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Home | Reconstructive Surgery

Reconstructive Surgery

While this Web site primarily focuses on your cosmetic surgery options, Lake Forest Plastic Surgery strives to remain a general plastic surgery practice, offering a wide array of sophisticated reconstructive surgery options for Chicago area patients. This most commonly involves the excision of benign or malignant skin lesions, especially in the facial area, but also involves breast reconstruction, repair of difficult hernias, hand surgery, scar revisions, facial trauma and complex wound management.

Excision of Skin Lesions

Many patients feel more comfortable asking a plastic surgeon to remove skin (or subcutaneous) lesions, understanding that properly designing removal of a skin lesion and utilizing finer closure techniques can make the difference between a well-hidden, nearly imperceptible scar, and an unattractive or obvious scar. As a plastic surgeon in Chicago, Dr. Steinwald has extensive experience in excision of skin lesions anywhere on the body, but especially in the facial area. These skin lesions may be:

• Benign lesions – including pigmented nevi (moles), cysts, lipomas (subcutaneous fatty tumors) or pre-malignant lesions such as actinic or seborrheic keratoses; or
• Malignant lesions - including (most commonly) basal cell carcinoma (BCC), followed by squamous cell carcinoma (SCC), and malignant melanoma (which may require more aggressive, wider-margin excisions, and/or regional lymph node surgery by a surgical oncologist).

Basically, any non-healing area of bleeding, excoriation (flaking) or ulceration (after 4+ weeks), or any rapidly developing or darkening nevus/mole should be considered for excisional biopsy (complete/definitive removal). For (non-pigmented) lesions that are suspected to be malignant, frozen section pathology can be arranged to obtain an answer as to the adequacy of margins during the case, which is usually performed under local anesthesia in the Lake Forest Hospital Minor Surgery Suite.

Plastic surgery closure techniques are used to obtain the best scar possible, which may include local tissue rotation techniques or skin grafts in the case of larger lesions, or those in cosmetically sensitive areas (such as the eye or nose areas).

Breast Reconstruction

Dr. Steinwald performs breast reconstruction in Chicago using several sophisticated techniques for his patients, either at the time of mastectomy, or performed in delayed fashion. He is one of the area's specialists in "autogenous"(or own) tissue techniques (i.e. TRAM flap or latissimus dorsi over implant reconstruction), but is also highly experienced with staged expander-implant reconstruction. Whatever your situation and needs, Dr. Steinwald and the staff at Lake Forest Plastic Surgery are dedicated to helping make you feel whole again during this trying period of your life.

Abdominal Wall Reconstruction

Patients with large or recurrent abdominal hernias (usually following prior surgery) may benefit from plastic surgery assistance to the general surgery team, to advance local tissues, place specialized mesh in the wound, or rotate distant fascial tissues to achieve stable wound closure and integrity of the abdominal wall.

Hand Surgery

• "Carpal Tunnel Syndrome" is a nerve compression syndrome that often occurs as the result of repetitive or "cumulative" trauma in the area of the base of the palm. The median nerve, which provides sensation to the thumb, index, middle and half of the ring finger (as well as motor innervation to several muscles of the palm, principally the thumb), is compressed by inflammation of the tunnel through which it passes at the base of the palm. Symptoms include paresthesias ("pins and needles") of the fingers described, occasionally awakening the patient at night, or in more advanced cases, numbness or even weakness of the hand. These symptoms are usually worsened by activities that initiated the process in the first place, or by positioning that places stress on the tunnel, such as typing or driving. Carpal tunnel syndrome is treated by release of the "roof" of the tunnel via a short lengthwise incision overlying the tunnel at the base of the palm. This outpatient surgery is usually performed under light sedation, and generally requires a wrist immobilization splint for 4-5 days. Other nerve compression syndromes at the elbow, forearm or base of the palm regions are treated in a similar manner.
• "Trigger finger" (or stenosing tenosynovitis), is more of a restriction of motion than a compression effect, this time involving the tendons at the base of the affected finger. In this situation, the small pulley through which the tendons pass becomes inflamed, and the fingers occasionally "stick" in a flexed position, leading to "locking" of the finger, which occasionally requires the patient to manually pull the finger back to the extended position. This can be treated by a steroid injection into the affected area, but if this fails after several attempts, open decompression under local anesthesia is recommended.
• "Dupuytren's Contracture" is a progressive scarring process of the subcutaneous tissues of the palm, and occasionally the overlying skin, usually involving the ring or little fingers. These often are pulled down into a flexed position, and cannot be actively or passively re-extended. This condition cannot be "cured," but rather alleviated by making zig-zag incisions through the involved area, excising the deeper scar tissue extending from the palmar area, and releasing the digital sensory nerves, which are often pulled into the scar tissue. A splint to hold the fingers in extension, and occasionally physical therapy, is required in the immediate post-operative period to achieve the best results with respect to full extension of the fingers treated.

Scar Revision

Lake Forest Plastic Surgery offers several methods of scar revision, most commonly involving excision and reclosure in the most favorable orientation possible. Often hypertrophic (dark/raised/thickened) traumatic or surgical scars are given at least six months to a year to mature before they are considered for scar revision. Keloid scars are raised, "cauliflower-like" scars that outgrow the original boundaries of the wound or incision, and more commonly occur in darker-skinned individuals. These often require surgical debulking, and adjuvant steroid injection therapy and/or post-operative pressure regimens to achieve significant improvement in their appearance.

Prospective patients from Chicagoland should know that very few scar revisions (even for traumatic scars) are being covered by insurance these days, but we strive to keep our fees reasonable, and most of these can be performed under local anesthesia only in the Lake Forest Hospital Minor Surgery Suite.

Facial Trauma

Patients who are involved in accidents resulting in either soft tissue trauma (lacerations) or bony fractures, especially in the facial area, are often referred to plastic surgeons to achieve the best scar/result possible. While minor soft tissue lacerations, in a favorable orientation and with no tissue loss, can usually be adequately treated by ER personnel, more complex lacerations often can benefit from plastic surgical intervention.

Facial fractures commonly treated by plastic surgeons may include nasal fractures resulting in nasal distortion or airway compromise, or cheek fractures, which may result in collapse of the cheek or even malposition/dysfunction of the eye indirectly involved.

While it is beneficial to cleanse and close lacerations within 6 hours of injury, we usually wait several days before assessing a facial fracture, to allow swelling to resolve, but ideally plan intervention within 10-14 days of the injury, before bony fractures set in a displaced position.

Wound Management

Complex or non-healing chronic wounds often require multi-disciplinary care, sometimes requiring the involvement of a plastic surgeon for definitive wound closure or reconstruction. Non-healing wounds may result from chronic edema, poor vascularity (arterial inflow or venous congestion), or diabetes, all of which are best managed by the appropriate specialists before plastic surgery can be considered. Generally for a wound to be appropriate for skin grafting or local rotation flap closure, it needs to be free of (dead tissue) debris or infection, swelling should be minimal, and nutrition should be optimized. Dr. Steinwald is glad to be a member of this multidisciplinary team to achieve stable coverage of complex wounds, provided the patient is compliant with the advice and treatment provided by other experts necessary to successful wound management.

Your Next Step

Dr. Steinwald is highly trained and experienced in performing reconstructive plastic surgery. To meet with him and discuss your concern, request a consultation online and save $50 off the regular consultation fee. Or, call the Lake Forest Plastic Surgery office at (847) 234-9464 to schedule your visit.