ANAPLASTOLOGY

Changing Appearances/C

hanging Liv

es

Sharon Jamison, RN, CORLN

Ab

stract

•W

e a

ll ha

ve im

perfe

ctio

ns in

our fa

ces a

nd

b

od

ies th

at w

e w

ould

like to

cha

ng

e. C

onsid

er,

thoug

h, th

e c

ancer p

atie

nt o

r the tra

um

a v

ictim

w

ho m

ust d

ea

l with

a fa

cia

l disfig

ure

ment th

at

com

ple

tely

cha

ng

es th

eir a

pp

ea

rance, a

nd

ofte

n, a

bility

to fu

nctio

n n

orm

ally

. Ana

pla

stolo

gy,

whic

h c

om

bin

es a

rt and

scie

nce th

roug

h

cre

ativ

ity a

nd

functio

na

lity, c

an m

ake

monum

enta

l imp

rovem

ents in

the q

ua

lity o

f a

cre

ativ

ity a

nd

functio

na

lity, c

an m

ake

monum

enta

l imp

rovem

ents in

the q

ua

lity o

f a

perso

n’s life

by g

ivin

g a

ccep

tab

le a

pp

ea

rance

ba

ck to

the p

atie

nt. C

usto

m-m

ad

e a

pp

liances

and

pro

sthetic

cre

atio

ns c

an b

ring

hop

e a

nd

confid

ence b

ack to

the p

atie

nt. In

div

idua

lized

a

da

pta

tions c

an m

ake th

e p

rosth

etic

a tru

e w

ork

of a

rt. Nurse

s work

clo

sely

with

pa

tients w

ho a

re

benefittin

g fro

m th

is cre

ativ

e p

rocess; a

nd

a

rrivin

g a

t a su

ccessfu

l and

ple

asin

g o

utc

om

e is

extre

mely

satisfy

ing

for th

e e

ntire

tea

m, th

e

pa

tient, a

nd

fam

ily.

Ob

jectiv

es

•1) d

efin

e th

e a

rt and

scie

nce

of A

na

pla

stolo

gy

•2) E

num

era

te th

e ste

ps

involv

ed

in c

rea

tion o

f in

volv

ed

in c

rea

tion o

f

pro

sthetic

s and

ap

plia

nces

•3) id

entify

the n

urse

’s role

in

ca

re o

f the p

atie

nt

und

erg

oin

g re

constru

ctio

n

and

pro

sthetic

/ ap

plia

nce

constru

ctio

n.

Conflic

t of In

tere

st?

•Th

e a

uth

or o

f this p

rese

nta

tion

ha

s no sp

ecia

l inte

rest in

any

pro

duct m

entio

ned

in th

is

pre

senta

tion, th

ere

are

no

pre

senta

tion, th

ere

are

no

unla

bele

d u

ses o

f pro

ducts

identifie

d, n

or d

oes sh

e h

ave

any c

onflic

t of in

tere

st to

announce.

Histo

ry o

f Ana

pla

stolo

gy

•O

rigin

s

•Evolu

tion

Typ

es o

f Pro

sthese

s

•O

cula

r

•N

asa

l

•A

uric

ula

r

•O

ral

•O

ral

Who a

re A

na

pla

stolo

gy C

lients?

Ca

ncer p

atie

nts

Hea

d/ n

eck c

ancers

Sin

us c

ancers (m

axillo

-facia

l

defe

ct)

Na

sal c

ancers (p

artia

l or to

tal

Na

sal c

ancers (p

artia

l or to

tal

rhin

ecto

my)

Auric

ula

r ca

ncers

Orb

ital c

ancers (e

xente

ratio

n w

ith/

with

out fre

e fla

p)

Traum

atic

inju

ries/ a

mp

uta

tions

Cong

enita

l gro

wth

defo

rmitie

s/ ab

sences

Coord

ina

tion

•D

iscip

lines

–H

ea

d-N

eck su

rgery

–Pla

stics/ R

econstru

ctiv

e S

urg

ery

–O

culo

pla

stic O

phth

alm

olo

gy

–O

culo

pla

stic O

phth

alm

olo

gy

–Ra

dia

tion O

ncolo

gy

–Psy

chia

try

–N

utritio

n

–Socia

l Serv

ices

–N

ursin

g

Nursin

g A

ssessm

ent

•N

utritio

n

•Psy

choso

cia

l statu

s

•Skin

inte

grity

•Fin

e m

oto

r ab

ility•

Fin

e m

oto

r ab

ility

•C

are

giv

er in

terv

entio

n

Pre

op

era

tive A

ssessm

ent

•Pre

op

meetin

g w

ith th

e a

na

pla

stolo

gist

�sh

are

photo

gra

phs w

ith a

na

pla

stolo

gist

�fa

cia

l fea

ture

s uniq

ue to

pa

tient

•Enha

nced

com

fort le

vel w

ith

ana

pla

stolo

gist

ana

pla

stolo

gist

�d

iscuss e

xp

ecta

tions/ g

oa

ls

�Id

entify

pa

tient p

refe

rences

•N

urse

pla

ys a

key ro

le�

coord

ina

tion o

f consu

lts

�p

rovid

e p

reop

era

tive in

structio

n a

nd

sup

port

�In

strum

enta

l in p

osto

pera

tive te

achin

g o

f hyg

iene, p

rosth

etic

ca

re, m

ana

gem

ent o

f outc

om

es.

