Reconstruction – PCLS Coffs Harbour http://pclscoffsharbour.com.au Tue, 04 Oct 2022 02:53:11 +0000 en-AU hourly 1 https://wordpress.org/?v=6.0.3 http://pclscoffsharbour.com.au/wp-content/uploads/2020/02/cropped-icon-40x40.png Reconstruction – PCLS Coffs Harbour http://pclscoffsharbour.com.au 32 32 Birthmark Management http://pclscoffsharbour.com.au/birthmark-management/ Thu, 26 Mar 2020 13:56:19 +0000 http://pclscoffsharbour.com.au/?post_type=procedure&p=1296 Birthmarks arising from blood vessels (vascular malformations and haemangiomas) are the most common birth defects seen in children. When the problem is present at birth, […]

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Birthmarks arising from blood vessels (vascular malformations and haemangiomas) are the most common birth defects seen in children. When the problem is present at birth, it is known as a vascular malformation and it grows very slowly, in keeping with the increase in size of the body.

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How can it help?

While best treated early to avoid the complications that could arise with increase in size, there is no urgency in this situation. It is a very different story with an haemangioma, which is first noted as a little red dot, about 3 weeks after birth and increases significantly in size and colour over the next 2 months. If you are concerned about a birthmark on yourself or your child please arrange an initial consultation with Dr Arianayagam who will make an assessment and provide you with recommendations.

procedure

Procedure

The traditional approach is one of “waiting and watching” and in a large percentage of cases, the growth stops by 6 months and by 2 years most of the haemangioma has disappeared. However, the problem is the unpredictability of the growth in the first 6 months, with some haemangiomas increasing in size by 1000 times making it too difficult to treat and causing severe problems to the patient and parents. The better approach would be for close monitoring of the problem, and if size increase is noted, for early intervention and removal of the problem with surgery or with laser or IPL treatment. This short-circuiting of a potential major problem is highly recommended to avoid getting into difficult and untreatable situations.

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To schedule a private consultation with Dr Arianayagam please call the office or request an appointment online

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Breast Reconstruction http://pclscoffsharbour.com.au/breast-reconstruction/ Thu, 26 Mar 2020 12:57:04 +0000 http://pclscoffsharbour.com.au/?post_type=procedure&p=1212 Breast reconstruction surgery restores the appearance of a woman’s breasts after a mastectomy undertaken to treat or prevent cancer. How can it help? A mastectomy […]

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Breast reconstruction surgery restores the appearance of a woman’s breasts after a mastectomy undertaken to treat or prevent cancer.

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How can it help?

A mastectomy drastically alters body appearance and can negatively impact self-image. Women who choose to undergo breast reconstruction generally do so to return their bodies to their former shape and regain confidence in their appearance.

consultation

When is the right time?

When you have a mastectomy you must make many important decisions during a physically and emotionally challenging time. The first decision is whether to have breast reconstruction at all. If you want to proceed then you must decide whether to have reconstruction at the time of the mastectomy or sometime afterwards.

Immediate reconstruction, done in conjunction with the mastectomy, has the advantage of avoiding a second surgery. No scar tissue has formed from the mastectomy and the remaining breast skin is still stretched to the original size and shape of your breast, so the results of reconstruction are likely to be better.

Delayed reconstruction may be recommended in cases involving intermediate or advanced breast cancer. Sometimes patients opt to wait simply because they need more time to think through their options.

procedure

Procedure

Once you have decided to have a breast reconstruction, you need to decide between having your breast replaced with an implant or an autologous tissue flap (your own body tissue). An implant is the most popular option because of the aesthetic appearance and minimal surgery time. Read our article on breast augmentation to find out more about implants.

Autologous tissue flap is a transplant of live skin, fat and muscle from another part of the body (usually the abdomen, buttock, thigh or hip). The advantage of this procedure is that the reconstructed breast remains live tissue, so the body will not reject it.

Grafting techniques are available that can create an areola and nipple. This is often done in a later operation. Once the new breast has been done, the opposite breast may need to be lifted, reduced or augmented to achieve symmetry.

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To schedule a private consultation with Dr Arianayagam please call the office or request an appointment online

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Scar and Wound Management http://pclscoffsharbour.com.au/scar-and-wound-management/ Thu, 26 Mar 2020 13:56:57 +0000 http://pclscoffsharbour.com.au/?post_type=procedure&p=1297 All surgery produces scars. Good scar management involves planning the type of incision (cut) to be made, achieving tension free wounds, delicate tissue handling, appropriate […]

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All surgery produces scars. Good scar management involves planning the type of incision (cut) to be made, achieving tension free wounds, delicate tissue handling, appropriate suture techniques and adequate post-operative care, including rest of the affected area.

Scar Management After Surgery

Early removal of skin sutures (3-5 days on the face and 7 days for most other areas) is essential and can be done safely, as most of these wounds have a buried layer of sutures in the dermis (deeper part of the skin) which dissolves in about 6-8 weeks.

Three to four weeks after suture removal the patient is started on scar management techniques.  Low pressure constant compression for at least 3 months appears to give the best results.  This can be intermittent scar massaging, a paper tape, silastic gel or sheeting or a compression garment.  The improvement is probably caused by compression as well as preservation of moisture in the scar.

Wound Healing

Wound healing after surgery is measured as “tensile strength” (the force needed to tear apart the wound) and 50% of this recovery of strength occurs in the first 3 weeks.  A further 20% occurs in the next 3 weeks and a final 30% in the last 6 weeks.  For patients recovering from surgery, especially major surgery, a “rule of thumb” on post-operative care and restrictions would be:

  • First 3 weeks: Get everyone else to look after you.
  • Second 3 weeks:  Look after only yourself.
  • Last 6 weeks: Normal activity, but no sports or exercise.  Gentle walking allowed.

