Introduction

The term plastic surgery is derived from the Greek word ‘plastikos’ which translates as ‘to form or mould’. Although often associated with skin conditions, plastic surgery is not limited to the skin. Modern plastic surgery includes a wide variety of subspecialty areas, many of which are far away from the ‘nip and tuck’ image commonly portrayed by the media. The British Association has recently changed its name from the British Association of Plastic Surgeons to the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) to highlight the role of the modern plastic surgeon as a reconstructive surgeon as well as an aesthetic surgeon. As with all surgical specialties, there are a number of subspecialty areas of interest for plastic surgeons including hand or breast surgery, burns, craniofacial, cleft lip and palate, head and neck surgery, skin cancer and aesthetic (cosmetic) surgery. The theme of soft tissue reconstruction underlies all these areas and is the fundamental core of the plastic surgery specialty.

To mould the skin a surgeon needs to understand a number of basic principles that have changed little since the writings of Sir Harold Gillies in 1920 (Table 29.1). The careful handling of tissues, replacement of like with like, replacing the landmarks, and the understanding of the relationship between beauty and blood supply are vital.