Plastic Surgeon

A surgeon, who can correct deformity, scars and disfigurement caused by accidents, birth defects and treat diseases like skin cancer (melanoma), is called a plastic surgeon. A plastic surgeon also performs surgeries purely based on cosmetic purposes, e.g. rhinoplasty. The first plastic surgeon of the U.S. was Dr. John Peter Mettauer who performed his first surgery of cleft palate in the year 1827. Plastic surgeons perform various levels of surgeries on human body to beautify and restructure it. The main surgeries performed by plastic surgeons:

Reconstructive surgeries: The most common surgeries in the reconstructive section are breast reconstruction, palate surgery, cleft lip, surgery for patients suffering from burns called contracture surgery. Another technique called microsurgery is performed where tissue is transferred from one place to another where tissue is damaged and needs replacement.

Cosmetic surgery: The most famous and common surgery in the area of plastic surgery is cosmetic surgery and is performed purely from beautification point of view. Cosmetic surgery also known as aesthetic surgery is done just to enhance the beauty of any part and may possibly be a reconstructive surgery. The surgery improves the beauty or looks of any part of the body and is usually referred with the name of that particular part of the body. For e.g. Abdominoplasty (tummy tuck - reconstruction of the abdomen), Blepharoplasty (eyelid surgery) - application of permanent eyeliner or reshaping the eyelids.

Cosmesis: Another common procedure called as cosmesis is a blend of reconstructive plastic surgery and cosmetic plastic surgery. In the process of reconstructive surgery, cosmetic surgery techniques are utilized thus improving cosmesis.

In addition to these branches of plastic surgery, there are also surgeries such as craniofacial surgery - mainly dealing with pediatric deformities, maxillofacial surgery - improvement of the jaw and the face.

The risk of handing over your beauty lies with the plastic surgeon. Ensure your surgeon is

• Certified by a board, e.g. American Board of Plastic surgery.
  
• The surgeon is rightly qualified, cross check his qualifications with the right body. He should have completed medical school and then specialized for five years in the field of general surgery and then plastic surgery. After this should have cleared oral and written examinations held by the board.
  
• Has the right infrastructure and facilities to handle surgeries. They should be well-equipped with the latest gadgets and facilities thereby making the procedure easy.
  
• Has enough experience in the field of plastic surgery.

Latest trends in plastic surgery

• Use of lasers and fiber optic telescopes to in the field has led to better results and satisfying customers. The outcome of the surgery is more enduring than earlier times.
  
• This method has made plastic surgery more economical and trouble-free as a result reduced side effects.
  
• An endoscopic method for facelifts and forehead corrections.
  
• Modern techniques mean smaller incisions and practically no scars left behind after the surgery.
  
• Also modern sedation techniques like the intravenous sedation save a lot of trouble and risk for the patients.
  

Proctoplasty

Proctoplasty is the plastic surgery of the anus or rectum. Reconstructive surgery and anaplasty are other broader terms for proctoplasty. Proctoplasty is performed predominantly on children born with ano-rectal anomalies. There are cases born without any opening at the anus. Congenital fistulae may be present in some infants. Surgery alone affords cure to cases of this nature. While cases born without any opening at the anus are treated as an emergency procedure, fistulae treatment can be delayed for about two to three years. For these cases, proctoplasty is an operation of choice, whenever possible.

Proctoplasty is also at times done during hemorrhoidectomy. Proctoplasty extends the removal of tissue higher into the anal canal so that redundant anal lining is also removed. Recently, transanal endoscopic assisted proctoplasty, which is considered as a safe procedure is adopted for anatomical reconstruction of the anorectum. In significant proportion of patients, it is also used for contemporaneous closure of the sigmoidostomy with imperforate anus without fistula. This is a novel surgical approach with less potential associated complications.

Bone Sarcoma

The word 'sarcoma' is derived from the Greek word for 'fleshy'. Sarcomas arise from Mesenchymal tissue which is the precursor to fibrous tissue, muscle, bone and fat. Bone sarcoma is malignant tumor or cancer of the bone. The difference between the terms sarcoma and carcinoma is that while sarcomas spread through blood, carcinomas through lymph fluid to the nearby lymph nodes.

Symptoms of bone sarcoma

• Pain in the bones.
  
• Pain may worsen in the nights.
  
• Swelling, redness and tenderness at the site of bone pain.
  
• Swelling of the leg or arm in longer bones such as above or below the knee or upper arm, shoulder etc.
  
• Bone fracture after a routine movement – like throwing a ball.
  
• As cancer weakens bones, broken bones tend to occur more easily.
  
• Fatigue, fever and weight loss and anemia are other signs.
  

Causes of bone sarcoma

The cause is unknown in most cases although bone sarcoma can develop from benign lesions in the bone and areas that previously received radiation. Therefore persons who received radiation therapy or chemotherapy can be at increased risk. A genetic syndrome called Li Fraumeni and retinoblastoma and a disease called Paget's Disease are also associated with sarcoma.

Types of bone sarcoma

1. Osteosarcoma that occurs in the bones around the knee and upper arm.
2. Chondrosarcoma that begins at the cartilage and ends of bones and lines of joints and in pelvis, upper leg and shoulder.
3. The Ewing sarcoma family of tumors that occurs in bone but may also be present in the connective tissues located in the pelvis, legs and arms.
4. Multiple Myeloma which is a cancer of plasma cells that originates in bones.

Bone sarcoma diagnosis

A doctor examines the patient physically after ascertaining family medical history. Then the physician may recommend the following diagnostic tests:

• X rays in various parts of the body to show location, size and shape of bone tumor.
  
• Bone scans
  
• CT scans which reveal cross sectional images to check if the tumor has spread.
  
• MRI scans
  
• PET scans that image the body's metabolic action to show if cancer has spread.
  
• Biopsy
  

Treating Bone Sarcoma

Surgery plays a primary role in the treatment of bone sarcoma. The goal of surgery is twofold. On the one hand it can remove the cancerous tumors and restore the physical function and appearance. On the other hand, a cuff of normal tissue is taken from around the tumor cells to minimize the risk of tumor recurring at the local resection site.

After surgery, the reconstructive or plastic surgery team performs the delicate task of replacing bone. Musculoskeletal oncologists and reconstructive plastic surgeons use donor bone, the patient's own bone from other sites and metal implants to reconstruct limbs and restore function.

Radiation therapy: This can be performed before or after surgery or even during surgery though the use of brachytherapy. Radiation therapy is used to treat tumors or when there is disease recurrence at the site of the original tumor or other localized site. This is especially used in treating chondrosarcomas more often than bone sarcomas.

Chemotherapy: Chemotherapy is given before surgery in order to shrink the tumor and allow for better resection. Surgery and radiation can only act on a small area tumor site. Chemotherapy kills any cancer cells floating undetected elsewhere in the body.

Follow-up depends upon the grade and type of bone sarcoma. In case of Osteosarcoma and Chondrosarcoma, follow-up includes physical exam, chest x-ray which should be performed every three months for at least two years initially and then after four months for a year and then every six months for two years and subsequently annually.