Plastic Surgery Using Prosthesis

Overview

Plastic surgery is a medical specialty that focuses on defect repair, cosmetic enhancement, and function restoration. Plastic surgery is distinct from cosmetic surgery, which is performed purely to alter a person's appearance in order to obtain what they believe is a more desirable appearance.

Plastic surgery can be done to fix the following:

• Congenital abnormalities such as cleft lip and palate, webbed fingers, malformed ears, and birthmarks
• Areas affected by malignant tissue removal, such as from the face or breast
• Severe burns or other major injuries

What is Prosthetic plastic surgery?

When a component of the body is lost due to accident or disease, the missing pieces can occasionally be replaced. Plastic surgeons strive to use the patient's own tissues for reconstructive surgery wherever possible. This is frequently referred to as a transplant (and called autologous reconstruction by experts).

However, if the missing components are too large (e.g., a whole leg or arm) or too complicated (e.g., a missing eye), one option is to replace the missing portions with an artificial (prosthetic) limb or body part. This type of treatment is known as prostheses. Almost every portion of the body may be replaced with a prosthetic limb or alternative, although the ability of a prosthetic body part (the prosthesis) to match the function and look of the missing part varies greatly.

Following the loss of any portion of the body, prosthetic plastic surgery may be a possibility. After the initial procedure to remove or treat the sick or damaged portion, no specialized surgery is usually necessary. Once the wounds have healed, the expert can fit a prosthetic limb or body component.

Prostheses provide a variety of functions. Breast implants of various types have been produced to repair or enlarge breasts. Implants are also used in a range of other cosmetic treatments, including as buttock, stomach, and calves’ surgery. Following amputations or the loss of face features such as the eyes, ears, nose, cheek, and teeth, prosthetic limbs are fitted.

Limb prostheses

A limb prosthesis is an artificial limb that replaces a missing body component, generally one that has been amputated.

The most common reasons for limb amputation include:

• Blood vessel (vascular) illness, especially diabetes or peripheral arterial disease
• Cancer
• Injury (for example, from a motor vehicle crash, work-related accident, or military combat)
• Congenital defect

In the United States, approximately one in every 200 persons is living with a limb loss, and over 500 amputations are performed each day. This percentage is expected to rise as the population ages and more people get diabetes and vascular disease.

A prosthesis (artificial limb) is frequently advised for persons who have undergone an amputation. A prosthesis should, at the at least, let the client to conduct everyday tasks (such as walking, eating, and dressing) independently and comfortably. A prosthesis may, at most, allow the individual to function as well as or nearly as well as before the amputation.

Success with a prosthesis is more probable when the clinical team includes a diverse range of clinicians, depending on the individual's circumstances. The surgeon, prosthetist, and physical therapist are the basic minimum of core team members. Prosthetists are experts who assess an amputee's overall functional abilities and develop a prosthesis treatment plan that includes designing, fitting, fabricating, and adjusting the prosthesis as well as providing lifetime follow-up care to maintain the prosthesis and provide advice and instruction on care. A physiatrist, occupational therapist, social worker, psychologist, and family members may be included to the team in more complex circumstances.

Prosthetic limb goals

Goals range from simple mobility to the ability to do high-impact sports like running and leaping. The components of the prosthesis are tailored to assist people attain their various objectives. Cushioning materials, prosthetic socket design, and foot, ankle, knee, hand, wrist, and elbow component technologies have all increased comfort and function dramatically. The prosthetist tries to ensure that the amputee is comfortable, stable when standing and walking, and capable of or achieving specific goals while fitting a prosthesis.

People with prostheses who are very motivated and otherwise healthy can achieve many incredible things (for example, go skydiving, climb mountains, complete triathlons, fully participate in sports, or return to demanding jobs or to active duty in the military). Whether used for basic mobility or more demanding activities, a prosthesis can bring significant psychologic advantages and increase quality of life.

The following factors contribute to successful prosthesis use:

• The individual's additional medical problems
• The person's physical and cognitive ability
• The amputation stump's qualities
• The degree to which the prosthetic socket fits and attaches to the body.

Fitting prostheses is a specialized ability. It can also be difficult for patients to make the physical and mental adaptations required to operate with the prosthesis. As a result, the whole process of choosing and changing components, as well as analyzing overall prosthesis function, is difficult and time-consuming. Not every patient is a good candidate for every type of prosthesis.

What happens after limb amputation?

