Trinity Health welcomed a new plastic and reconstructive surgeon mid-July. Dr. Jeffrey Pitcher, the new surgeon, has begun work with many different types of surgeries.
"Most people think that plastic surgery is all about aesthetics, but it spans more than that," Pitcher said. "It can be everything from craniofacial reconstruction for kids born with congenital deformities, to hand surgery, microsurgery, and burn-injury surgery."
Plastic and reconstructive surgeons do all types of procedures, from the aesthetic, to the reconstruction of traumatic injuries.
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Katina Tengesdal/MDN - - Dr. Jeffrey Pitcher, plastic and reconstructive surgeon for Trinity Health, speaks to a patient about surgery options.
For reconstructive surgeries, microsurgery has greatly enhanced the field, he said. Microsurgery allows surgeons to put together tiny blood vessels and nerves, structures that are only two to three millimeters in size.
"Microsurgery was born out of necessity out of traumatic injury, when surgeons had to move muscle and skin to replace lost tissue," Pitcher said. "Microsurgery can be done in traumatic injury cases and in cancer patients to help them regain function."
"It began in the mid-1960s, and in the mid to late-1990s, we developed flaps that are highly specialized for this type of surgery," Pitcher said. "Since then it's exploded. Today we have a number of different flaps we can do."
"Flaps" are pieces of tissue that are moved from one place on the body to another place, depending on the size of the defect and whether the injured site has enough blood vessels that can be reconstructed, he said. Reconstructive surgeons can use more than 300 different types of flaps.
"We have a number of workhorse, or standard, flaps that we use," Pitcher said. "Any muscle that is considered expendable or redundant can be used, if the patient has the receiving arteries for it."
For patients with traumatic injuries, the ability to replace the injured area with healthy tissue means that they can slowly regain function. It also means patients' injuries can heal more quickly, with decreased patient morbidity, less need for transfusions and shorter hospital stays.
"If you are filling a defect, a hole from cancer or from trauma, patients can be out of the hospital within seven to eight days, though large bony defects take longer," Pitcher said. "Many people will regain function within six to eight months."
Body contouring
On the aesthetic side of surgery, Pitcher described a procedure that has become increasingly popular in recent years body contouring. Body contouring involves reshaping skin for patients that have undergone a large weight loss.
"For patients that have had a massive weight loss, 75 to 100 pounds or more, they have excess skin that gets in the way," he said. "Skin will generally snap back after a weight loss or a pregnancy, but with a massive weight loss, the elasticity of the skin is gone. The only way to improve that is to remove excess skin and re-drape the skin."
"Body contouring has gained significant popularity as gastric bypass and gastric banding procedures become more popular," Pitcher said. "It has become significantly more common. More people are aware of appearances, and plastic surgery has become less of a taboo."
The body contouring procedure involves removing a wedge of tissue above a patient's abdomen, and separating the skin from the abdominal wall up to the ribs. The abdominal muscle is reshaped, and the skin is stretched back down and sutured together.
Before undergoing the procedure, Pitcher said, patients should consider all of their options and understand the procedure itself.
"We want to make our patients aware that the procedure is often more painful than people anticipate, and it takes longer to get on their feet than they anticipate," he said. "It can take up to a month to get back on their feet. TV presents this as a slick practice, but that's not always true. Patient education is important."
Patients who undergo the procedure must also be good candidates for it. They need to have kept a stable weight for at least three months, be non-smokers, and be able to comply with a surgery after-care plan. The after-care plan will include not participating in strenuous activity for a month, so patients should have a support system in place.
"It's very important that patients know they are going to be able to maintain their weight, too," Pitcher said. "If they don't, what will happen is the skin will stretch, the scars will widen, and the repair can degrade over time."
"In patients who haven't maintained, it can be hazardous to operate on them again because the natural tissues have been completely changed from their normal state. We want to make sure patients are remaining in a stable weight range before this procedure is done," he said.
Those considering the surgery should also have well defined and realistic goals, and should take note that most testimonials they'll see on the Internet about the procedure should be taken with a grain of salt.
"The pictures (of patients who have undergone the procedure) online are either the worst results possible, or the best results possible," Pitcher said. "Patients should find out their own available options and have realistic expectations."
Pitcher will do many types of plastic and reconstructive surgery for Minot area patients, and looks forward to it.
"With reconstructive surgery and aesthetic surgery, I enjoy both," Pitcher said. "Both are interesting, and they both have their different challenges."