Plastic and Reconstructive Surgery for Traumatic Injuries

Plastic and reconstructive surgery is an integral service provided by the Level I Trauma Center and Level II Pediatric Trauma Center at Robert Wood Johnson University Hospital (RWJUH) New Brunswick.

Our Emergency Department cares for patients with serious and often life-threatening injuries. Resources such as airlift transportation provide critical patients with prompt access to life-saving trauma care and physicians with a wide array of expertise. This includes a team of experienced surgeons capable of addressing a variety of injuries. Our team of physician experts helps make RWJUH a leader in trauma care.

Traumatic injuries occur every day from car accidents, work injuries, falls, acts of violence, burns and other unforeseen events. These injuries often require the intervention of an expert plastic and reconstructive surgeon to restore form and function to the site of injury. Our experienced surgeons apply their expertise to injuries all over the body.

A hallmark of an American College of Surgeons (ACS)-verified Level 1 Trauma Center is the availability of experts in microsurgical techniques who can address reconstructive needs in an emergency.

One of the many services that our microsurgeons provide is limb salvage surgery to prevent amputation after a serious limb injury. This includes reconstruction of large wounds, blood vessels and nerves, and occasionally, limb reattachment.

At RWJUH, fellowship-trained plastic surgeons are available to respond swiftly when they are needed. We work together with specialists in other fields including neurosurgery, orthopedic surgery and acute care surgery to ensure that all patient needs are addressed. Our team is here for you, ready to take care of you when you need us the most.

Facial Injuries

Facial injuries can involve the facial bones and/or the overlying soft tissues. When facial bones are broken, imaging and evaluation by an experienced surgeon is often required to determine whether surgery should be performed.

When needed, surgery typically involves repositioning the broken bones and securing them with metal plates and screws.

Traumatic facial wounds also require careful evaluation to determine if any important structures underneath the skin are injured; for example, nerves that provide facial movement and sensation, glands, muscles, and other specialized structures.

Caring for these injuries requires an in-depth understanding of facial anatomy and specialized training to restore the appearance and function to the face.

Hand Injuries

Hand injuries can involve the bones or ligaments that provide stability to the hand, tendons or muscles that provide motion, nerves that provide movement and sensation, blood vessels, or skin.

Broken bones (fractures) and dislocations often require repositioning the bones back into place (reduction) and application of a splint or cast to protect the area (immobilization).

It is important to follow the instructions provided regarding how to care for the splint or cast and what activities to avoid in order to prevent further injury.

Sometimes broken bones in the hand are treated with surgery using pins, wires, screws, or metal plates. Injuries to tendons, nerves, and sometimes blood vessels can also require surgical repair.

When a hand injury results in an open wound, plastic surgeons can also perform procedures to cover important structures that are exposed. The hand has complex anatomy and biomechanics; treatment of hand injuries requires an in-depth understanding of the anatomy and specialized training.

Limb Injuries

Limb injuries can result in large open wounds, broken bones, damaged nerves or damaged blood vessels. When complex wounds occur, plastic surgeons can perform reconstructive procedures to provide soft tissue coverage over important structures. This is done by recruiting muscle and/or skin into the defect, often using advanced microsurgical techniques. For example, when a broken bone is exposed (also known as an open fracture), plastic surgeons often work with orthopedic surgeons to provide coverage over the bone.

In severe limb injuries, special procedures can sometimes be performed to save the limb and prevent amputation. This includes blood vessel or nerve repair, reconstruction to cover the open wound and sometimes limb reattachment.

Plastic surgeons also treat various nerve injuries in the limbs to restore strength and sensation (see peripheral nerve surgery).

In patients who do require amputation, plastic surgeons perform procedures to decrease pain and improve use of prosthesis such as targeted muscle reinnervation (TMR) surgery and regenerative peripheral nerve interface (RPNI) surgery.

Complex Wounds

Trauma often results in large or complicated wounds.

Plastic surgeons have a unique understanding of wound healing and often make recommendations on how wounds should be cared for.

Wounds that are complex or too large to heal on their own may require surgical reconstruction.

Depending on the defect, this can be achieved with skin grafting, skin substitute products, or coverage with a flap. A flap is tissue that is recruited from another area of the body and can include skin, muscle or bone. The flap is either kept attached to its original blood supply, or it is transplanted to another location using advanced microsurgical techniques.

Burns

Burn injuries can have a significant impact on a patient’s health, function and appearance. Plastic surgeons are trained to care for burns throughout the healing process and afterwards.

Burns sometimes require surgical reconstruction using methods such as skin grafting.

Once burns have healed, patient’s often have scars that cause pain, tightness, stiffness, and changes to their appearance. Plastic surgeons can perform scar release procedures to restore form and function after these injuries.

Lacerations

Lacerations, or cuts, sometimes require stitches when they are deep or extensive. While many physicians are trained to perform simple laceration repairs, more complex lacerations often require repair by specialized surgeons.

Plastic surgeons are trained to handle injured soft tissue with care to minimize further damage. This ability combined with advanced understanding of anatomy allows plastic surgeons to reconstruct complex injuries.

We can also do scar revision surgery to improve the appearance of thick scars after they have healed.

Dog Bites

Dog bites commonly result in complex injuries that require meticulous reconstruction to restore appearance and function. The face is commonly affected, involving areas that are important to a person’s appearance such as the nose or lips.

Plastic surgeons can realign these critical structures accurately to restore anatomy. When skin has been lost, plastic surgeons can use reconstructive procedures to replace the missing tissue.

Patient Stories

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