When their recuperation allows, patients should begin to desensitize the end of their stump by massage, tapping, vibration, and bearing weight on it.

Prosthesis fitting can commence once the surgical site has healed sufficiently and the edema has subsided, assuming the patient has sufficient general strength and joint range of motion. Prosthesis fitting typically takes place 7 to 10 weeks following amputation.

The amputation stump changes for 6 to 18 months after amputation as more fluid exits the stump and muscles reshape. Prosthetists may fit one or more temporary sockets until the amputation stump stabilizes while these changes are taking place. Prosthetists fit the person with a definitive prosthesis when the amputated stump seems to be near to its ultimate size and form. A temporary prosthesis allows people to get used to the pressures and forces that come with using a prosthesis.

What are the parts of a Prosthetic limb?

A limb prosthesis has 4 main parts:

1. Interface
2. Suspension
3. Structural components
4. Appearance components

Interface between the residual limb (stump) and prosthesis

The prosthesis is attached to the body either through direct skin contact or through an interface consisting of different thin cushion materials worn over the residual limb.

A gel cushion interface, placed over the residual limb, preserves the skin and aids in pressure distribution. For unusual stump shapes, custom molded interfaces may be required (because of, for example, deep scars, sharp bones, or burns). People should ideally have two identical interfaces that can be switched from day to day. Alternating the interface allows it to retain its flexibility and form while lasting longer. Interfaces should be updated every 6 months and, for very active patients, every 3 to 4 months.

A prosthetic sock can be worn in place of or in addition to a gel interface. Socks are often constructed of wool, nylon, or synthetic materials, with gel sandwiched between the layers. Socks come in a variety of thicknesses (plies). The residual limb's size fluctuates naturally during the day according to activity, weather, and other variables. To handle these changes, prosthetic socks and specific cushions are employed. A user can alter the fit of the socket to make it more comfortable when the residual limb changes size over the day by putting on or taking off one or more socks of varying thicknesses. When prosthetic socks or special pads fail to provide a pleasant, stable fit, the prosthetist can alter the socket.

Suspension

Suspension is the method through which the prosthesis is attached to the residual limb. Some gel interface materials are more suited for specific suspending applications than others (such as suction, pin, or vacuum).

The following suspension systems are commonly used:

• Vacuum: A vacuum pump, either electric or mechanical, removes air from the socket. This is the most effective approach for attaching a prosthesis to the residual limb and also aids in the stabilization of the residual limb's fluid level. For this form of suspension, urethane gel interface is used.
• Passive suction: Air is pushed out of the socket when the residual limb is inserted. Suction is created by preventing air from reentering through a seal above. To allow air out, a one-way valve can be installed at the bottom of the socket.
• Interface with a locking pin: A cushion interface with a detachable, adjustable stainless steel suspension pin at the bottom is put into the plastic socket's locking mechanism. The individual removes the prosthesis by pressing a release button to disconnect the pin.
• Anatomical: Bumps on the extremities of bones, such as the knee, ankle, or elbow, can be utilized to assist keep the socket in place.
• Belts and straps: If the user cannot tolerate or finds the vacuum, suction, or pin methods too challenging, a belt and/or straps may be utilized to keep the prosthesis in place.

Structural components of a limb prosthesis

The basic components of a prosthesis include the following:

• Socket (plastic receptacle in which the residual limb is contained)
• Appendage (hand or foot)
• Joint (wrist, elbow, shoulder, ankle, knee, or hip)
• Connecting module that connects the appendage and joint to the socket

The socket is the most significant component because it supports the body and transfers pressure and forces from movement to the residual limb.

Appearance of a limb prosthesis

Some people prefer that their prostheses seem physically natural. Over the plastic and metal components, technicians apply and mold a soft foam substance with the consistency of muscle and tissue. This material may be molded to fit the person's natural limb and can prevent clothes damage. A synthetic skin in a color that matches the person's skin tone can be put over the anatomic contour.

Some people, particularly sportsmen, choose to remove the anatomic form and skin during competition, leaving the plastic and metal components exposed. This decreases weight and enables for additional performance-adjustments.

Prosthetics in Facial Reconstruction

Because of the multiple variables for effective rehabilitation, head and neck reconstruction can be a challenging task. Although head and neck deformities were traditionally thought to be irreversibly morbid and linked with a low quality of life, breakthroughs in surgical technique have greatly helped these patients' well-being. However, not all patients are surgical candidates, and many have turned to nonsurgical methods for functional and aesthetic restoration.

