Microsurgery

Microsurgery is a common part of many reconstructive procedures, particularly breast reconstruction.

Microsurgical techniques allow living tissues to be transferred to reconstruct areas that have been affected by cancer, trauma or congenital abnormality.   The transferred tissue is called a “flap” and consists of tissue and the blood vessels that supply it.  An example is the “DIEP flap”  which is harvested from the lower abdomen.  This is the tissue removed normally in a tummy tuck (abdominoplasty) procedure – in the case of the DIEP flap the tissue is preserved and is regarded as the best way to rebuild a breast.

Nerve surgery also may involve microsurgery.  A common example is nerve repair following injury to the hand or fingers.

Common microsurgical procedures Dean performs include;

  • breast reconstruction
    • DIEP flap
    • TRAM flap
    • TUG flap
    • GAP flaps
    • LAP flap
    • Latissimus dorsi flap
  • limb reconstruction
    • ALT flap
    • groin flap
    • radial forearm flap
  • nerve repair
    • hand and finger injuries
    • leg injuries
    • facial injuries

Skin Cancer

Skin cancer is an extremely common problem and most Australians will have a skin cancer during their lifetime.  Fortunately, most of the time they are easily cured by excision and usually with careful planning excellent cosmetic results are seen.

The most common of type of skin cancer is a Basal Cell Carcinoma (BCC).  This tends to grow fairly slowly and doesn’t metastasise (spread) to distant areas.  Squamous Cell Carcinoma (SCC) and Melanoma are the other main types of skin cancers.  Both can spread but generally if treated early have an excellent prognosis.

The majority of skin cancers can be simply removed without the need for advanced techniques such as skin grafting or moving skin around (a technique known as a flap).  The method of reconstruction of the defect created by removal of the skin cancer depends on the size and the location of cancer, as well as other factors such as patient age and body shape and other medical conditions.

Dean has vast experience in treating all kinds of skin cancers and will be able to offer you the best methods to ensure that the cancer is properly treated and the cosmetic results are as good as can be.

Hand Surgery

Hand surgery is a large part of Dean’s practice.
He has considerable experience in common hand disorders such as:

  • carpal tunnel syndrome
  • Dupuytren’s disease
  • trigger finger
  • hand tumours
    • lipoma
    • giant cell tumour
  • hand trauma
    • amputation
    • nerve injury
    • tendon injury
    • fractures
    • nail injury

Carpal Tunnel

Carpal tunnel syndrome is a common disorder which results from compression of the median nerve at the wrist.  The usual symptoms are pain, tingling, numbness, weakness in the affected hand.

The carpal tunnel is a small space made up of bone and ligament which contains the median nerve and 9 tendons which run from the forearm into the hand.  Anything that makes the tunnel smaller will put pressure on the nerve which causes the symptoms.

Things that make make tunnel smaller include swelling from conditions such as:

  • diabetes
  • hypothyroidism
  • pregnancy
  • arthritis
  • repetitive strain injury (for example repeated bending of the wrists)

Carpal tunnel syndrome is usually diagnosed by your doctor and can be confirmed with a nerve conduction test.

Treatment options include:

  • pain killing medications (short-term option) such as paracetamol or ibuprofen
  • modification of activities
  • splints
  • hand therapy
  • corticosteroids
  • surgery

Surgery is a straightforward procedure which can be undertaken under local or general anaesthesia.  The procedure takes less than 30 mins and is a day procedure performed in hospital.   The hand has a light bandage for around 1 week and sutures are dissolvable.  Most patients will require less than 2 weeks off work and their hand is back to normal by 6 weeks.

Dupuytren’s Disease

Dupuytren’s disease is condition where one of the tissues of the hand (the palmar fascia) becomes thick and contracted.  It may result in clawing of the hand, particularly the ring and little fingers.

The cause of the condition is unknown, but it is an inherited condition that affects people of Scandinavian and Celtic descent especially.  Other risk factors include age, epilepsy, diabetes and alcoholism.

Treatment options include:

  • injection with medications
    • corticosteroids to reduce inflammation
    • enzymes to break down the bands
  • surgery
    • cutting the bands to release the contracture
    • removing affected fascia
    • removing affected skin
    • releasing affected joints
  • hand therapy
    • is an important part of treatment
    • splinting
    • massage
    • rehabilitation after surgery

Surgery is a day procedure performed in the operating theatre under local or general anaesthetic.  Depending on the severity of the disease it usually requires around an hour of surgery and 2 weeks off work.  Most patients require hand therapy and can expect their hand to be nearly back to normal by 6 weeks.

Trigger Finger

Trigger finger is a condition where the finger or thumb locks when bent.  It can be a clicking or painful sensation.  Sometimes the affected digit will need to be manually straightened once locked in the bent position.

Trigger finger occurs because the tendon is inflamed and then rather than sliding under the pulley system in the hand, it catches and causes a clicking or locking feeling.  Things that may precipitate this include:

  • diabetes
  • repeated activity (i.e. grasping tools)
  • arthritis
  • gout

Trigger finger occurs more commonly in people who are 40-60 years old and it is more common in women than men.

Treatment options include:

  • injection of corticosteroid
  • pain killing medications such as paracetamol or ibuprofen
  • hand therapy
  • surgery

If surgery is required, it is a day procedure undertaken in the operating theatre under local or general anaesthetic.  The procedure takes less than 30 minutes.  A small incision is made in the palm to divide the pulley that catching the affected tendon.  Sutures are dissolving and most patients are back at work within 2 weeks.  Generally the hand will be back to normal soon after this.