Optimal timing for plastic surgical procedures for common congenital anomalies: A review

Abstract

Apart from listening to the cry of a healthy newborn, it is the declaration by the attending paediatrician in the labour room that the child is normal which brings utmost joy to parents. The global incidence of children born with congenital anomalies has been reported to be 3%-6% with more than 90% of these occurring in low- and middle-income group countries. The exact percentages/total numbers of children requiring surgical treatment cannot be estimated for several reasons. These children are operated under several surgical disciplines, viz, paediatric-, plastic reconstructive, neuro-, cardiothoracic-, orthopaedic surgery etc. These conditions may be life-threatening, e.g., trachea-oesophageal fistula, critical pulmonary stenosis, etc. and require immediate surgical intervention. Some, e.g., hydrocephalus, may need intervention as soon as the patient is fit for surgery. Some, e.g., patent ductus arteriosus need ‘wait and watch’ policy up to a certain age in the hope of spontaneous recovery. Another extremely important category is that of patients where the operative intervention is done based on their age. Almost all the congenital anomalies coming under care of a plastic surgeon are operated as elective surgery (many as multiple stages of correction) at appropriate ages. There are advantages and disadvantages of intervention at different ages. In this article, we present a review of optimal timings, along with reasoning, for surgery of many of the common congenital anomalies which are treated by plastic surgeons. Obstetricians, paediatricians and general practitioners/family physicians, who most often are the first ones to come across such children, must know to guide the parents appropriately and convincingly impress upon the them as to why their child should not be operated immediately and also the consequences of too soon or too late.

Keywords: Plastic surgery; Congenital anomalies; Pediatric plastic surgery; Facial cleft; Microtia; Vascular anomalies; Syndactyly; Hypospadias; Optimal timing; Pediatric surgery

Core Tip: This review comprehensively summarises the optimal timing for surgical intervention for various common congenital anomalies which are operated on by Plastic Surgeons. There are various considerations, both general and specific to a condition which dictate the most appropriate time to operate, and find a balance between several advantages and disadvantages of an earlier or more delayed surgery. Parents of children suffering from these anomalies must be guided appropriately by the obstetrician, paediatrician and the family physician, with convincing reasons as to why so much delay is required, before these children are referred to a plastic surgeon. This article is an attempt in that direction.