Reconstructive Surgery
Function, Tissue Integrity and Natural Appearance in Reconstructive Surgery
Reconstructive surgery aims to reconstruct tissue losses caused by congenital differences, trauma, burns, tumor surgery, infection or chronic wounds. The main goal of treatment is not only to close an open area, but also to restore the function, durability and anatomical integrity of the damaged area to the most appropriate possible level.
In the evaluations performed by Prof. Dr. Osman Kelahmetoğlu at his clinic in Istanbul Şişli / Nişantaşı, the location, size and depth of tissue loss, the condition of surrounding tissues and the person’s general health characteristics are considered together. The surgical plan may include different methods, from simple wound closure to skin grafts, from local flaps to microsurgical tissue transfers.
What Is Reconstructive Surgery?
Reconstructive surgery is a broad field of plastic surgery that covers the reconstruction of structures such as lost skin, fat tissue, muscle, tendon, nerve, vessel or bone. The method to be applied is planned not only to improve the appearance of the problem, but also to preserve the function of the area.
Not every tissue loss can be repaired with the same method. While small and superficial wounds can be closed directly, skin grafts, local flaps, regional flaps or free tissue transfer may be required in large or deep defects.
Restoring Function
The aim is to support functions such as movement, grasping, chewing, swallowing, speaking and providing protective tissue coverage.
Anatomical and Aesthetic Integrity
The repaired area is intended to be compatible with the surrounding tissues, durable and as natural-looking as possible.
In Which Situations Can Reconstructive Surgery Be Applied?
Reconstructive surgery may be considered in tissue losses and functional disorders that occur for different reasons. The scope of treatment varies according to the cause of the damage and the affected anatomical structures.
- Tissue losses after cancer surgery
- Injuries related to trauma and work accidents
- Wounds and movement limitations developing after burns
- Chronic wounds that do not close for a long time
- Congenital tissue and shape differences
- Large tissue losses in the head and neck region
- Complete or partial loss of breast tissue
- Hand, finger, tendon, vessel and nerve injuries
- Tissue losses related to infection or circulatory disorders
The reconstruction plan is not determined only by the size of the wound
The depth of the wound, blood circulation, infection status, exposed bones or tendons and the person’s additional diseases directly affect the surgical method.
Breast Reconstruction
Breast reconstruction aims to recreate the breast form after all or part of the breast tissue has been removed due to breast cancer. Reconstruction may be planned in suitable patients during the same session as cancer surgery or at a later date after the treatment process is completed.
Silicone breast implants, tissue expanders or the person’s own tissues taken from the abdomen, back, thigh or buttock area may be used in reconstruction. The choice of method is determined according to the cancer surgery performed, history of radiotherapy, existing tissue amount, additional diseases and the person’s expectations.
Breast Reconstruction with Implant
In people with suitable tissue coverage, breast volume can be recreated using a tissue expander or permanent breast implant.
Reconstruction with the Person’s Own Tissue
Skin and fat tissue taken from the abdomen, back or another area can be transferred to create the breast form.
In the later stages of breast reconstruction, procedures to increase symmetry with the opposite breast, nipple and areola reconstruction or scar revisions may be considered.
Breast reconstruction can be a personalized and staged process
Some reconstructions can be completed in a single session, while more than one surgical stage may be required to create the final shape.
Reconstruction After Cancer Surgery
Reconstruction after cancer surgery is planned to close the tissue defect that occurs after the tumor is removed with safe margins and to preserve the function of the affected area.
Tissue losses of different sizes may occur after skin cancers, soft tissue tumors, head and neck tumors or breast cancer. The reconstruction method should be determined without limiting the boundaries of cancer surgery and without making the follow-up process of the disease difficult.
Superficial Tissue Losses
Small areas can be repaired with methods such as direct closure, local flap or skin graft.
Deep Tissue Losses
In cases where muscle, bone, tendon or important vessels are exposed, stronger and well-vascularized tissues may be required.
Preserving Function
Region-specific functions such as movement, speech, swallowing or facial expression are taken into account in the reconstruction plan.
Oncological Follow-Up
It is important that the reconstruction performed is compatible with imaging, examination and the subsequent follow-up processes of the disease.
