Elective Plastic Repair of Congenital Defects

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IT is not surprising that the parents of an infant recently born with a congenital anomaly are interested primarily in how soon the defect can be repaired. It would be ideal if all such procedures could be carried out immediately after birth. Of course, if immediate repair is essential to survival, it matters little whether or not the immediately postnatal period is the time of election for operation. Most congenital anomalies, particularly those managed by the plastic surgeon, tolerate postponement until the optimum time for surgical repair. This particular moment varies considerably, not only from patient to patient, but from surgeon to surgeon. For example, one surgeon may elect to repair a cleft lip as soon as possible after delivery, while another defers treatment for six or more weeks. Various factors such as inadequacy of available anesthesia, unsatisfactory operating room facilities, or inadequate nursery care may also influence this decision.

From the practical standpoint, it is possible to set up several criteria that are useful in determining the ideal times for these procedures. First, the mortality associated with the elective operation must be small, and the time selected for the procedure should not modify this figure. Second, subsequent function and normal growth should be interfered with as little as possible. Finally, the feelings of the infant’s parents cannot be ignored. It frequently is cruel if not impossible to keep emotionally distraught parents waiting weeks or years for the arrival of the ideal date.

The plastic surgeon is called upon to. . .



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