Halsted once described plastic surgeons as “the surgeon’s surgeons.” Yet in today’s era of media hype about cosmetic surgery, this turn of phrase feels long-forgotten. Despite what reality television may have you believe, the specialty remains at its core about reconstructive surgery, and collaboration is still a key element.
Here, a few points that show those words are as true now as they ever were:
We manage a patient’s expectations. Patients may have high expectations for how their scars will look, particularly on cosmetically sensitive parts of the body. Whether it is a thyroidectomy incision on the neck, a sternal wound on the chest, or a facial laceration on a child, when a patient expresses concern about “not wanting to have a scar,” it may be a good idea to get a plastic surgeon involved. We, as a group, may be able to explain what to realistically expect from a scar after surgery. We may also be able to offer optimal wound closure (to a plastic surgeon, this is based on fundamental principles of layered, tension-free closure). Finally, we may be able to help with scar management after surgery, using an array of silicone gel, silicone sheeting, and steroid injections to help achieve the desired results.
We can share the responsibility for a high-risk patient. Some patients have the decks stacked against them. They may be older, frail, beleaguered by other medical conditions, or operated on multiple times. For individuals in these subsets – those who are likely to encounter roadblocks in the healing and recovery process – a plastic surgeon may be able to help. Whether your case involves a vasculopath with an infected groin wound; a cardiac surgery patient with diabetes; a knee replacement candidate with a connective tissue disease; or anyone who is elderly, sarcopenic, or likely to have a wound complication – a plastic surgeon who performs a wound closure is shouldering the responsibility should that wound break down. This is a very real way to help you sleep better at night.
Advanced techniques have come a long way. As a discipline, plastic surgery has evolved tremendously in the past fifty years. Grafts, pedicled flaps, and free flaps are some of the many techniques now in our armamentarium. We can use a patient’s own skin, muscle, bone, and cartilage to fill a hole or cover an important structure. There are also dozens of new biomaterials made from donor humans and animals that can help with difficult reconstructive surgery problems. For patients with chronic wounds – venous stasis or decubitus ulcers, for example – there are many new types of dressings and treatments available. The state-of-the-art standard is always changing, and we can offer patients excellent techniques and options that previously eluded us.
In our daily lives as attendings, many of us are so busy juggling families and careers that we forget how much fulfillment we got out of working alongside our peers during medical school and residency. Plastic surgery is my own specialty, of course, and I am passionate about its applications and potential. However, consulting a plastic surgeon for assistance with a difficult case is just one way to reach out to a fellow doctor in your community or at your hospital. Most importantly, no matter the specialty, collaborating to solve a challenging patient care problem can offer deep value to the case, and as such can be extremely personally and professionally satisfying.