Plastisch Rekonstruktive Chirurgie Schweizer Paraplegiker-Zentrum

Plastic and Reconstructive Surgery

The Plastic Surgery department at the Swiss Paraplegic Centre (SPC) cares for complex wounds using a range of surgical procedures. Performing over 300 operations per year, it is Switzerland’s largest centre of excellence in this field.

Plastic and reconstructive surgery as a specialism is primarily concerned with resolving soft tissue defects (skin, fatty tissue, muscle, and some bones) and problematic scars which may be caused by accidents, the removal of tumours, complications following surgery, or chronic wounds. Specific surgical techniques are used in this process, in order to restore lost function and form, and to reintegrate the patient into everyday life.

Treatment options

  • A complete or partial loss of sensitivity, and spending long periods of time seated in the wheelchair, puts patients with plegia at particular risk of developing pressure sores (also referred to as decubitus or bed sores). In this process, pressure from bodyweight results in the skin and underlying fatty tissue dying off at exposed points over protruding parts of bone. Muscles and bones may also be affected in advanced cases.


    The following areas of the body are most frequently affected:
    - The coccyx
    - The ischium
    - The trochanter
    - The ankle
    - The foot


    As long as the skin is still at least partially intact, scar-free healing is possible provided that the relevant point is completely relieved of pressure, i.e. through bed rest and proper wound treatment. In the event of deeper, extended tissue deterioration, surgical measures are generally required in order to reconstruct the tissue defect. An initial step of cleaning the wound, i.e. removing dead tissue (also referred to as debridement), is often required. The defect can be covered if the wound is clean. In most cases, this is achieved using a tissue transfer. This involves relocating healthy tissue to the defect and stitching it in with the objective of making the soft tissue as stable as possible, and therefore enabling the patient to be re-mobilised in a wheelchair, and to return to normal activities.
    In parallel with surgical treatment, it is necessary to identify what caused the pressure sore, and to remedy that using appropriate measures such as seat adjustment, in order to prevent the pressure sore forming again.

  • Because it is recurring strain, primarily in the seat and sacrum area, which often results in thinning of the skin and fatty tissue, and because previous surgery can cause scarring, it is possible to try to prevent a pressure sore forming. A fatty tissue transplant can be used to pad soft tissue and improve the quality of the skin. However, this is not a suitable substitute for regularly reducing pressure and implementing other preventive measures; it only serves to improve the tissue situation on a localised basis.

Our specialist

  • Reto Wettstein

    Specialist in Plastic, Reconstructive and Aesthetic Surgery FMH, Specialist in Hand Surgery FMH

    1999-2014
    Plastic, Reconstructive and Aesthetic Hand Surgery 

    2011 
    Speciality Registrar, University Hospital of Basel

    2010 
    Lead physician, Solothurner Spitäler AG 

    2008 
    Centre Hospitalier Universitaire Vaudois (CHUV)/Clinique Longeraie 

    2006 
    Hôpitaux Universitaires de Genève (HUG) 

    2004 
    University Hospital of Basel 

    1999 
    Centre de Chirurgie Plastique Dôle Lausanne 

     

    2000-2002 Chirurgie 

    2000 
    Centre Hospitalier Universitaire Vaudois (CHUV) 

    2002 
    Lucerne Cantonal Hospital

     

    1998-Jan 2001 Research 

    1998 
    University Hospital of Bern (Prof. D. Erni) 

    2001 
    University of California, San Diego (Prof. M. Intaglietta)

     

    Publications

    Wettstein R, Savic M, Pierer G, Scheufler O, Haug M, Halter J, Gratwohl A, Baumberger M, Schaefer DJ, Kalb-ermatten DF Progenitor cell therapy for sacral pressure sore: a pilot study with a novel human chronic wound model. Stem Cell Res Ther. 2014 Jan 29;5(1):18.

     

    Wettstein R, Tremp M, Baumberger M, Schaefer DJ, Kalbermatten DF Local flap therapy for the treatment of pressure sore wounds. Int Wound J. 2015 Oct;12(5):572-6.

     

    Erba P, Wettstein R, Schumacher R, Schwenzer-Zimmerer K, Pierer G, Kalbermatten DF Silicone moulding for pressure sore debridement. J Plast Reconstr Aesthet Surg. 2010 Mar;63(3):550-3.

     

    Erba P, Wettstein R, Tolnay M, Rieger UM, Pierer G, Kalbermatten DF Neurocutaneous sural flap in paraplegic patients. J Plast Reconstr Aesthet Surg. 2009 Aug;62(8):1094-8.

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