Head and Neck Reconstruction
Head and neck reconstruction includes the reconstruction of tissue losses in the face, jaw, inside of the mouth, tongue, neck and scalp caused by tumors, trauma, infection or congenital problems.
Reconstructions in this region may affect not only appearance but also essential functions such as speaking, chewing, swallowing, breathing and facial expression. Therefore, the reconstruction plan is created by considering the type of missing tissue and the patient’s daily life needs.
Intraoral and Jaw Reconstructions
In soft tissue and bone losses, reconstructions that support speech, chewing and swallowing functions may be planned.
Face and Scalp Reconstructions
In addition to tissue coverage, the preservation of facial contours, hairline and surrounding anatomical structures is targeted.
Head and neck reconstructions require multidimensional planning
Plastic surgery, oncological surgery, ear, nose and throat, maxillofacial surgery and other branches may need to work together.
Microsurgical Tissue Transfer
Microsurgical tissue transfer is an advanced reconstruction method that allows skin, fat, muscle or bone tissue taken from one part of the body to be transferred to another area together with its vessels.
The artery and vein of the transferred tissue are connected to the vessels in the recipient area under an operating microscope. In this way, large or complex tissue losses can be covered with living tissues that have their own blood circulation.
Free Tissue Transfer
The tissue is completely separated from the donor area together with its vessels and connected to the vessels in the needed area using microsurgical techniques.
Selection According to Tissue Need
Different flaps containing thin skin, bulky soft tissue, muscle or bone may be preferred according to the area to be reconstructed.
In which situations may microsurgical tissue transfer be required?
- Large head and neck tissue losses
- Breast reconstruction
- Open bone and tendon wounds in the lower or upper extremity
- Large soft tissue defects after trauma
- Complex cavities formed after cancer surgery
- Cases where local tissues are insufficient for reconstruction
Microsurgery requires close postoperative follow-up
The circulation of the transferred tissue is regularly monitored in the first hours and days. Early recognition of changes in vascular circulation is important.
Hand Surgery
Hand surgery is a specialized surgical field in which bone, joint, tendon, nerve, vessel and soft tissues are evaluated together. Even damage to a small area of the hand can affect grasping, sensation and delicate movements.
Sharp object injuries, work accidents, tendon ruptures, nerve cuts, fractures, crush injuries and congenital hand differences are included in the evaluation area of hand surgery.
Tendon Injuries
After the repair of tendons that allow the fingers to bend or extend, controlled rehabilitation is required.
Nerve Injuries
Nerve cuts that cause loss of sensation and movement can be repaired with microsurgical techniques.
Vascular Injuries
In vascular injuries affecting hand and finger circulation, microsurgery may be applied to restore blood flow.
Bone and Joint Injuries
Fractures and joint injuries are evaluated in a way that preserves hand alignment, movement and grip strength.
In hand surgery, postoperative physical therapy and hand rehabilitation are as important as the operation itself. Personalized exercise programs may be required for tendon gliding, preservation of joint movement and regaining muscle strength.
Replantation of Severed Fingers and Limbs
The reattachment of severed fingers or limbs is called replantation. In this procedure, many anatomical structures such as bone, tendon, vessel, nerve and skin must be repaired separately.
Not every amputation injury may be suitable for replantation. The type of injury, degree of tissue crushing, preservation conditions of the amputated part, elapsed time and the person’s general health condition affect the treatment decision.
Correct Preservation and Transfer
The severed part should be placed in a clean bag without direct contact with ice, and this bag should be transported inside another container containing iced water.
Timely Intervention
For tissue circulation to be restored, it is important that the patient and the severed part are transported to an appropriate center as soon as possible.
Reattachment of the part does not mean a full function guarantee
Postoperative circulation, nerve healing, joint movement and the rehabilitation process affect the function that can be achieved.
Burn and Wound Treatments
Burn and wound treatments include the closure of acute burns as well as the management of post-burn scars, contractures limiting joint movement and wounds that do not heal for a long time.
The depth of the burn, the body surface area it affects, its location and accompanying health problems determine the treatment method. In deep burns, damaged tissue may need to be cleaned and the wound covered with a skin graft or flaps.
