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Plastic Surgery: What our surgeons do to enhance the quality of life for our patients

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Photo courtesy of Allen Kramer (Texas Children's Hospital)

As a board-certified pediatric plastic surgeon at Texas Children’s, it is a privilege to serve my patients and their families in the same hospital where I received my fellowship training in pediatric craniofacial surgery. While there are many subspecialties in plastic surgery, my focus is the treatment and surgical correction of cleft lip and palate anomalies, and craniofacial abnormalities in children and adolescents.

At a very young age, I always knew I wanted to become a surgeon, but it wasn’t until my undergraduate years as a biomedical engineering college major that my interest in plastic surgery emerged. While at the University of Cincinnati College of Engineering, I was in a co-op program that was already preparing me to go on to medical school as long as I met certain metrics. During my one-year co-op experience, I was paired up with the tissue engineering research lab at Cincinnati Children’s Hospital that was run by the division of plastic surgery. It was there, in the operating room, that I was first introduced to pediatric plastic surgery, specifically pediatric craniofacial surgery. I was in awe of some of the operations their surgeons performed. It was an “aha” moment for me. I knew plastic surgery is what I wanted to pursue.

Pediatric plastic surgery is a very fascinating field of medicine. It’s a discipline of application of principles rather than procedures. Plastic surgery instantly appealed to me because it spoke to my engineering roots, where you learn principles to solve problems rather than repeating the steps of procedures over and over again. In plastic surgery, each problem we face is unique. It’s not a one-size-fits-all-operation. We are one of the very few subspecialties that operate from head to toe. At Texas Children’s, we have grown to become one of the largest plastic surgery programs in the nation dedicated specifically to the treatment of the pediatric population. To give you a brief overview of what our surgical team does, I’ve provided answers to some of the most commonly-asked questions about pediatric plastic surgery.

What is pediatric plastic surgery?

Plastic surgery is derived from the Greek word, plastikos, which means to mold or shape – and that’s really what our plastic surgeons do. We focus on the reconstructive and aesthetic improvements of a child’s appearance, with the goal of restoring functionality and improving the quality of life for children and adolescents with anomalies, whether they be congenital or acquired from an illness or traumatic event. In most cases, a combination of reconstructive and aesthetic surgeries are used to treat our patients.

What conditions do plastic surgeons treat at Texas Children’s?

There are many pediatric problems that pediatric plastic surgeons treat. For me, that involves craniofacial care and specifically cleft care, as well as children with craniofacial disorders. Additionally, our plastic surgeons treat many general pediatric conditions that require plastic surgery including cysts, nevi or moles. We treat burns and perform wound care, which includes anything from simple dressing changes to complex reconstruction where we move tissue from one part of the body to the other, or replace large areas of tissue that is missing. Our surgeons also perform hand and peripheral nerve reconstruction.

Since we want our patients to look and feel their best, our plastic surgery team treats both common and complex surgical needs. We have many, diverse areas within our surgical subspecialty including:

  • Craniofacial and cleft surgery: for patients born with orofacial differences, craniosynostosis (premature fusion of skull sutures leading to a misshaped head) and facial fractures;
  • Pediatric hand surgery: for treatment of congenital hand/wrist and upper-extremity anomalies as well as those as a result of infection, trauma and tumors;
  • Microvascular surgery: surgical repair of blood vessels and nerves under the microscope to restore and treat soft tissue problems or bony defects, including finger/hand amputation with replantation, brachial plexus repair or free tissue transfer for wound coverage and facial paralysis;
  • General pediatric plastic surgery: for treatment of moles, cysts, tumors, burns, traumatic injuries, complex wounds and vascular anomalies;
  • Aesthetic plastic surgery: to address functional imperfections using a variety of procedures such as body contouring after weight loss, rhinoplasty to improve nasal airflow, otoplasty to correct prominent ears, breast reduction causing chronic neck and back pain, and treatment of gynecomastia (excessive glandular tissue development in the male chest).

How would you describe the multidisciplinary approach to caring for these patients?

Our Plastic Surgery team comprises surgeons who are fellowship trained and use a multidisciplinary approach to treat the unique challenges presented by certain conditions that require plastic surgery. Depending on the type of condition being treated, our plastic surgeons work closely with many other subspecialties including Ear, Nose and Throat, Dermatology, Neurology, Neurosurgery, Orthopedics, Physical and Occupational Therapy, Physical Medicine and Rehabilitation, Radiology, Speech Language and Learning and Genetics, and Social Work, among others. Together, these teams help us determine the correct intervention and the precise time to perform the intervention to ensure the best patient outcomes. By leveraging each other’s knowledge and expertise, we can provide 360-degree care for these patients.

Additionally, the department of Plastic Surgery has specialized clinics to treat children with different medical conditions that may require plastic surgery. Click here for a list of our clinics that are staffed by advanced practice providers (nurse practitioners, physician assistants), nurses and other support staff.

Why is it important for a child to see a pediatric plastic surgeon?

Our surgeons have specialty training that you just don’t get anywhere else. There are other specialties where there is considerable overlap, but we have a very specific training process and board certification process to ensure we not only meet the high standards the American Board of Plastic Surgery holds, but through our training and certification, we are able to provide the most up-to-date and safest patient care possible.

It’s also important for children to see a pediatric plastic surgeon because children are anatomically and functionally different from adults. Therefore, it’s important for them to be seen by specialized pediatric plastic surgeons because we are specially trained to treat kids with a congenital or acquired anomaly.

What research is the plastic surgery team involved in? Pediatric plastic surgery is constantly evolving thanks to advances in research and state-of-the-art technology to treat a myriad of medical conditions that require plastic surgery. Many of our pediatric plastic surgeons, like myself, are involved in clinical outcomes research. Being in an academic institution like Texas Children’s and Baylor College of Medicine, we’re always asking ourselves questions like, “How could we have performed this surgery differently? Would it have made a difference?”

Right now, I’m actively researching patients with Pierre Robin sequence. These children are born with a small mandible and oftentimes require surgery to distract or expand the mandible so they can breathe appropriately, thus avoiding the need for a tracheostomy. Many of these children also have an associated cleft palate and thought to be at risk of developing obstructive airway disease after palate repair.  Currently, we’re conducting a sleep study to evaluate how these patients are breathing at night, both before and after surgery, to make sure they’re not going to develop long-term consequences from having obstructive sleep apnea and further assess their risk.

We also have a lot of active research projects underway as far as surgical techniques go in the treatment of our craniosynostoses population. These are patients who are born with premature fusion of some of the joints of the skull that can cause growth restriction on the developing brain leading to abnormal head shape. Our plastic surgeons have the opportunity to treat these patients if we catch them early on through minimally invasive methods. But the exact kind of technique – such as which bones to cut and how many cuts are required – is somewhat controversial. So, we’re actively conducting a randomized trial to determine if one technique is superior to the other. Additionally, we’re part of a multi-institutional study right now looking at techniques of palate repair and whether or not one is superior to the other as well.

Click here to learn more about our Plastic Surgery team and services offered at Texas Children’s.