Plastic surgery is essentially an anatomical and structural science dealing with modification

Every activity in life is a reflex activity – a sensory stimulus processed by the brain elicits a functional response. The locomotor system comprises of the sensory end organs like the pain, pressure and temperature receptors, the peripheral nerve which transmits the impulses to and fro from the brain and the final component comprising of the muscle, tendon, bone and joint complex which executes the complex movements of the face, hands and the legs. Peripheral nerves, tendons and the muscles are considered as an important component and plastic surgeons have had varied interest in this area.

Medical therapy relies on the modulation or modification of the physiologic processes to achieve relief of symptoms. Plastic surgery is essentially an anatomical and structural science dealing with modification or structural alteration that eventually will help the condition.

A plastic surgeon looks for a definitive surgical cause, generally a focal or local cause so that the exact timing and appropriate surgical procedures can be given. This is not only to not delay treatment, but to avoid the disuse atrophy of the end organs if not corrected at the right time. Motor, sensory and sudomotor problems, positive and negative symptoms or a combination of these may affect an individual. Face, hands, and the feet from the primary areas of interest of a plastic surgeon. Let’s look at some of the examples to get an idea of things dealt by a plastic surgeon.

Most may recover when the primary cause is found and treated by the neurologist, neurosurgeon and a physiotherapist. Residual and irreversible palsy with resultant permanent effects not only gives an expressionless face at rest but on animation of the face like smiling, produces a devastating and often depressing effect to the patient. Several procedures on the nerve itself, like primary nerve repair or nerve graft, using microsurgery can be performed if this is recognized at the time of injury like mastoid surgery or direct injury to the facial nerve.

Muscle transfers or tendon related procedures could be performed to get a pleasing effect at rest and a satisfactory result during animation and smiling. Obstetrical birth palsy or Erb’s palsy as it is commonly referred to, not only bring images of the brachial plexus and the complex anatomy but notion of poor results generally prevalent among the doctors and public alike. It is essentially the damage to the peripheral nerve and the resultant atrophy of the muscle-tendon -joint complex.

Bony correction in the form of osteotomy and repositioning of the bones alone can correct this condition. The best time to intervene is within the first 3-6 months of age. Careful evaluation is necessary. Damage to the nerves can be effectively treated with a combination of neurolysis, neuroma excision and primary suturing and in severe injuries with nerve grafting with the use of microscope.

Other condition which is the domain of the plastic surgeon /peripheral nerve surgeon is the hand and the feet. When medical treatment does not produce desired relief, plastic surgery is a viable option.