimum treatment of the disease is not compromised by reconstructive considerations. With good teamwork, availability of skilled reconstructive surgery can actually enhance disease treatment by allowing excision of large tumours close to vital structures with immediate coverage of the defect: a successful reconstruction can then facilitate optimum post operative radiotherapy in a tumour with a close surgical margin.