chapter  Chapter 20
17 Pages

plastic Surgery

WithKangesu Loshan, Jonathan A. Britto, Neil Bulstrode, David Dunaway, Paul Morris, Branavan Sivakumar, Gill Smith, Guy Thorburn

Children presents to the dermatologist as blistering with minimal trauma. Referral to the plastic surgeon may be either in relation to the acquired hand deformities or the presence of skin malignancy. A multi-disciplinary team approach is required that includes dermatologists, plastic and orthopaedic surgeons, paediatricians, geneticists and psychologists. The lesions are commonly isolated and consist of dilated capillaries; studies have indicated a lack of vasoconstrictor innervation. With time the surrounding soft tissue and even bone can hypertrophy causing further deformity and the need referral for plastic surgery. Most patients with cleft palate achieve normally intelligible speech. Up to 25% of patients will require secondary surgery either for complications such as fistula or the development of velopharyngeal incompetence due to poor soft palate lift or length. Unicoronal synostosis causes orbital asymmetry such that squint surgery may be required after corrective craniofacial surgery is undertaken.