Fundamental Planning: Reconstruction

Abstract

This chapter outlines the thought processes that go into reconstructive planning and choice of reconstruction.

The crucial determinants of choice of reconstructive modality are considered and include “defect factors,” “patient factors,” and “physician factors.”

The importance of complete teamwork and collaborative thinking are stressed in planning a given case. Inherent patient factors as well as details of excision with their anticipated functional and aesthetic implications are discussed, outlining the principles of a custom-made reconstruction as far as possible in every case. The potential role of prosthetic rehabilitation in highly select situations is mentioned.

The ideals of an optimal donor site are stressed, namely:

Concealment: under normal clothing/looking at oneself in the mirror

Consistency: of donor vessels and vascular perfusion of the flap

Comfort: at the donor site, with minimal long-term morbidity

Essential principles of aftercare are discussed to enhance outcomes, minimize complications and re-exploration, and ensure uneventful postoperative recovery.