Restoring form and function

FROM breast reconstruction, skin cancer removal, face lifts, cleft lip and palate repair, plastic and reconstruction surgeons have one of the most diverse jobs in medicine.

This week, Weekend Argus spent some time with plastic and reconstructive surgeon Liezl du Toit, and her team at Netcare Blaauwberg Hospital.

Du Toit, 45, performed a cleft lip repair on one-year-old Kaia Nixon, from Strand.

A cleft lip is a physical split or separation of the two sides of the upper lip and appears as a narrow opening or gap in the skin of the upper lip.

This separation often extends beyond the base of the nose and includes the bones of the upper jaw and/or upper gum.

Kaia’s mother, Veronique described her daughter as a fighter.

“She does not get sick, knows what she wants and likes to eat.

“At least when she starts crèche or school she will go with confidence and there won’t be any bullying which was a big fear,” she said.

Du Toit said it is all about the form and function.

Plastic and reconstructive surgeon Dr Liezl du Toit operated on Kaia. Pictures: Brendan Magaar African News Agency (ANA)

“The form is how it looks and the function is how it works.

“This is to restore the anatomy of where things are supposed to be.

“The most important part of the operation is the muscle.

“If you don’t restore the muscle you will not be able to speak and eat properly and in the long run you will be able to see it.

“Infants usually get to go home the following day if everything goes well.

“However, we still need to be careful,” she said.

In three months’ time, the one year old will need to have a cleft palate repair, a surgery to fix a cleft, or hole, in the palate or the roof of the mouth.

Du Toit said the risk of the surgery was also an anaesthetic risk – to have both the cleft lip and palate repair on one day.

“The longer you operate the higher your risks complications. To put a small child through such a lot of surgery is very traumatic for their system.

“If you get a complication like an infection, you lose everything,” she said. Some of the cleft lip and palate symptoms include: difficulty with feeding, difficulty swallowing, with potential for liquids or foods to come out the nose, speech abnormalities and chronic ear infections.

The Milnerton resident performs operations every Tuesday at the hospital and the number of patients varies each week. She is also part of the cleft team at Tygerberg Hospital, where she usually does paediatric surgery, mostly cleft lip and palate.

Du Toit and her colleague, Sandra Baker are also part of Operations Smile.

Dr Liesl Du Toit is a plastic and reconstructive surgeon. Picture: Brendan Magaar/African News Agency(ANA)

Once a year, they go away for 10 days to help children in Africa suffering from cleft lip and palate.

Meanwhile, plastic and reconstructive surgeon at Red Cross War Memorial Children’s Hospital, Saleigh Adams, said he strived for excellence in the global management of all forms of tissue defects, which includes bone, cartilage and soft tissue.

“People see plastic surgeons for the comprehensive management of all conditions that involve tissue, regarding form or function.

“The pathology may be as a result of trauma, neoplasia, congenital birth defects or even in the form of degeneration such as normal ageing,” said Adams, who usually does 10 operations per week.

“I operate mostly on congenital birth defects and on the sequelae of trauma and burn victims. These operations are primarily to restore function and secondly, to improve on form back to the expected normality.

The father of three usually wakes up before dawn and starts his day by giving thanks. When Adams arrives at work, he will start by seeing in-room patients followed by surgeries in the first half of the day.

Most afternoons are spent in the formal teaching and training of undergraduate and postgraduate students via ward rounds and clinics and these days, online via lectures.

Some part of the day is spent on administration and self-enrichment.

He added: “Surgeries are firstly, done to achieve the desired outcome and secondly, are used as examples for training and teaching of both trainee plastic surgeons and for interested undergraduate and elective students to the discipline.”