Plastic surgery is a science regarding the aetiopathogenesis of malformations, diseases and trauma consequences requiring reconstructive treatment as part of surgical treatment in order to reconstruct missing body parts and their functions.

The most important fields of plastic surgery include malformations of the facial skeleton and skin, post-traumatic and post-disease deformations, treatment of burns and their consequences, treatment of skin neoplasms, hand surgery, microsurgery consisting in a transfer of free tissue flaps with microvascular and microneural anastomosis, replantation and transplantation. Plastic surgery also includes aesthetic surgery, the aim of which is to correct appearance that significantly differs from approved aesthetic standards. Based on the issues of plastic surgery mentioned above it can be concluded that its nature is interdisciplinary as it is a surgical speciality including problems associated with general, paediatric, oncological surgery, neurosurgery, orthopaedics trauma surgery, laryngology, ophthalmology and facio-maxillary surgery.

The articles presented in this issue of „Postępy Nauk Medycznych” represent the fields of plastic surgery mentioned above.

Microsurgery has been the most significantly growing field of plastic surgery within the last decade, the proof of which is the establishment of global, regional and national Associations of Microsurgery. The article by Molski presents one of the most difficult therapeutic problems associated with microsurgery, namely avulsion traumas, and the excellent outcomes that might be achieved when microsurgery solutions are used. Treating this speciality as a highly specialist procedure supported by MZ would create conditions where microsurgery would be a standard procedure in the centres of plastic surgery.

Development and improvement of microsurgical techniques are conditioned by the progress in diagnostics and imaging tests of the vascular system. The article by Pietrasik presents imaging tests of the vascular system used currently. As a result of performing microvascular anastomosis using perforators it is possible to preserve axial vessels and prevent functional disturbances in a donor site.

The articles by Dębski and Osuch present another important field of plastic surgery, namely surgical treatment of skin neoplasms. Based on the review of literature regarding surgical treatment of skin neoplasms it can be concluded that on the basis of few prospective articles it is not possible to prepare management standards and therefore further studies in this field are indispensable. The problem is underestimated for at least two reasons: the low mortality rate in the case of basal cell carcinoma and significant functional disturbances present as late as during the final stages of a neoplastic disease. Skin cancer is the most common neoplasm. Costs of its treatment are multiplied when a recurrent neoplastic disease is found and complex reconstructive treatment is required. The articles by Dębski present current views on the aetiopathogenesis, diagnostics and treatment of skin cancer as well as the necessity to conduct prospective studies regarding this field.

Hand surgery is another field of plastic surgery presented in this issue. The articles by Kulicki and Nowak present a complex problem namely reconstruction of defects of digital nerves which significantly affect hand functions as well as diagnostics and treatment of carpal tunnel syndrome – the most common peripheral nerve compression syndrome. Diabetic patients, chronically haemodialysed patients and patients after oncological treatment of breast cancer with carpal tunnel syndrome are special cases where it is necessary to modify treatment. Arthrosis of the first carpometacarpal joint is the most common degenerative disease of hand joints, whereas giant cell tumour is the second most common tumour of the hand. As a result of familiarisation with these problems, presented in the articles by Skowrońska and Ulatowski, not only surgeons but also physicians of non-surgical specialities can provide correct diagnosis, and consequently refer patients to appropriate treatment.

The consequence of frequently non-effective treatment of acne rosacea is rhinophyma, in the case of which only surgical treatment is effective. The article by Osiak presents this problem and therapeutic possibilities.

Surgical treatment in the field of aesthetic surgery is not a therapeutic option. Therefore it is necessary to apply caution and appropriate selection when patients are qualified for surgical procedures in the field of aesthetic surgery, because in the case of complications leading to functional disturbances a therapeutic regimen is necessary. The article by Szabela presents unfavourable consequences and complications following the introduction of permanent, synthetic soft tissue fillers. Complications associated with this procedure require therapeutic management within different medical specialities.

The article by Noszczyk presents current potential of regenerative medicine and future potential of gene therapy using the example of epidermolysis bullosa, a group of rare inherited diseases of skin and epithelia in which genetic defects cause damage to proteins in the basal membranes, and their treatment is only symptomatic. It is likely that in the near future they will constitute additional tools for plastic surgeons, supporting their visions and imagination in the process of tissue reconstruction.

Summing up, modern plastic surgery restores functions and appearance of damaged body parts and increasingly leads to restitutio ad integrum using different surgical techniques for tissue reconstruction.

Prof. dr hab. med. Józef Jethon