Deformity & reconstruction

Reconstruct and Restore Form and Function

Often a defect caused from trauma or cancer excision can leave a functional and a cosmetic deficit. As a skilled plastic and reconstructive surgeon, Dr Rajapakse employs a variety of techniques from his “reconstructive tool box” to restore form and function to defects all over the body.

Types of Reconstructions performed: 

Head and neck reconstruction surgery

This is usually performed to rebuild defects in the face and neck by using blood vessels, bones, tissue, muscle and skin removed from other parts of the body. Skin grafts or healthy tissue flaps are transferred to the affected area of head or neck for reconstruction.

Lower limb reconstruction

This type of reconstructive surgery is where defects are corrected by using flaps of tissue, skin, bone, along with underlying blood vessels or muscle to rebuild the damaged tissues.. Reconstructive surgeries on the lower limb are performed to improve the structural, functional and cosmetic outcome of injured limbs.

Surgical reconstruction techniques

Surgical reconstructive techniques include:

Skin grafts

A skin graft is a healthy patch of skin taken from another part of your body (donor site) to cover the damaged or missing area.

Flap surgery

Flap surgery is the transfer of a piece of tissue from one part to the other part of your body, along with blood vessels. The types of flaps used include:

Local flap: This is a flap from the skin lying close to the wound, along with its underlying tissue and blood supply it is moved over the wound.

Regional flap: This is a tissue flap that keeps a specific blood vessel attached to it. The flap will be moved to cover the injured site while keeping a narrow attachment common with the original site (pedicle)

Free flap or microsurgery (microvascular reconstruction): Tissue from regions away from the site of surgery are connected via the blood supply of the flap with those at the new site. This delicate work is performed under a microscope. Microvascular reconstruction includes:

  • Free muscle transfer: Muscles from your back or abdominal region or other body region is used to reconstruct the defect..
  • Free bone transfer: Your surgeon will use the fibula (calf bone) or a part of the rib for lower jawbone, midface and orbitomaxillary(eyes and upper jaw) reconstruction.
  • Free skin and fat transfer: Your surgeon will use the skin, fat or fascia (tissue surrounding muscles, nerves and blood vessels) from the forearm or thigh for reconstruction. This approach can be used for contour defects in head and neck or lower limb.

Deformity & reconstruction FAQs

What is the treatment course and recovery period?

This depends on the type of reconstruction and defect.

Head and neck surgery especially if your mouth, lower jaw bone, neck or throat has to be reconstructed, a temporary tracheotomy (opening of the airway in the windpipe) for safe breathing maybe in place in the immediate postoperative period.

Immediately after the surgery, you will have to be on strict bed rest for 24 hours. You will be hospitalized for 7 – 9 days. In the initial 24 -48 hours, your free flaps will be checked frequently for viability.

You will be advised to keep yourself well hydrated and take measures to prevent anaemia and clots in the veins. Usually you will be prescribed anticoagulants after a free tissue transfer. You will be assessed with physical therapy or rehabilitation after discharge.

Lower limb surgery:

After the reconstructive surgery, you have to stay on bed rest until the swelling at the site of reconstruction has reduced and the flap has adhered to the damaged site. You will be advised to dangle the tips of your operated hand or leg for short periods to ensure that your mobility does not modify the blood supply. Your therapist will assist you with a wheelchair or crutches. Usually you will have been prescribed blood thinners to prevent the risk of deep vein thrombosis (clot formation) and pulmonary embolism (blockage of artery in the lungs).

Risks and complications

As with any surgical procedure, free flap reconstruction involves potential risks and complications. These include:

  • Flap failure due to inadequate blood flow, twisting of the narrow attachment and blood vessels that are common to the donor site, or tension during setting the flap
  • Hematomas (pooling of blood outside a blood vessel) causing flap tissue death
  • Infection at the wounded site
Will I need anaesthesia?

Depending on the size and location of the skin lesion Dr Rajapakse performs surgery either under local anaesthesia with or without sedation or under general anaesthesia. Some procedures may be suitable for local anaesthetic and can be performed in the rooms.

If general anaesthesia or sedation is required Dr Rajapakse will engage the services of a qualified anaesthetist who is a fellow of the Royal Australian and NZ College of Anaesthetists (FRANZCA).

Your anaesthetist will ask you about all the medications that you are taking or have taken and any allergies that you may have.

Will there be scarring?

Unfortunately scars are an inevitable part of any surgery and depending on how each person heals, there can be no guarantee for a perfect outcome.

Dr Rajapakse is highly skilled to minimize scarring and to keep your scars as inconspicuous as possible by placing the incision in natural crease lines.

Scars do fade and if scarring is a concern for you after surgery, Dr Rajapakse will provide you with specially tailored treatment plan to expedite the healing of your scars.

Where is the surgery taking place?

All free flap surgeries are performed at a reputable internationally accredited facility.

What are the costs?

You have the right to be informed about the costs associated with you surgery.

When choosing a surgeon for your reconstructive surgery, remember that factors such as surgeon’s training, qualifications, experience and your comfort them are just as important.

Most hand surgery procedures are covered by private health insurance and carry an MBS code. If your policy covers these item numbers then you are in luck as your insurance will cover a large portion of your hospital and operation costs. If you don’t have private insurance, medicare will reimburse you a portion of the cost (if you are an Australian Resident.)

Costs associated with the procedure may include:

  •  Dr Rajapakse’s surgical fee
  • One year of Surgical follow up
  • Accredited hospital facility cost
  • Anaesthesia fee
  • Prescription for medications
  • Post- surgery garments
  • Medical tests

After your consultation an informed financial consent will be sent as well as an information pack to read before the second pre-surgery appointment. This second optional appointment is free of charge and your preoperative photos and measurements for any compression garment taken (if required).

Send an enquiry or call (02) 8964 8090

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