Five “Ds” of plastic surgery

Although there are a variety of definitions that describe plastic surgery, confusion persists in the minds of both the lay public and doctors. A common lay misconception is that actual pieces of plastic are used to repair injured tissues or placed over defects to make them appear better. On the other hand, resident doctors from specialities such as ear-nose-throat and general surgery fail to appreciate the vast scope that plastic surgery specialty entails. In recognition of this, trainee plastic surgeons are often asked to briefly define our specialty in their final exams, so that subsequent misconceptions are minimized.

Plastic surgery is a specialised branch of surgery that is primarily concerned with deformities of the integument and underlying musculoskeletal system.^[1] It is a surgical specialty involving the restoration, reconstruction, or alteration of the human body and includes cosmetic or aesthetic surgery, reconstructive surgery, craniofacial surgery, hand surgery, microsurgery, and the treatment of burns.^[2] The term “plastic” is derived from the Greek word plasticos that means “mouldable”.^[3]

From a practical perspective, it is imperative that every practising plastic surgeon has a clear reconstructive plan for every case that is salient and easily recalled. To this end, we have distilled this into five categories represented by the following five “Ds”:

1. Defect - Loss or breach in tissue continuity;

2. Deformity - Alteration in shape and contour;

3. Dysfunction - Abnormality and impairment of a bodily organ or system;

4. Disability - Impairment, limitation of activity and participation;

5. Disfigurement - An aesthetically unacceptable surface abnormality that overlies normal contour.

Any plastic surgery condition can be placed into one of categories above and managed accordingly. This five “Ds” concept brings the key elements of the vast specialty of plastic surgery into focus. It is our hope that it will make it easier to understand the problems and their solutions more effectively.

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