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PEDIATRIC PLASTIC SURGERY

PEDIATRIC PLASTIC SURGERY

Pediatric plastic surgery is a specialized field that focuses on the surgical treatment and correction of congenital and acquired deformities, anomalies, and aesthetic concerns in children and adolescents.

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Common conditions treated in this group are:

  • Cleft lip and palate:

A cleft lip is a split or opening in the upper lip, which can range from a small notch to a complete separation that extends into the nose. A cleft palate is a split or opening in the roof of the mouth, which can affect the soft palate at the back of the mouth, the hard palate at the front, or both.

 

These conditions occur early in pregnancy when the tissues that form the lip and palate do not fully come together. It can have significant effects on a child’s ability to eat, speak, hear, and breathe properly. They can also impact facial appearance and lead to social and psychological challenges. Treatment typically involves surgical repair to close the cleft and restore function and appearance. This may require multiple surgeries over several years to achieve the best results. Early intervention with feeding techniques and speech therapy is also crucial for optimal development.

  • Vascular anomalies:

They anomalies can range from benign and self-resolving to potentially life-threatening. There are two main categories of vascular anomalies:

  • Hemangiomas:

These are the most common vascular tumors in infants. They typically appear shortly after birth as red or purplish raised lesions and can grow rapidly in the first few months of life before gradually shrinking and involuting over several years.

  • Vascular Malformations:

These are structural abnormalities of the blood vessels that are present at birth and continue to grow proportionally with the child. They can be further classified based on the type of blood vessel affected (capillary, venous, lymphatic, or arteriovenous malformations) and their depth within the tissue (superficial, deep, or mixed).

 

Management of vascular anomalies depends on the specific type and severity of the condition. Options may include observation, medical therapy, or various interventional procedures, including:

  • Propranolol:

This medication has become the first-line treatment for infantile hemangiomas due to its ability to promote regression and reduce complications.

  • Sclerotherapy:

This involves injecting a sclerosing agent into the abnormal blood vessels to cause them to collapse and shrink.

  • Embolization:

 This procedure involves blocking the blood supply to a vascular malformation using small particles or coils inserted into the blood vessels.

  • Sclerotherapy:

 This involves injecting a sclerosing agent into the abnormal blood vessels to cause them to collapse and shrink.

  • Surgical Excision:

In some cases, surgical removal of the vascular anomaly may be necessary, particularly for localized lesions or those causing significant functional impairment.

Congenital hand anomalies:

  • Polydactyly:

This condition involves extra fingers or toes. It can range from a small, rudimentary digit to a fully formed extra finger with bones, joints, and soft tissues.

  • Syndactyly:

Syndactyly is the fusion of two or more fingers or toes. It can involve only skin or extend to bones and other structures. Syndactyly can occur alone or as part of a syndrome.

  • Thumb Hypoplasia:

 This condition involves an underdeveloped or absent thumb. It can range from mild thumb size reduction to complete absence. Thumb hypoplasia can significantly impact hand function.

  • Radial Club Hand:

Radial club hand is characterized by an underdeveloped or absent radius bone in the forearm, leading to hand deformities such as a curved or shortened forearm with limited wrist and finger movement.

  • Symbrachydactyly:

This condition involves short or missing fingers, often accompanied by other abnormalities of the hand and forearm. It can affect one or both hands and varies in severity.

  • Ulnar and Radial Deficiency:

 Ulnar deficiency involves underdevelopment or absence of the ulna bone, while radial deficiency involves underdevelopment or absence of the radius bone. These conditions can result in significant hand and forearm deformities and functional limitations.

  • Constriction Band Syndrome:

This condition occurs when fibrous bands wrap around limbs or digits, leading to constriction and potential malformation or amputation of affected tissues.

Surgical correction may be recommended for certain congenital hand anomalies to improve hand function, appearance, and alignment. The specific surgical approach will depend on the nature of the anomaly and may involve procedures such as reconstruction, release of constricting bands, bone or soft tissue grafting, or finger or thumb reconstruction.

Ear anomalies:

Some common congenital ear anomalies:

  • Microtia:

Microtia is a condition where the external ear (pinna) is underdeveloped or malformed. It can range from a small, abnormally shaped ear to complete absence of the external ear. Microtia can occur unilaterally (affecting one ear) or bilaterally (affecting both ears).

  • Anotia:

Anotia is the absence of the external ear (pinna) at birth. It is a rare condition that can occur independently or as part of a syndrome.

  • Ear Canal Atresia:

Ear canal atresia involves the absence or closure of the ear canal, which can result in conductive hearing loss. It may occur in isolation or be associated with other congenital abnormalities of the outer and middle ear.

  • Stahl's Ear:

Stahl’s ear, also known as “elf ear,” is characterized by an extra fold or point in the upper portion of the ear, giving it a pointed appearance.

  • Cryptotia:

Cryptotia is a condition where the upper portion of the ear is partially or completely buried under the skin of the scalp. It may be apparent at birth or become more noticeable as the child grows.

