As orthopedic surgeons are the masters of bones, plastic surgeons are masters of soft tissue management and manipulation.

Wikipedia defines soft tissue like this: “In anatomy, soft tissue includes the tissues that connect, support, or surround other structures and organs of the body, not being hard tissue such as bone. Soft tissue includes tendons, ligaments, fascia, skin, fibrous tissues, fat, and synovial membranes (which are connective tissue), and muscles, nerves and blood vessels (which are not connective tissue)”.

 Feel the fresh sea breeze blowing over your skin, the touch of your grandfather’s calloused hands, the warmth of the winter sun, the squelching of mud through your toes, the shiver down your spine as the south easterly wind blows right through you, the sting of a thorn in your foot, the heat rising on your neck from embarrassment, the cold sweat forming on your forehead as you lie on the operating table…

These evoke strong emotions, yet, none of these sensations are emotional – they are all purely functional: the result of millions of nerve endings, part of your skin, sending powerful messages to your brain. And without the amazing barrier between you and the outside world, these sensations would never evoke any memories at all.
18% of our body weight can be attributed to skin, which will cover a surface area of about 1.8 square meters. It is the easiest organ of the body to examine and is often a reflection of health. The skin performs many functions, like regulating body temperature, sensation detection, immune responsiveness, energy storage, Vitamin D production and protection against the environment.

It undergoes many changes during a lifetime – expanding as we pick up weight, “shrinking” as we lose some, stretching during pregnancy, and adapting from water to air when we are born. Hormonal changes impact on our skin too, taking us through puberty, menstruation, childbirth and menopause.

Profound changes can occur during disease, injury and trauma. Environmental factors, such as sun damage, smoking, scarring and other psychological factors can drastically alter the appearance and function of the skin.

Our skin can heal when injured. Sometimes it does so, without extra help, when the injury is minor, and sometimes it needs a lot of tender care for prolonged periods of time when the injury is larger.

Sometimes we use tissue glue, stitches or staples to close “holes” in the skin. Possibly first manipulating the skin to close the “hole” by means of flaps. These are not only used to close a hole, however, but, as is the purpose of a plastic surgeon, these are also used to create the most pleasing cosmetic result. When the “hole” created either by removing a tumour, or by injury, is too large to close by means of mere manipulation of skin by means of a flap, we can borrow skin from one area of the body, and transplant it to another area, by either using a full thickness skin graft or a split thickness skin graft.

And in cases where large areas of skin were damaged and needs time to repair itself, as in the case of a major burn, we can use skin substitutes temporarily to protect the body from outside elements, until the skin heals, or until we can place skin grafts.