PLASTIC SURGERY

The medical sub-specialty known as plastic surgery is mainly concerned with the restoration of both physical form and function of a part of a body. The best known form of plastic surgery is aesthetic or cosmetic surgery. However, other forms of plastic surgery exist such as craniofacial surgery, microsurgery, hand surgery, surgical treatment of extensive burns and reconstructive surgery.

Procedures.

1.   Skin Grafting.

The most common procedure in plastic surgery is skin grafting. Skin grafting is a term used to describe the procedure of transfer of whole or a part of skin tissue. Usually skin grafting is used to manage extensive wound trauma, burns, extensive skin loss as a result of dermatological infections (such as purpura fulminans and necrotizing fasciitis); and for specific surgeries such as wide surgical excision of skin cancers.

The skin graft can either be taken from a donor or from within the recipient as described hereafter. Autografts are skin grafts taken from the patient undergoing skin grafting (who in this case is referred to as the recipient). However, if the recipient is deficient in natural healthy skin tissue, the two alternatives that are feasible are to either to culture sheets of epithelial cells (harvested from the recipient) in vitro or to utilize synthetic compounds ( for example integra which is made up of synthetic silicon complexed with bovine tendon which still contains its natural glycosaminoglycans). Allografts are skin grafts derived from another person (donor is the same species as the recepient) and lastly xenografts are skin grafts derived from donors who belong to a different species relative to the recipient.

To obtain excellent outcomes from skin grafting, it is mandatory that the plastic surgeon should plan his or her surgical incisions to coincide with the natural skin folds and tension lines. Excellent results from skin grafting are also obtained when the plastic surgeon uses the most appropriate option of wound closure (which mainly involves wound suturing), uses the most appropriate suture materials and also ensures that exposed sutures are removed as early as possible so as to ensure that the buried sutures do hold the closed wound.  

2.   Aesthetic surgery.

Cosmetic or aesthetic surgery is an elective procedure performed by plastic surgeons on normal and healthy body parts with the explicit objective of removing any signs of aging or just for beatification purposes. According to the American Society for Aesthetic Plastic Surgery, the most common forms of aesthetic surgery performed in the United States of America are breast augmentation (a type of mammoplasty), abdominoplasty (a surgical procedure aimed at reshaping and restoring the firmness of the entire abdomen), liposuction (a surgical procedure aimed at excising excessive fat tissue from the body), eyelid surgery (aimed at reshaping the eyelids) and nasal surgery (aimed at reshaping the structure and restoring the firmness of the nose). Facelift and rhinoplasty are also popular worldwide.

Some of the aesthetic surgical procedures are augmented by non-surgical procedures such as laser hair removal and Botox treatment. In some parts of Asia, especially Thailand, sex reassignment surgery done in conjunction with breast augmentation is quite popular.

Other popular cosmetic procedures are phalloplasty, buttock augmentation, chemical peel, cryolysis, cryoneuromodulation, lip enhancement, otoplasty, labiaplasty, genioplasty, orthognathic surgery, cheek augmentation, brachioplasty, keloid removal and laser-guided skin rejuvenation.

COLON CLEANSE.

            Colon cleanse aims to get rid of nonspecific harmful toxins from either the colon or the entire intestinal tract. The procedure utilized to cleanse the colon is commonly known as colon therapy. Colon therapy utilizes several alternative medical therapies. With the advent of infomercials and internet marketing, colon cleansing was re-braded and referred to as colonic irrigation or colon hydrotherapy.

            There are several forms of colon therapy. Some forms utilize flexible tubes to infuse a liquid formula into the intestinal tract or the colon through the rectum via the use of a special equipment. The liquid formula commonly used is either pure water  which is used for colonic irrigation or colonic hydrotherapy, or water mixed with a predetermined content of herbs and/or a fixed amount other liquids which is then injected into the colon through the rectal route. Other forms of colon therapy utilize oral cleaning regimens. The oral cleaning regimens are usually made up of dietary fibres, laxatives, dietary supplements and herbs either singly or combined at a predetermined proportion.