Skin Graft
A thin layer of skin taken from another part of the body can be placed on a suitable wound bed to provide tissue coverage.
Flap Surgery
In wounds where bone, tendon or important structures are exposed, thicker tissues with their own blood circulation may be used.
Which problems can post-burn reconstruction target?
- Skin tightness that restricts joint movement
- Contractures developing in the neck, hand, arm or leg
- Thickened and raised burn scars
- Deformities around the eyelids or mouth
- Tissue and hair loss on the scalp
- Burn wounds that do not close for a long time
Surgical Treatment of Chronic Wounds
A chronic wound is a wound that does not close within the expected time despite appropriate care and is often associated with circulatory disorder, diabetes, pressure, infection or nerve damage. Diabetic foot wounds, pressure sores and wounds related to vascular diseases may be included in this group.
In treatment, simply closing the surface of the wound is not sufficient. Factors that prevent wound healing, such as blood circulation, infection, blood sugar control, pressure load and nutritional status, should be addressed together.
Wound Cleaning
Dead and infected tissues can be removed with surgical or appropriate wound care methods.
Infection Control
Culture, antibiotic treatment and necessary surgical procedures are planned to prevent the spread of infection.
Circulation Assessment
In wounds with insufficient blood flow, evaluation by vascular surgery or related branches may be required.
Closure with Tissue
After the wound bed becomes suitable, permanent closure can be planned with a graft, local flap or free tissue transfer.
Chronic wound treatment may require a multidisciplinary approach
Plastic surgery, infectious diseases, vascular surgery, orthopedics, endocrinology and wound care teams may work together.
Methods Used in Reconstructive Surgery
The reconstruction method is planned from the simplest and safest option toward more complex techniques. This approach is called the reconstructive ladder, but the same order does not have to be followed in every patient.
Direct Closure
Small tissue losses can be closed by bringing surrounding tissues together without excessive tension.
Skin Grafts
Skin tissue taken from another area can be used on suitable, well-vascularized superficial wounds.
Local and Regional Flaps
Skin, fat or muscle tissue near the wound can be transferred to the damaged area while preserving its own circulation.
Free Flaps
Tissue taken from a distant area can be used in the reconstruction of complex defects by connecting its vessels with microsurgery.
Evaluation Before Reconstructive Surgery
Before surgical planning, the cause and duration of the wound, previous treatments, infection status and blood circulation of the surrounding tissues are evaluated. Imaging, vascular examinations, laboratory tests or pathology results may be required.
Diabetes, vascular disease, immune system problems, medications used, smoking and nicotine use can directly affect wound healing. It is important to bring these factors under control as much as possible before surgery.
Analysis of Tissue Loss
Missing skin, fat, muscle, tendon, nerve or bone structures are evaluated separately.
Blood Circulation
The circulatory adequacy of the recipient area and the donor tissue to be used is examined.
Infection and Wound Status
Active infection, dead tissue and foreign bodies are brought under control before reconstruction.
Functional Goals
The movements and functions intended to be preserved or restored after reconstruction are determined.
Surgery and Recovery Process
The duration and scope of reconstructive surgery vary according to the method to be applied. The operation, hospital stay and recovery processes of a small skin graft and a large microsurgical tissue transfer are not the same.
After surgery, wound care, dressing, movement restriction, splinting or protective positioning may be required. In microsurgical procedures, the circulation of the transferred tissue is closely monitored. In hand and extremity reconstructions, the physical therapy process may be planned in the early period.
Wound and Tissue Follow-Up
The color, temperature, circulation and wound healing of the repaired area are evaluated with regular follow-ups.
Rehabilitation
Physical therapy may be required to preserve movement in reconstructions around the hand, arm, leg and joints.
Things to consider during the recovery period
- Following wound care and dressing recommendations
- Avoiding smoking and nicotine use
- Protecting the repaired area from pressure and impacts
- Using prescribed medications regularly
- Not interrupting the physical therapy program
- Attending follow-up appointments regularly
- Contacting the doctor in case of color change, increasing pain or fever
Healing is not completed only when the wound closes
Regaining muscle strength, joint movement, sensation, tissue softness and adaptation to daily life may require a longer process.