As a result, the introduction of prosthesis has alleviated such worries and given a feasible option for some patient populations. A team of head and neck surgeons, maxillofacial surgeons, and prosthetic experts can most successfully coordinate a multidisciplinary approach to head and neck reconstruction focused on appropriate expectations and patient-centered goals.

Head and neck prosthesis try to restore aesthetic look and functioning by providing a synthetic substitute for ablative, congenital, or traumatic abnormalities of the head and neck. The two aims of craniofacial reconstruction, form and function, may frequently be fulfilled in a harmonic manner. The difficult anatomy and physiology of the head and neck, on the other hand, can be intimidating and time consuming even for the most experienced surgeon.

Presurgical Evaluation

Because the treatment of these problems is complicated, a multidisciplinary approach to head and neck reconstruction is essential. In some circumstances, replacing biologic structures with prosthesis is useful and may be preferable than surgical reconstruction in terms of function and appearance.

When rebuilding a head and neck defect, several aspects must be considered, including the size, location, age of the lesion, and amount of nearby supportive tissue surrounding the defect. To assure fit and survival, overly big defects and defects near to movable structures may be more effective with a surgical vs prosthetic method.

In situations of trauma-induced abnormalities and congenital deformities, the timing of repair is important. Patients' ages, as well as their expected growth, have a role in recreating an anatomical area that complements their look. Prosthetics can be adjusted to patients' ages and facial characteristics at various phases of development.

Materials

Silver, leather, porcelain, papier Mache, gelatin, latex, and acrylic have all been used in prosthetic reconstruction throughout history.

Durability, flexibility, weight, color matching, lifespan, biocompatibility, texture, cleanliness, and thermal conductivity are all important considerations when designing an optimal facial prosthesis. Methacrylates, polyurethane elastomers, and silicone elastomers are the three types of modern materials utilized for head and neck prosthesis. These clinically inert materials absorb pigmentation easily and may be customized to match the color and texture of the surrounding structures for a more realistic appearance.

Silicone is now one of the most often utilized materials in face prostheses. A silicone elastomer's smooth and flexible texture preserves body temperature without distortion and may be stretched until translucent to merge with surrounding skin. However, face prostheses are not without drawbacks. Every two years, a face prosthesis is remade or reconditioned. Environmental factors, UV radiation, and discoloration all play essential roles in prosthesis degeneration, which places a significant burden on patients.

Ear Prostheses

Auricular abnormalities are frequently related with congenital deformities, ablative tumor surgery, or trauma. The size and degree of the malformation decide whether the defect may be corrected surgically or with a prosthetic.

The optimum surgical strategy of restoring the auricle is determined by patient desire, surgeon experience and comfort, and accessible tissue. Larger deformities are more difficult to repair surgically and rely on a number of conditions to be successful.

To maintain an autologous transplant, the neighboring skin and subcutaneous tissue, which are commonly injured by trauma or radiation therapy, must be healthy and have a good blood supply. Even the most skilled surgeon will find auricular reconstruction difficult. Multiple procedures are needed for graft harvesting, tissue growth, and aesthetic modification, which increases morbidity and the risk of complications.

At the implant and graft site, bleeding, infection, and hematoma are more common than with an auricular prosthesis. Furthermore, because of uneven cosmetic outcomes, total patient satisfaction is typically lower.

An auricular prosthesis is simple to use and offers considerable functional and cosmetic benefits. Sound amplification and acoustic gain are significantly reduced in the malformed ear. Auricular prostheses give clinically appropriate acoustic gain at specific head orientations and frequencies, assisting with speech detection in noisy environments.

Nasal Prostheses

Nasal lesions may necessitate partial or whole excision and are frequently repaired using localized flaps. Because of the same skin color and texture to the nasal area, the paramedian forehead flap is the most aesthetically appealing. Nonetheless, color matching is not always perfect, and revision operations have a higher morbidity and fatality rate.

Furthermore, individuals who receive postoperative radiation have delayed wound healing and a higher likelihood of flap failure. In certain circumstances, prosthesis may be the best option for matching and restoring the defect with a nose that matches the surrounding anatomy in color, thickness, and texture.

Before deciding on the best way of repair, the retention mechanism for a nasal prosthesis must be thoroughly examined. Because of the continual air exchange, humidification, and moisture in the nasal cavity, adhesives have a short life cycle and frequently fail.

