Surgical Method Substitutes Body Parts

Mary Reynolds

by Mary Reynolds | September 22, 2010 @ 12:00PM

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Finding replacements for some human body parts may be as close as a patient's own bones and tissues.A nose can be built from a forehead or an ear from a rib. And if a patient loses a breast, the stomach or back -- muscle, that is -- can become a fine substitute. Reconstructive surgery, or "micro-surgery" as it is referred to in healing circles, uses muscle tissue and even bone to rebuild the human anatomy.

According to Dr. Tracy Hankins, a microsurgeon at Mohave County Reconstruction, the technique has become very common. Hankins is the only surgeon in Lake Havasu City to use this reconstructive method for organs like noses and breasts -- body parts that were either damaged due to disease or accident. Hankins has literally rebuilt noses that were removed due to cancer. He said the procedure is referred to as a "forehead flap" in which skin is cut from the forehead, flipped down to the sinus cavity and shaped into a nose. It is also called a pedicle flap and was first tried in the 1600s in eastern India -- it is only new to Western culture, he said. The miracle of the procedure is that the blood vessels are left intact -- by the pedicle -- keeping the skin alive and vibrant.

Depending on the severity of the defect, said Hankins, the reconstruction is done in stages. On one patient, cancer had started in the basal cells on the nose, which spread and killed all the tissue, he said. The forehead skin was cut and shaped onto a nose and oxygenated by the portion of skin that remained attached while it healed, Hankins said. The pedicle is only severed after it completes amastomosis -- the development of its own blood vessels that grow from the cheeks. However, the brain still thinks the skin is on the forehead, said Hankins. That means, if your forehead itches, you have to scratch your nose -- and vice versa.

Borrowing from Peter to pay Paul also works in breast reconstruction, said Hankins, who has performed surgery that builds new breasts from stomach and back muscle.

Called a TRAM flap (transverse rectus abdominus musculotaneous) or Latissimus flap (back muscle), Hankins can take living fat and tissue from the torso, maneuver it under the skin to the bosom and make a new breast. Hankins said patients have to meet certain criteria for eligibility on these breast procedures. It can't be done on diabetics, smokers or women who are morbidly obese or too thin because a certain amount of fat is necessary, he said. And age has absolutely nothing to do with it, he added. Hankins did a TRAM flap on a 73-year-old woman who recovered beautifully, he said.

The actual procedure takes approximately five hours and the patient will stay in the hospital four to five days. The advantages of the procedure are obvious -- patients have their own tissue and muscle -- and failure happens only 3 percent of the time. "The greatest risk is up front," said Hankins, "Because of the large wound in the abdomen. But we will know in 24 to 48 hours if there's a problem."

When a woman has a mastectomy, she usually knows ahead of time whether she will choose reconstructive surgery or a prosthesis. "I do a lot of breast reconstruction with skin-sparing mastectomies," explained Hankins. "When the surgeon removes the cancer, an expander is placed is in the skin that will be filled with a saline solution to hold open the space." Then Hankins steps in and takes stomach or back muscles to reconstruct the breast.

"Both types of flap give a more natural look," said Hankins. "A nipple is formed and tattooed to complete the symmetry."

In all, Hankins said that essentially any part of the body can be reconstructed using muscle and tissue from other areas. An ear can be rebuilt from the rib cartilage, a penis can be reconstructed from thigh muscle and toes can be used for fingers and thumbs. It's kind of like being listed as your own recipient on a donor card.

The youngest patient Hankins ever worked on was a 6-year-old who had a leg muscle replaced.

The oldest, was the 73-year-old woman who received a TRAM flap.

"I don't think any woman is too old for breast reconstruction," said Hankins. "It's the woman's decision." 

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