Possible Risks of Reconstructive Surgery
As with every surgical procedure, reconstructive surgery may involve bleeding, infection, delayed wound healing, fluid accumulation, noticeable scars, changes in sensation and anesthesia-related complications.
Partial failure of a skin graft, impaired flap circulation, wound problems in the donor area or the need for additional surgery are among the risks specific to reconstruction. In microsurgical tissue transfers, urgent reoperation may be required if a clot forms in the vascular connections.
The level of risk varies according to the scope of the wound and surgery
The person’s general health status, smoking, circulatory disorder, diabetes and previous radiotherapy may affect the healing process.
Why Prof. Dr. Osman Kelahmetoğlu?
Reconstructive surgery requires not only the ability to close a wound, but also knowledge of anatomy, assessment of tissue circulation, microsurgical experience and management of possible complications.
Prof. Dr. Osman Kelahmetoğlu’s academic and clinical experience in plastic, reconstructive and aesthetic surgery contributes to the comprehensive evaluation of breast reconstruction, head and neck reconstruction, hand surgery, microsurgical tissue transfer, reconstruction after cancer surgery and wound treatments.
Reconstructive and Microsurgical Experience
Graft, flap and microsurgical options can be evaluated according to the need for different tissue losses.
Balance of Function and Appearance
In the reconstruction plan, the durability, movement and natural harmony of the area with surrounding tissues are considered together.
Reconstructive Surgery Prices in Istanbul
Reconstructive surgery prices in Istanbul may vary depending on the size of the tissue loss, the method to be applied, operation time, need for microsurgery, hospital stay and whether more than one surgical stage is required.
Skin graft, local flap, free tissue transfer, breast reconstruction, hand surgery and chronic wound reconstruction have different treatment scopes. For an accurate cost plan, examination, tests and determination of the surgical method are required.
Frequently Asked Questions About Reconstructive Surgery
What is the difference between reconstructive surgery and aesthetic surgery?
Reconstructive surgery primarily aims to recreate lost tissue and function. Aesthetic harmony is also an important part of the treatment plan.
Does every tissue loss require microsurgery?
No. Small wounds can be repaired with direct closure, skin grafts or local flaps. Microsurgery may be required in larger and more complex defects.
Can breast reconstruction be performed at the same time as cancer surgery?
Simultaneous reconstruction can be performed in suitable patients. The characteristics of the cancer, the need for radiotherapy and the person’s general condition affect timing.
Is reconstruction with the person’s own tissue more suitable?
There is no single method that is best for everyone. Reconstruction with the person’s own tissue and implant-based reconstruction have different advantages and limitations.
What is the difference between a skin graft and a flap?
A skin graft is placed on the wound bed without its own vessels and receives nourishment from there. A flap is a thicker tissue transferred while preserving its own blood circulation.
How long does microsurgical tissue transfer take?
Operation time varies according to the type of tissue to be transferred and the scope of reconstruction. These procedures usually require detailed vascular and tissue repair.
Can a severed finger be replanted in every case?
The level of injury, amount of crushing, elapsed time, preservation conditions of the part and the person’s health status affect the decision.
Why does a chronic wound not close?
Circulatory disorder, diabetes, infection, constant pressure, nutritional problems and dead tissues may prevent wound healing.
Is physical therapy required after reconstructive surgery?
Physical therapy may be required to regain movement and function in hand, tendon, nerve, joint and extremity reconstructions.
Will there be scars after reconstructive surgery?
Scars occur with every surgical incision. The appearance of scars varies according to the location of the wound, the method applied, skin structure and the healing process.
Contact and Appointment
To create a personal evaluation about breast reconstruction, head and neck reconstruction, hand surgery, microsurgical tissue transfer, reconstruction after cancer surgery or burn and wound treatments, you can contact Prof. Dr. Osman Kelahmetoğlu’s clinic in Istanbul Şişli / Nişantaşı.
During the examination, the scope of tissue loss, existing function, applicable surgical methods, recovery process and possible risks are evaluated according to your personal condition.
Personalized reconstructive surgery planning in Istanbul Şişli / Nişantaşı
You can create an appointment for a reconstructive surgery plan in which function, tissue integrity and natural appearance are evaluated together.
