Asst. Prof. Dr. Motaz Alawna explained the topic as follows:
Plastic surgery is a different from of cosmetic surgery, which is carried out to reshape structures of the body and to improve appearance by remodeling of body features. Plastic treatment includes surgical and nonsurgical procedures which aims to transfer tissue from one area to another. Physical therapy has a great role during the different stages of plastic surgeries, thus close co-operation is needed between physiotherapist and the surgery team to achieving maximum results. However physiotherapist is a basic team member that should be involved in all round of plastic treatment and contribute to the discussion on patient’s situation and the whole treatment plan.
Skin grafting is one of the common types of plastic surgeries in different conditions including (burns, trauma, and amputations, and so on). The physiotherapy role in these cases is highly demanded and variable. Ideally, the physiotherapists are asked to co-operate under the following headings:
-
Preoperative physiotherapy applications
Generally physiotherapists should briefly explain to the patient the surgery procedures, surgery outcomes and the treatment process and stages which will be applied after the surgery. The physiotherapist also should prepare the limb or the areas about to be immobilized, about to be exercised, or about to be grafted. The preparation of these areas includs the application of heat modalities and massage to improve movement, increase blood circulation, and to soften and loosen scars prior to excision. In hand burn cases, the immediate favored treatment procedure is to use the Bunyan bag and irrigation with Mililton (l-5%). Bunyan bag can help in decreasing pain, provision of a transparent occlusive dressing, ease of nursing, clearing the present infections, and prevents infection occurrence. Another advantage of Bunyan bag, is the possibility to perform exercises and apply different splints while the patient is wearing the bag.
-
Intermediate physiotherapy applications
The main role of physiotherapist in this stage is to improve the abdominal tuibed pedicles circulation before the transference. This can be achieved by applying heat modalities and massage on to the mainly concerned cramped areas during the transference of a tubed pedicle to the distant areas.
-
Postoperative physiotherapy applications
The goal of physiotherapy during this stage can be classified to indirect and direct goals. The indirect goals include: circulation and movement restoration of the different body areas (shoulders, forearms, hips, knees, etc…..) after removing fixation, and management of nerve and muscle lesions. The direct goals include: management of the free and pedicled grafts to reduce the degree of contractures especially in the free grafts, as contractures can occur with a higher degrees in the free grafts. Physiotherapist should also take care of the sutures line, by improving blood circulation and the appearance of suture lines. Also the light rotatory grease massage is an important application especially for the free graft which should be applied by the physiotherapist and can be taught to the patient to apply it himself after discharge.
-
Remedial physiotherapy applications.
In this stage physiotherapist should work to increase range and power of movement, by applying purposive splinting with exercises against elastic resistance. Active exercises also can be used during this stage to restore movement, e.g. jaw exercises after bilateral condylectomy, function restoration of the different body areas after fixation removal following burns and skin grafting. A combination can be made when required between these exercises and massage, heat, saline soaks, wax baths and galvanism.
Exercises can be classified into two grades: light and heavy exercises. Light exercises include: chair-seat making, string bag making, light carpentry, and basketry. While heavy exercises include: foot-operated loom, walking and games, bicycling, treadle-saw, rowing, and exercises against weights.
Special concerns
-
Contractures that occur due to scars and grafts. The physiotherapist should mainly focused on decreasing and preventing these contractures.
-
During limbs fixation and in recently burned hands, functional maintenance is a crucial issue.
-
Functional restoration by decreasing the stiffness in the different body part pre and post operation.
-
Use various and interesting exercises to keep the patient interested in this long treatment procedures. The patients preferred exercises should be taken in consideration if it’s suitable to the patient situation.
Summary
Physiotherapists have main role in the various type of plastic surgery. There is high demand of highly qualified physiotherapist to work in the field of plastic surgery. The main goals of physiotherapy are to, prepare patients to the surgery, decrease pain, prevent and decrease contractures, and restore and maintain functions. However there is lack of evidence about the role of physiotherapy in plastic surgery thus developing an evidence based clinical guidelines and clinical researches are highly demanded.
