What does a (general and abdominal) surgeon need to know on plastic surgery?

Abstract

Background: Plastic surgery was first introduced as a sub-specialty of general surgery in Germany in 1978. Since then, this surgical subspecialty/discipline has evolved enormous potential, e.g., in the collaboration with other disciplines such as general and abdominal surgery. Aim: To highlight and summarize the basic potential, technical options and novel aspects of plastic surgery, which are relevant for the common interdisciplinary surgical strategies of plastic and general as well as abdominal surgery in clinical practice. Method: Short and compact narrative review based on i) a selection of relevant references from the medical scientific literature and ii) surgical experiences obtained in daily work. Results (selected corner points): 1) Biological protection procedures in vascular surgery by flap coverage after meticulous debridement with or without autogenic vascular reconstruction are used to overcome infection of a vascular prosthesis, a serious problem, associated with the risk of anastomotic rupture and bleeding by transfer of immunological competence due to tissue coverage and finally to induce healing in the area of an infected vascular prosthesis. 2) Fistula treatment for aorto-tracheal or aorto-duodenal fistulas, a big challenge for the referring general surgeon, can be treated by flap coverage, such as by using the interposition of a pectoralis-major flap and the omentum-majus flap, respectively. 3) With regard to nerve surgery, encouraging results after early microsurgical recurrent laryngeal nerve repair with improved subjective voice quality or concerning reconstitution of respiratory capacity in diaphragmatic palsy has been reported. 4) Lymphatic surgery for lymphedema occurring either primarily due to an absence or lack of lymphatic vessels or secondarily due to infection, trauma, radiation therapy or surgery can be indicated in specialized microsurgical centers, e.g., for surgical repair of the lymphatic pathway by i) the interrupted lymphatic system can be reconstructed by an interposition, or ii) the lymphatic fluid can be drained extraanatomically (e.g., by a lymphatico-venous anastomosis). Further techniques are free lymph-node transplantation included in a free vascularized groin flap or autologous lymphatic-vessel transfer or vein-graft interposition (used for lymphatic-vessel interposition). 5) Mass reduction such as dermolipectomy with subsequent split-thickness is a valuable option, which provides excellent volume reduction. 6) Defect coverage: A. Split- or full-thickness skin grafts are a common method of defect coverage in case that the wound bed is clean and well-vascularized and if there is a lack of donor skin, or if the graft bed is of questionable quality using various allogenic or xenogenic skin substitute materials. B. Further methods offer a wide-range armamentarium of local and free fasciocutaneus and musculocutaneous flaps, e.g., after abdomino-perineal rectum extirpation using the vertical rectus-abdominis myocutaneous flap (VRAM) or propeller flaps according to the “angiosome”. 7) Abdominal wall hernia closure with instable skin coverage, flap closure, either alone or in combination with mesh is superior to mesh closure only. 8) Free flaps: If there is no option for a local or pedicled flap availabe, free flaps can be well used for abdominal wall-defect closure (complication rate in experienced hands, low). Conclusion: Plastic surgery is an indispensable partner for specific surgical problems and clinical situations of general and abdominal surgery, which indicates that each general and abdominal surgeon should be well notified on the great options and surgical techniques, which modern plastic surgery can provide to achieve best outcome and quality of life for the patients by combined expertise of these two surgical disciplines.