Plastic surgery

The past decade has seen an incredible explosion in the techniques available to the plastic and reconstructive surgeon and the basic science to back up his or her growing surgical armamentarium. As quickly as new techniques have become available, old techniques have been refined and better understood. Common procedures have been made safer, and the indications have been better defined. No other area of the field has benefited more than pediatric plastic surgery, which in fact has evolved during this period from a specialty primarily confined to the treatment of congenital deformities, such as cleft lip and palate or craniofacial malformations, to one that involves the care of congenital and acquired defects using all the techniques previously applied in adults. During this period of increasing specialization in pediatric plastic surgery, we have come to realize that significant modifications of the techniques previously used in adult plastic surgery are necessary to compensate for the size of the patients and that considerations of differences in healing, scarring, and the effects of growth must be taken into account. With these modifications has come an increasing appreciation of how surgery and growth can be used to complement one another and to allow complex reconstructive procedures to be completed at earlier ages. The following review has been gleaned from an extensive bibliography of papers, from August 1988 through July 1989, either dealing directly with pediatric plastic surgical procedures or touching on the application of well-established procedures to pediatric patients. In addition, some of the papers examine the effects of the reconstructive procedures on the psychologic development of the pediatric patient.