Auric

ula

r Defe

cts

•To

tal p

rosth

esis is e

asie

r to

accom

plish

–Pa

rtial p

rosth

etic

req

uire

s fine m

oto

r sk

ills

•A

n a

uric

ula

r pro

sthesis w

ork

s best

on a

flat fla

p o

r surfa

ce

•A

n a

uric

ula

r pro

sthesis w

ork

s best

on a

flat fla

p o

r surfa

ce

•Im

pre

ssions o

f both

sides a

re

typ

ica

l–

Donor m

od

els

•Eyeg

lass a

ttachm

ent sh

ould

be

consid

ere

d

Auric

ula

r Reconstru

ctio

n

Na

sal D

efe

cts

•D

entu

re fa

bric

atio

n o

r revisio

n m

ust

be c

om

ple

ted

befo

re in

itiatin

g

pro

sthetic

pro

cess

•N

asa

l pro

sthese

s are

diffic

ult to

secure

se

cure

–Full m

idfa

ce im

pre

ssion m

ay b

e

necessa

ry

–fa

cia

l anim

atio

n (sm

iling

,

laug

hin

g, g

rima

cin

g)

com

pro

mise

ad

here

nce o

f

pro

sthesis

Na

sal R

econstru

ctio

n

Orb

ital E

xente

ratio

n

�Reconstru

ctio

n p

ost

exe

nte

ratio

n

�Fre

e fla

p

�Skin

gra

ft

�D

ep

end

ent o

n

exte

nt o

f in

terv

entio

nin

terv

entio

n

�Tim

e fra

me p

ost

exe

nte

ratio

n fo

r p

rosth

esis p

rep

ara

tion

�Id

ea

lly 6

month

s

�D

eb

ulk

ing

ma

y b

e

necessa

ry

�C

onca

ve su

rface

Orb

ital P

rosth

esis

Crite

ria

•Pro

sthesis m

ust c

onfo

rm to

skin

conto

urs

•Reconstru

cte

d tissu

e m

ust b

e

com

ple

tely

hea

led

from

su

rgic

al in

terv

entio

n/

surg

ica

l inte

rventio

n/

rad

iatio

n.

•Th

ere

must n

ot b

e in

fectio

n o

r irrita

tion o

f the in

volv

ed

tissues

Techniq

ues a

nd

Ma

teria

ls

•A

lgin

ate

s, silicones

–Fle

xib

le, n

on-to

xic

, light w

eig

ht

•M

ould

s

–Rig

id su

pp

ort fo

r constru

ctio

n

•Fix

atio

n-

•Fix

atio

n-

–A

dhesiv

es

–C

lips

–O

sseo-in

teg

rate

d im

pla

nts

•M

ag

netic

imp

lants m

ay re

quire

ad

ditio

na

l

surg

erie

s

Meta

l atta

chm

ents

Ma

inte

na

nce

•A

dhesiv

es

•Rem

ova

l ag

ents

•C

ond

itionin

g

•C

lea

nsin

g•

Cle

ansin

g

Fix

ativ

es, C

ond

itioners,

Cle

anse

rsC

ase

Stu

dy

Ca

se stu

dy

Ca

se S

tud

yC

ase

Stu

dy

Ca

se S

tud

yC

ase

Stu

dy

Ca

se S

tud

yC

ase

Stu

dy

Ca

se S

tud

y

Many th

anks to

Pattii

Montg

om

ery, P

eggy W

esle

y a

nd

Montg

om

ery, P

eggy W

esle

y a

nd

Bita

Esm

aeli, M

.D., F

.A.C

.S.fo

r

their k

ind a

ssis

tance

Refe

rences

•Bro

wn, J

. S., S

ha

w, J

. (2010, O

cto

ber).

Reconstru

ctio

n o

f the m

axilla

and

mid

face:

Intro

ducin

g a

new

cla

ssifica

tion. La

ncet.

•M

cKin

stry, R

. (1995). Fundamentals of fa

cial

prosthetics. A

rling

ton, V

A: A

BI P

rofe

ssiona

l

Pub

lica

tions

•M

ed

icin

eN

et.c

om

(Octo

ber 2

003). D

efin

ition o

f

ana

pla

stolo

gy.

http

://ww

w.m

ed

term

s.com

/scrip

t/ma

in/a

rt.asp

?a

rticle

key=24556

•Th

om

as, K

. (2009). Th

e art o

f clinical

anaplastology. G

rea

t Brita

in: Im

prin

t dig

ital.n

et