Compression garments should be used for the first 3 months (where appropriate), starting by the end of the first week.

Other methods of scar management, including intermittent massaging and constant compression with paper tape, silastic gel or sheeting are started at 3-4 weeks.

Management of Abnormal Healing

This is a significant risk of abnormal healing, either hypertrophic or keloidal, after injury and surgery.  This could be due to poor scar management or other intrinsic factors, such as the position of the scar or the ethnicity of the patient.

If the problem is mild and localized, limited use of intralesional steroid (Kenacort) injections can be sufficient.

Alternatively, some form of compression therapy could be tried to see if any improvement is possible.  In a percentage of patients, the only improvement possible is by excision (removal) of the scar and starting all over again.

While this seems a reasonable approach, the danger is the possibility of a recurrence and to avoid this post-operative compression therapy is a must and all preparations need to be in place after surgery.

A common problem is post earlobe piercing keloids.  Before surgery a suitable pair of earrings has to be made to measure, to permit usage 2 to 3 weeks post surgery.

If a compression garment has to be used, it is available before surgery.

In difficult situations, such as over a joint, where a compression garment and immobilisation would be required, a pre-operative trial is given for about 2 weeks to give the patient a chance to see if the required garment and immobilisation is acceptable.

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To schedule a private consultation with Dr Arianayagam please call the office or request an appointment online

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Scar Revision http://pclscoffsharbour.com.au/scar-revision/ Thu, 26 Mar 2020 13:57:44 +0000 http://pclscoffsharbour.com.au/?post_type=procedure&p=1298 Scars are the inevitable consequence of deep skin injuries or surgery. Sometimes scars can cause functional problems or be aesthetically displeasing once healed. The good […]

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Scars are the inevitable consequence of deep skin injuries or surgery. Sometimes scars can cause functional problems or be aesthetically displeasing once healed. The good news is that with specialist skills it is possible to disguise or improve scars using both surgical and non-surgical treatments.

Dr. Arianayagam will provide a detailed assessment of the problem and recommend appropriate treatment.

The specific treatment will depend on the initial assessment. Sometimes, a scar is best removed while in other situations, scar revision will be more appropriate. Occasionally a scar is removed and revised at the same time.

There are no templates to use in these complicated situations and any intervention has to be weighed against possible complications caused by the attempted “correction”.

This difficult area of treatment is best left to the expert!

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To schedule a private consultation with Dr Arianayagam please call the office or request an appointment online

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Skin Cancer Laser Removal http://pclscoffsharbour.com.au/skin-cancer-laser-removal/ Thu, 26 Mar 2020 13:51:45 +0000 http://pclscoffsharbour.com.au/?post_type=procedure&p=1279 Certain types of cancers can be treated very successfully with a CO2 laser. As well as removing the cancer, the laser also has the added […]

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Certain types of cancers can be treated very successfully with a CO2 laser. As well as removing the cancer, the laser also has the added advantage of making the skin look younger.

help

How can it help?

A Carbon Dioxide or CO2 Laser is a “fractionated” laser, which means a single wavelength of light frequency is used, providing greater precision than is possible with a surgical scalpel. Lasers are able to remove certain cancers with minimal scarring, which is obviously welcome particularly in sensitive areas like the lips, nose and face.

The CO2 Laser is also used for facial rejuvenation, to remove general sun damage, age spots and fine lines. By removing unwanted pigmentation and stimulating collagen formation, the treatment will have the welcome side effect of making your skin firmer and fresher looking.

consultation

Consultation

During the initial consultation Dr. Arianayagam will carefully and thoroughly examine your skin. We recommend a total body check to ensure that no skin cancers or pre-cancerous spots or lesions remain undetected. If you prefer, Dr. Arianayagam can examine only those spots or lesions that you are particularly concerned about.

He will also ask you a variety of questions about your current health situation, medications, allergies and any past medical treatments, before discussing the options available and his recommendations.

procedure

Procedure

CO2 Laser treatments are performed at the Scarba Street Clinic. Depending on the area covered the treatment can last anywhere from 30 minutes to 2 hours. You will be able to go home soon after your treatment.

Usually only one treatment is required.

recovery

Recovery

After treatment you should expect your skin to be red and there may also be some swelling. Some people experience stinging or itching, which subsides after 12-72 hours. After 5-7 days the treated area of skin will dry and peel.

While your skin is healing you will be asked to apply an ointment to the treated area to keep it moist, and to avoid all sun exposure. The downtime will depend upon the depth and breadth of the treatment. Dr. Arianayagam will discuss this during your consultation and at the time of treatment.

Your skin may be temporarily lighter after treatment as a new layer of skin is exposed. It is critical to keep the skin well moisturised and use a broad spectrum sunscreen to protect the new skin.

Frequently Asked Questions

The CO2 laser cannot be used on all types of cancers. However, it does have a very high cure rate for the following cancers:

  • Superficial Basal Cell Carcinomas (BCCs)
  • Squamous Cell Carcinoma (SCC) in situ
  • Bowen’s Disease
  • Leukoplakia (sun damage to the lips)
  • Non-cancerous and pre-cancerous spots and lesions

All of these conditions tend to be limited to the upper layer of the skin, known as the epidermis, and are very responsive to laser treatment.

For more invasive BCC’s and SCC’s and for melanomas laser treatment is not appropriate.

The main side effects are skin redness, mild, temporary swelling and crusting.

royal college surgeons Edinburgh
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To schedule a private consultation with Dr Arianayagam please call the office or request an appointment online

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