Plastic Surgery

What is plastic surgery

Plastic surgery has two main components: reconstructive plastic surgery which is all about restoring appearance and function to the human body after illness or accident and aesthetic (often called “cosmetic”) plastic surgery which is done to change the appearance from choice.

Although you hear people mostly talking about cosmetic plastic surgery, the main work of nearly all plastic surgeons is reconstructive: covering all aspects of wound healing and reconstruction after congenital, acquired and traumatic problems, with aesthetic surgery playing a smaller but important part in their working week.

History of Plastic Surgery

The specialty developed from its ancient Egyptian origins more than three thousand years ago. It progressed geographically, as knowledge disseminated, including northern India at about 600 BC, Sicily in the 15th century Renaissance, Germany in the 19th century, and finally Britain in the two world wars. Modern plastic surgery in Great Britain was formalised by Sir Harold Gillies by the creation of the British Association of Plastic Surgeons in 1946 following pioneering work by him and others such as McIndoe, Kilner, Mowlem, and Barron on casualties from the first and second world wars. The specialty slowly evolved to one treating a wide range of conditions and anatomical areas.

The Department

The Department of Plastic and Reconstructive Surgery cares for the people of Devon and Cornwall by providing a wide range of Plastic Surgery services across the two counties. As one of only two such centres in the Peninsula, the service is responsible for a catchment of 1.2 million people. Tertiary services for the Peninsula population of 1.7 million require specialist input from Plastic Surgery.

The service at Derriford Hospital provides a Plastic, Reconstructive and Hand Surgery Service for both adults and children with a large proportion of activity focused around management of skin cancer, soft tissue sarcoma, breast reconstruction and hand surgery. University Hospital Plymouth is a designated Trauma Centre and Burn Facility. The department plays an essential role in supporting a wide range of other services within UHP and from other Trusts, including Perineal Reconstruction with Colorectal Surgery and Chest wall Reconstruction with Cardiothoracic Surgery. Paediatric Urogenital reconstruction and Congenital hand Surgery services are delivered in a self-contained Paediatric Surgical Unit.

The Unit provides a tertiary service for Cornwall, the Isles of Scilly, Plymouth District and South & West Devon; a population of 1.2 million. The Unit covers the whole spectrum of Plastic and Reconstructive Surgery with the exception of craniofacial surgery and cleft surgery.

  • Sarcoma surgery and Reconstruction
  • Head and Neck Reconstruction
  • Hand Surgery
  • Breast Reconstruction
  • Paediatric Plastic Surgery
  • Thoracic Reconstruction
  • Perineal Reconstruction

There are 8 middle or registrar doctors and 5 junior doctors.

The role of the present nursing and therapy staff has been extended to contribute much more to service provision through the development of nurse led and therapy led follow up, clinical nurse specialists for skin cancer surveillance and follow-up. Senior nurse Trauma Co-ordinators and see referrals and facilitate the administration of trauma patients. Consultants support non-medical staff by contributing to their day to day support and training.

Inpatient facilities include Lyhner Ward an adult ward situated on Level 5 of the main hospital building. Its 30 beds are distributed between single rooms, two, four and six bedded bays. On level 4, there is trauma clinic area where trauma referrals are seen each weekday morning by the on-call team. Also there is a dedicated Dressings Clinic with an experienced dressings nurse.

The paediatric ward is Woodcock Ward, on Level 12 of the main hospital block, accommodates mixed speciality surgical paediatric patients.

Most surgical procedures are undertaken in the two designated Plastic Surgery Theatres in the main Hospital, Tavistock hospital and

There are 6 dedicated Plastic Surgery trauma lists throughout the week (including Saturday am). The trauma service is supported by a full-time trauma coordinator..

The unit works in close collaboration with Physiotherapy and Occupational therapists who provide the hand therapy, splinting and pressure garment service.

The Department of Plastic and Reconstructive Surgery collaborates with various specialities within the trust. There are a number of joint clinics held with members of other Specialties:

Head and Neck Combined Clinic

Held within the ENT Department occurring on a weekly basis, in conjunction with the Maxillo-Facial and ENT departments, Speech Therapy, Prosthetics and Dieticians.

Joint Sarcoma Clinic

This is a monthly clinic held in conjunction with Oncology.

Skin Cancer Clinic

This weekly clinic is held in conjunction with the Dermatology department.

Breast reconstruction clinic.

 

Staff

Consultants

Surg Cdr R F Rickard RN

Soft Tissue Sarcoma and Lower Limb Reconstruction. Microvascular surgery.

Mr L Currie

Hand surgery and microvascular surgery.

Mr D MacKenzie

Paediatric Plastic Surgery, Skin malignancy, Vascular anomalies.

Mr D Camp

Skin cancer

Col C Taylor RAMC(Rtd)

Sarcoma, lower limb trauma

Miss J Zakaraite

Skin cancer, burns

Mr J Dickson

Breast reconstruction

Mr G Price

Skin cancer, head and neck reconstruction

Miss J Hughes

Sarcoma, lower limb trauma, hand surgery

 

Advanced Nurse Practioners for Trauma

S Barclay

L Walker

S Robinson

R Cornish

 

Advanced Nurse Practioner for Burns

I Penn

 

Directorate Manager

S Kowalski

 

Admin Managers

D Frost

T Lamerton

 

Description of the work of the Specialty

Junior doctors working in the unit will gain a broad experience in disease and techniques related to plastic surgery. These include:

  • Management of skin cancer,
  • Management of Head and Neck Malignancy.
  • Breast Reconstruction
  • Management of Hand disease and injuries.
  • Management of soft tissue tumours.
  • Management of congenital conditions e.g. Hypospadias surgery (except craniofacial disease)
  • Multidisciplinary Management of the multiply injured patient
  • Lower limb reconstruction
  • Management of burn injury
  • General reconstructive principle.

The department works with the departments of Orthopaedics, Cardiothoracics, ENT, Neurosurgery and Maxillofacial Surgery, Oncolcogy, Dermatology and Rheumatology, to deliver these services. 

Management of emergency admissions with burns, soft tissue injuries to face, hands and limbs, especially if associated with tissue loss.

Reconstruction techniques from skin grafting to microsurgical tissue transplantation are practised on the unit in the course of management of elective and emergency cases.

Management of emergency and elective hand surgery service, including rheumatoid hand surgery in association with the Department of Rheumatology.

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