  • Constricted Ear:

Constricted ear is a term used to describe an ear that is abnormally small, with a narrowed or cup-shaped appearance. It may result from abnormal folding or incomplete development of the ear during fetal development.

Surgical procedures may be performed to correct structural abnormalities, reshape the external ear, or restore the ear canal to improve hearing and aesthetic appearance. Techniques such as ear reconstruction using rib cartilage grafts or tissue expansion may be utilized.

Melanocytic nevi

Congenital nevi are types of moles that are present at birth or appear shortly thereafter. They are benign skin lesions that develop from melanocytes, the pigment-producing cells in the skin. Congenital nevi can vary in size, shape, color, and texture and may be classified based on their size and appearance.

 – Small Congenital Nevi: These are less than 1.5 centimeters in diameter at birth.

   

   – Medium Congenital Nevi: These range from 1.5 to 19.9 centimeters in diameter at birth.

   

   – Large or Giant Congenital Nevi: These are 20 centimeters or larger in diameter at birth.

They can have various appearances, including flat or raised, smooth or rough, and light or dark in color. They may also have hair growth or be surrounded by a rim of darker pigmentation.

While most congenital nevi are harmless and do not cause any health problems, there is a small risk of complications associated with larger or giant congenital nevi. These complications may include an increased risk of developing melanoma (a type of skin cancer), particularly in association with large or giant nevi. 

Common plastic surgery procedures used in the management of congenital nevi:

  • Excision:

Surgical excision involves removing the congenital nevus along with a margin of surrounding healthy tissue. This technique is often used for small to moderate-sized nevi that are not associated with significant functional impairment or cosmetic concerns. The excised area is then closed using sutures or skin grafts.

  • Tissue Expansion:

Tissue expansion is a technique used to stretch healthy skin adjacent to the congenital nevus to provide adequate coverage after excision. A silicone balloon expander is placed beneath the skin and gradually filled with saline over several weeks or months to create excess skin. Once enough tissue expansion has occurred, the balloon expander is removed, and the expanded skin is used to cover the defect created by excising the nevus.

  • Skin Grafting:

Skin grafting involves transplanting skin from one area of the body to another to cover a defect created by excising the congenital nevus. There are two main types of skin grafts: split-thickness and full-thickness. Split-thickness grafts involve removing a thin layer of skin from a donor site, while full-thickness grafts involve removing the entire thickness of the skin. Skin grafts are often used for larger defects or areas where tissue expansion is not feasible.

  • Flap Reconstruction:

Flap reconstruction involves transferring adjacent tissue, such as skin, muscle, or fat, to cover a defect created by excising the congenital nevus. Flaps can be local, regional, or distant, depending on the location and size of the defect. Flap reconstruction is often used for larger defects or areas where skin grafting is not suitable.

  • Tissue Rearrangement Techniques:

Tissue rearrangement techniques, such as Z-plasty, W-plasty, or rotation flaps, may be used to redistribute tissue and improve the appearance of scars resulting from excision of congenital nevi. These techniques can help minimize scar contracture, improve wound healing, and optimize cosmetic outcomes.

  • Adjunctive Procedures:

In some cases, adjunctive procedures may be performed in conjunction with surgical excision to optimize aesthetic results. These may include laser therapy, dermabrasion, tissue expansion, or tissue rearrangement techniques to improve skin texture, color, or contour.

Wounds (Bites, Burns)

Wounds, bites, and burns are common injuries that children may experience, resulting from accidents or interactions with their environment. These injuries can vary in severity, from minor cuts to lacerations to more serious wounds.

  • Wounds:

It can be cuts, scrapes, punctures, or abrasions. They may result from falls, collisions, sharp objects, or accidents during play.

Minor wounds can often be managed at home with proper cleaning, disinfection, and bandaging. More severe wounds may require medical attention, including wound irrigation, debridement, and closure with stitches or adhesive strips.

  • Bites:

Bites in children can come from animals (such as dogs, cats, or insects) or humans (such as bites from other children during play or fights). Treatment for bites depends on the type and severity. Animal bites may require cleaning, tetanus vaccination, and antibiotic therapy to prevent infection. Deep or severe bites may need medical evaluation and possible closure with sutures.

  • Burns:

Burns in children can result from contact with hot objects or surfaces, scalding liquids, flames, chemicals, or electrical sources. Treatment for burns varies depending on the severity and depth of the burn. Minor burns may be managed with cool water, topical ointments, and bandaging. More severe burns may require surgical care in form of collagen dressing or excision and grafting

BEST QUALITY

Our Goal is Quality Treatment with Satisfaction:

At Sukriti Clinic we believe that quality and customer satisfaction are crucial in any medical practice, including plastic and pediatric surgery clinics. We focus on providing personalized care tailored to each patient's needs. This involves clear communication, empathy, and involving patients in decision-making processes regarding their treatments. We emphasis on:

  • Safety Protocols
  • Quality of Care
  • Patient-Centered Care
  • Ethical Practices
  • Holistic Approach
  • Transparent Communication
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