Pediatric Plastic Surgery at Emory Plastic and Reconstructive Surgery Center
Emory plastic and reconstructive surgeons provide diagnostic evaluation and reconstructive and cosmetic treatment services for children of all ages in the following specialties:
Cleft Lip/Palate Surgery
Because the lip and palate develop at different times, it is possible for a child to be born with only a cleft lip, only a cleft palate, or with both a cleft of the lip and the palate. Since cleft lip and/or cleft palate are extremely complex conditions, Emory plastic surgeons collaborate in prescribing treatment with specialists from otolaryngology, nursing, oral surgery, pediatric dentistry, orthodontics, prosthodontics, audiology, speech therapy, social services and child psychology. In addition to these disciplines, ophthalmology and neurosurgery participate on the craniofacial team. Following the initial consultation and examination of the patient, the most appropriate surgical approach will be determined. In the years from infancy to young adulthood, patients may undergo four to five operations, including primary lip repair, primary palate repair, pharyngoplasty, alveolar bone grafting, orthognathic jaw surgery and rhinoplasty.
Craniofacial and Congenital Abnormality Reconstruction
Craniofacial reconstruction repairs abnormalities in the shape of the child's skull and facial features resulting from birth defects, genetic disorders or physical trauma. When determining the particular surgical approach, the surgeon plans for the future growth of the child's facial bones and skull. In addition to the various surgical procedures that can be applied, such non-surgical methods are available as cranial orthodic bands that correct severe positional head deformities associated with premature birth, restrictive intrauterine positioning, cervical abnormalities, birth trauma, torticollis (shortening of the sternocleidomastoid muscle) and sleeping positions.
Ear Reconstruction
Typically beginning when the patient is approximately five years old, reconstruction of the ear requires several staged operations. In the first stage, cartilage is removed from the lower ribs of the opposite side of the body, carved to resemble an external ear and then placed under the skin of the affected side. All attempts are made to incorporate whatever portions of the ear are present. In the second procedure, the earlobe is rotated into position. In the third, the ear is raised away from the head and a skin graft applied to the back surface. The skin graft is usually taken from the top of the thigh or buttock. Additional surgeries may be unnecessary, though a fourth procedure can be done to give the ear a more natural appearance.
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Genital Reconstruction
There are a variety of surgical techniques available to reconstruct genital defects, many of which involve using tissue from the arm, abdomen or thighs. The plastic surgeon will often collaborate with an urologist or gynecologist for the procedure.
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Hand Surgery
Emory plastic and reconstructive surgeons treat trauma, congenital deformities and vascular injuries to the hand, wrists, forearms, and sometimes the shoulders and elbows using traditional and innovative microsurgical techniques which can reattach amputated fingers or limbs. For very young patients, specialists design a plan for surgical intervention that conforms to the timing for developmental milestones in hand-to-eye coordination and that makes use of the flexibility of the growing skeleton, thereby minimizing psychological damage. Most hand surgery procedures are done on an outpatient basis using local anesthetic and IV sedation. Recovery times differ depending on the type of hand surgery received. Post-op physical therapy is often required.
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Upper and Lower Jaw Reconstruction (Orthognathic Surgery)
When the teeth do not fit together properly (malocclusion) and there is an associated facial deformity or disfigurement such as an imbalance in facial proportions, orthognathic surgery can be applied to revise the position of the upper and/or lower jaws. The procedure corrects the malposition of the mandible and/or maxilla, improving the positioning of the teeth while restoring balance and symmetry to the face.
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Laser Surgery
Due to the unique properties of pediatric skin and the vast array of laser technologies available, laser surgery can make a significant improvement in many pediatric skin lesions. The most commonly used lasers in the treatment of vascular malformations are the pulsed-dye laser, the Nd:YAG laser, the CO2 (carbon dioxide) laser, the argon laser, the KTP laser and the Diode laser. While younger children usually require general anesthesia during laser surgery, it is typically done as an outpatient procedure.
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Nerve Surgery
During various reconstructive procedures, microsurgical suture repair of any damaged nerves associated with the region being treated is often incorporated.
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Nose Reconstruction
Surgery may be necessary to improve the appearance and function of the nose after injury or following cleft lip and/or cleft palate surgery or other craniofacial procedures. Rhinoplasty, which reshapes the nose, is one of the most commonly performed plastic surgery procedures and involves separating the skin of the nose from the bone and cartilage, which are then surgically modified to the desired shape.
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Otoplasty
Also known as ear pinning, surgeons generally perform otoplasty to correct the size and/or placement of the ears when the patient is between four and fourteen years of age. The procedure involves making an incision in the fold behind the ear, removing some skin and/or cartilage and pinning the ear with permanent sutures. In some cases, the surgeon will remove a sliver of cartilage from the ear and suture the gap shut, allowing it to fuse together closer to the head. In addition to repositioning the ears, this technique can also be used to reduce their size. The resulting scars are quite small and easily hidden by the crease where the ear meets the head. Most ear pinning procedures are performed under light sedation, although very small children may be given general anesthesia to prevent fidgeting.
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Pharyngoplasty
This procedure involves the repositioning of tissue from the palate and the back of the throat to occlude the over-escape of air through the nose occasionally caused by cleft palate surgery. Depending on the child's specific needs, speech therapy may be recommended post-procedure.
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Throat Reconstruction
Restoring defects of the throat caused by cancer surgery, trauma or congenital problems can often be accomplished with microvascular techniques that permit the transfer of tissues from different parts of the body to the head and neck region. These tissues may include skin, muscle and bone either separately or together.
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Scar Revisions
This specialty is available to patients with scars from injury or surgery. Depending on the severity, revision of the scarred tissue may aid in the restoration of both form and function. Most minor scars can be treated by injecting a steroid medication directly into the scarred tissue. Other methods include:
- Silicone Gel Sheets
These clear sheets are placed on the scar and worn 24 hours a day.
- Z-Plasty and Related Tissue-Rearrangement Techniques
The scar is oriented by cutting the skin around the scar in small triangular flaps that usually follow a Z-shape, though the technique chosen depends on the shape of the scar. The flaps are repositioned to follow natural lines and creases of the skin. Z-plasty can also help relieve the pressure of contracture scars.
- Vascular Laser
This method shrinks the blood vessels that feed the scar, thus improving the coloration of red scars. This treatment is often done without anesthetic, the sensation being similar to that of a rubber band snapping on the skin.
- Tissue Expansion
In this procedure, a "balloon" is inserted under a patch of healthy skin near a scar and filled with a saline solution to stretch the skin. When the skin has been adequately stretched, which can take several weeks or months, the balloon is removed. The scar is then surgically removed and the balloon-stretched skin is pulled over the previously scarred area and closed.
- Skin Grafts
Skin is taken from a healthy part of the body and transplanted to the injured area. While not always cosmetically perfect (for example, the grafted skin may not match the surrounding skin's color or texture), skin grafts can greatly restore function to a severely scarred area.
- Collagen Injections
This technique is used to raise or fill in sunken scars. The results of collagen injections are immediate but not permanent, with scars eventually having to be re-filled as the body slowly absorbs the collagen.
- Laser Skin Resurfacing
The two types of lasers used for reducing the uneven surface of scars are the CO2 laser and the Erbium YAG Laser. The CO2 laser is typically used for deeper scars, while the Erbium is used for superficial scars and deeper skin tones. Both remove the topmost layers of skin, allowing new, smooth skin to form. Color lasers can effectively treat the abnormal red pigmentation of certain scars.
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