Reconstructive Surgery

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While this Web site primarily focuses on your options for cosmetic plastic surgery in the Chicago area, Lake Forest Plastic Surgery also offers a wide array of sophisticated reconstructive surgery options. Reconstructive surgery most commonly involves the excision of benign or malignant skin lesions (especially in the facial area), but also involves breast reconstruction, repair of difficult abdominal hernias, hand surgery, scar revisions, facial trauma and complex wound management. Indeed, plastic surgeons are often called upon by other surgeons to help manage many soft tissue problems, leading to the reconstructive surgeon's unofficial nickname, "the surgeons' surgeon."

Meet Dr. Steinwald

Paul M. Steinwald, M.D. is one of the few plastic surgeons in Chicago who is double-board certified in both plastic and general surgery. Read On

Excision of Skin Lesions

Plastic surgeons are often called upon by dermatologists (or knowledgable patients themselves) to remove new, non-healing or chronic-but-changing skin lesions, especially in cosmetically sensitive areas such as the face or neck area. 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. What they may not know is that these excisions are covered by their insurance plans a great majority of the time. As one of the Chicago plastic surgeons serving Highland Park, IL, Dr. Steinwald has extensive experience in excision of skin lesions anywhere on the body, but especially in visible areas. 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).

As a point of information, 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 (definitive removal). Less-suspicious or benign-appearing lesions such as dominant pigmented lesions can be removed in the office. For (non-pigmented) lesions that are suspected to be malignant, frozen section pathology can be arranged to obtain an immediate answer as to the adequacy of margins during the case, which is usually performed under local anesthesia in the Northwestern Lake Forest Hospital Minor Surgery Suite. In our opinion, this is a preferred alternative to Chicago area Moh's microsurgery techniques, which often leave larger defects, left open for hours or even days while pathology is being processed.

Plastic surgery closure techniques - characterized by fine, exacting orientation and suturing methods - are used to obtain the best scar possible. This may also include local tissue rotation techniques or skin grafts in the case of larger lesions, or in areas with limited local tissue (such as the eye, ear or nose areas).

Breast Reconstruction

Renowned for his skills as a breast surgeon in the Chicago area, Dr. Steinwald performs breast reconstruction using several sophisticated techniques for his patients, either at the time of mastectomy, or performed later. 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.

"Dr. Steinwald clearly explained the procedures and answered all my questions in terms that I could clearly understand. His patience and bedside manner are outstanding! Dr. Steinwald made me feel at ease and helped relieve my anxieties about the process."

– Sue, breast reconstruction

Hand Surgery

While the options for Chicago hand surgery are numerous, Dr. Steinwald is well-trained to handle a variety of (elective) surgeries of the hand and fingers, including Carpal Tunnel Syndrome, Trigger Finger and Dupuytren's Contracture. He is also able to treat traumatic injuries as well, especially involving the nerves or soft tissues of the hands and fingers. For more complex traumatic, bony or reconstructive hand surgery, Chicago and its surrounding areas has many full-time hand-specialists to whom we can refer.

  • "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 the nerve 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 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 (which may decrease inflammation and provide relief for several months, but if this fails after several attempts, definitive 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/occupational 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

Dr. Steinwald offers several methods of Chicago scar revision, most commonly involving excision and reclosure in the narrowest and 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 (and occasionally radiation) regimens to achieve significant improvement in their appearance.

Prospective patients 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 Northwestern Lake Forest Hospital Minor Surgery Suite.

Facial Trauma

Patients who are involved in accidents resulting in either soft tissue trauma 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 be and usually are adequately treated by ER personnel (but may be "followed-up" in our office), more complex lacerations often can benefit from plastic surgical intervention soon after injury.

Facial fractures commonly treated by plastic surgeons may include nasal fractures resulting in immediate nasal distortion or airway compromise, or cheek fractures, which may result in collapse of the cheek, or even eventual malposition/dysfunction of the eyeball. It is therefore imperative - especially with eyeball "blowout" fractures - to undergo facial fracture repair in a timely fashion.

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.

Some facial trauma is more chronic in nature, such as a condition many people have in Chicago, split earlobes. This can result from the chronic stretching or trauma of large, heavy earrings, or from acute injuries as well. Although split earlobe repairs (involving either excision of the tract, or wedge excision of complete tears) are usually not covered by insurance, these procedures can be performed under local anesthesia only, either in the office or at the Northwestern Lake Forest Hospital Minor Surgery Suite. Any fees charged usually include the price of repiercing the earlobes at an appropriate later date (usually 3+ months later).

Wound Management

Dr. Steinwald is a founding member of the multi-disciplinary physician's panel at the Northwestern Lake Forest Hospital Wound Center (phone number 847-535-7600), which opened in September of 2009. Complex or non-healing chronic wounds often require multi-disciplinary care (such as internists, podiatrists and/or vascular surgeons), but sometimes necessitate the involvement of a plastic surgeon for definitive wound closure, skin grafting or tissue flap 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. Recently introduced to the North Shore of Chicago, hyperbaric oxygen therapy can occasionally be beneficial pre- and/or post-operatively.

The goal of the Wound Center is to have all wounds healed within 16 weeks of initiating multi-disciplinary care, and to date we can claim a 90%+ success rate. Dr. Steinwald is glad to be a charter member of this Physician Panel, which meets monthly and works together to achieve stable closure and/or 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 many types of reconstructive plastic surgery. To meet with him and discuss your concerns, please call the Lake Forest Plastic Surgery office at (847) 234-9464 - if not the NLFH Wound Center at 847-535-7600 (Dr. Steinwald attends this clinic on Tuesday mornings) - to schedule your visit.

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