Decision-making in reconstructive surgery

Plastic surgery is a specialty in constant flux as it seeks to meet the needs of patients and colleagues in a changing medical environment. In the current era, areas and procedures historically under the purview of plastic surgical expertise have become consumed by other specialties seeking to broaden their service lines. This has increasingly driven reconstructive surgery into new territory as innovation dynamically shapes and reshapes what is possible in the specialty. New surgical tools are continually being introduced and refined from super microsurgery to composite tissue allotransplantation. Each new treatment option deepens the requirement of the practitioner to remain familiar with the literature while potentially obfuscating the reconstructive decision-making process.Attempts have been made in the past to “algorithmatize” decision-making in plastic surgery. In certain instances and with more straightforward defects, this has proven to be a very successful approach such as in the treatment of frontal sinus fractures or simple hand fractures. In many cases, however, the defects presenting for reconstruction are simply too complex for merely one approach or procedure to be sufficient. One of the great strengths of reconstructive surgery is the ability of its practitioners to apply fundamental surgical principles and knowledge of anatomy to custom tailor solutions to a broad number of problems throughout the entire body. It is this need to be able to improvise that sets reconstructive surgery apart from many other disciplines. It is the need to be able to do this predictably and well that can be quite daunting to the practitioner.