Mechanical retention may be sufficient if the implant is well positioned with the right surgical undercuts and enough surface area is accessible to ensure adequate anchoring. Because of its tenacity and endurance in the face of changing environmental circumstances, osseointegration has considerably enhanced nasal implant retention. This approach, however, is reliant on the quantity and quality of bone supply available.

To allow the prosthesis to fit adequately without requiring a large construct, sections of the native anatomy, such as the ala, anterior septum, and columella, may need to be removed. To avoid a strong contrast between original tissue and the prosthesis, care must also be taken not to disturb the top lip. While nasal prostheses have significant drawbacks, they give a visually beneficial outcome that may be accomplished with a low morbidity surgical operation.

Maxillary and midface prosthesis

Reconstruction of midface and maxillary deformities is a difficult task. Mastication, phonation, malar projection, and deglutition all rely on the maxilla. The maxilla is a structural support structure between the skull base and the occlusal plane, as well as a support structure for face tissues engaged in expressive motions.

Closure of the mouth cavity, support of orbital contents and maxillary buttresses, restoration of teeth and functioning, and restitution of midface shape and symmetry must all be accomplished during maxillary defect reconstruction.

Maxillectomy defects were traditionally restored using prosthetic obturation, with the primary purpose of separating the oral cavity from the nasal cavity. Obturator stability is directly proportional to the quantity of tissue available for support, and substantial hard palate resections compromise the obturator's airtight fit with remaining structures. Because of this instability, leakage from the nasal cavity and sinuses occurs, causing discomfort and wear on the oral cavity.

For proper support, midface abnormalities often need three to four implants. Stable recipient locations include the zygomatic buttress, supraorbital rim, vomer, and horizontal section of the hard palate. The quantity of residual palate and/or neighboring abutment tooth used for prosthesis stability and retention is crucial.

Canine and molar tooth integrity is also important for effective prosthesis retention. Downward gravity forces, upward occlusive forces, and rotating forces related with functional speech, swallow, and mastication must all be addressed when fitting a prosthesis.

Eye prosthesis

The eyes are essential for vision as well as self-image and expression. Orbital exenteration has a significant influence on a patient's self-confidence, needing prompt correction. Orbital enucleation removes the globe by cutting the optic nerve and extraocular muscles, whereas evisceration removes the whole globe while keeping the surrounding orbital contents intact, including Tenon's capsule, extraocular muscles, and the optic nerve. The most extreme is exenteration, in which all orbital contents, including the globe, are ejected.

Exenteration reconstruction is patient-specific and can be accomplished using a microvascular free flap or an orbital prosthesis. Repair using a prosthetic eye, on the other hand, is the most prevalent technique of reconstruction for the aforementioned minor abnormalities.

After the eye is removed, an orbital implant is inserted for 4 to 6 weeks. The implant fills the area that will eventually contain the prosthesis and avoids scarring and tissue contraction. To provide an adhesive basis for the implant, the bone cavity is lined with a split-thickness skin graft.

To prevent enophthalmos, the orbital borders must be stable and healthy, the sinuses must be blocked from the orbital contents, and the depth of the defect must be maintained. The inferior resection margin should have a firm shape and be stable enough to support a prosthetic load. To keep the brow in place, the superior section should be carefully considered.

The extraocular muscles remain linked to the scleral membrane that lines the implant during evisceration surgery. Enucleation necessitates reattachment of the muscles to the implant directly or indirectly via a wrapping substance over the implant for anchoring. The orbital implant is mostly responsible for the aesthetic success. If properly installed, the prosthetic eye will look and move like the contralateral eye.

Conclusion

When a bodily component is lost due to an accident or disease, the missing portions can sometimes be replaced. Wherever feasible, plastic surgeons attempt to employ the patient's own tissues for reconstructive surgery. This is commonly known as a transplant. If the missing components are too vast or too delicate, one alternative is to replace the missing sections with a prosthetic limb or body part.

Prostheses provide a variety of functions. Breast implants of various types have been produced to repair or enlarge breasts. Implants are also used in a range of other cosmetic treatments. Following amputations or the loss of face features such as the eyes, ears, nose, cheek, and teeth, prosthetic parts are fitted. Technological advancements have resulted in significant advances in the look and customization of prostheses to an individual's needs; yet, difficult judgments about trade-offs between usefulness and aesthetic of the prosthesis may be required. The advancement of osseointegration methods has resulted in far more stability and security than was previously possible.