            Practitioners of colon cleansing postulate that feaces do putrefy within the colon and that significant amounts of these putrefied feces do attach themselves to the walls of the colon and in the process end up lining the inner wall of the colon, and their subsequent accumulations do provide a pleasant environment for pathogenic intestinal flora and parasites to anchor, grow and reproduce. It is these pathogenic intestinal flora and parasites that cause non-specific gut symptoms and sometimes general ailment. This auto-intoxication postulation was first put forward by Ancient Greeks and Egyptians.

            Based on the above-mentioned postulation, it is thus deemed necessary for one to irrigate his or her colon using pressurized liquid so as to cause the attached putrefied feaces to detach from the intestinal lining thereby denying the pathogenic intestinal flora and parasites a medium to attach themselves to, and in the process their rate of growth and reproduction will be sufficiently reduced to levels which would not support their causation of non-specific symptoms.

            It is believed that this auto-intoxication causes gut irritability, headache, loss of appetite and fatigue. However, current medical knowledge does attribute these symptoms of auto-intoxication to mechanical distension (that resolves itself) of the colon or the intestines, and as such colon cleansing is not necessary. There have been reported adverse effects of colon cleansing in modern clinical literature. Some of these adverse effects are dehydration, electrolyte imbalance, perforation of the rectal wall, amoebic infection, heart problems and constipation.

SURGICAL IMAGING.

Surgical imaging (also referred to as Image-guided surgery) augments surgical procedures as it enables the surgeon to utilize intra-operative and postoperative images to track surgical instruments in intra-operative surgery or to indirectly guide a surgical procedure. As such, it complements the surgical practice. Surgical imaging is classified as one of the sub-categories of computer assisted surgery. Surgical imaging, by nature, is usually non-invasive or minimally invasive. The novel field in surgery and medicine that pioneered, revolutionized and specializes in non-invasive or minimally invasive surgical imaging is called interventional radiology (also called Vascular and Interventional Radiology, or Surgical Radiology).

History.

Surgical imaging was originally developed to aid in the treatment of brain tumors (or cerebral neoplasias) using a surgical technique combining radio-surgery and stereotactic surgery under the guidance of positron emission tomography ( abbreviated as PET), magnetic resonance imaging (abbreviated as  MRI) and  computed tomography (abbreviated as  CT) via utilization of an avant-garde technological tool called N-localizer. In general, an N-localizer is a surgical tool that facilitates either radio-surgery or stereotactic surgery via the utilization of tomographic images obtained through medical imaging technologies. Widespread utilization of the N-localizer stimulated interest in surgical imaging and it also led to further development in the core aspects of image-guided surgery.

Utility.

Currently, surgical imaging is widely utilized in surgery of maxillary and frontal sinuses where it confers the unique advantage to the surgeon of enabling him or her to have accurate images which enables him or her to avoid damaging either the delicate nervous system or causing a contusion in the deeper lying brain matter. It has also aided surgeons to perform mechanical atherectomy, stenting and angioplasty in cases of peripheral artery disease.

In the field on oncology, surgical imaging has enabled the surgeon or intervention radiologist to characterize the tumor type, tumor size, extent of spread of the malignancy and the anatomical relation of the cancer; and this goes a long way in enabling the surgeon to successfully select the correct course of treatment and surgery. It has also complemented oncological interventional modalities such as high-intensity focused ultrasound (abbreviated as HIFU), irreversible electroporation (abbreviated as IRE), radiofrequency ablation (abbreviated as RFA), microwave ablation and cryoablation.

Surgical imaging system.

The most essential component of an image-guided surgery system is a hand-held (portable) surgical probe. The Surgical imaging system tracks this probe and also displays the real-time anatomy beneath the probe as 3 orthogonal image slices (as is common in workstation-based three-dimensional imaging system).

Current Surgical imaging systems uses the following tracking techniques: electromagnetic, optical, mechanical and ultrasonic trackers. However, a fluorescence modality can be adopted into surgical imaging, and the technique is thereby referred to as fluorescence image-guided surgery.