Plastic and Reconstructive Surgery
Plastic & Reconstructive Surgery focuses on restoring form and function through soft‑tissue repair, microsurgery, grafting, flap reconstruction, and cosmetic procedures. CSTs in this specialty support a wide range of cases including breast reconstruction, hand surgery, facial trauma repair, skin grafting, and aesthetic procedures. This specialty requires precision, delicate instrument handling, and strong knowledge of anatomy, microsurgical workflows, and reconstructive techniques.
Role of CSTs
- Prepare plastic surgery instrument sets, microsurgical tools, and specialty trays for reconstructive and cosmetic procedures.
- Assist with patient positioning, prepping, and draping for facial, breast, hand, and soft‑tissue surgeries.
- Maintain sterile technique during delicate procedures involving nerves, vessels, and soft tissue.
- Anticipate surgeon needs during dissection, graft preparation, flap elevation, and micro‑anastomosis.
- Manage microsurgical instruments, loupes, and operating microscopes.
- Support reconstructive workflows following trauma, cancer resection, or congenital abnormalities.
- Handle specimens including skin, tissue biopsies, and mastectomy specimens with proper labeling.
- Assist with accurate counts and efficient room turnover during multi‑stage reconstructive cases.
Essential Skills
- Strong understanding of soft‑tissue, nerve, and vascular anatomy.
- Proficiency with microsurgical instruments and delicate tissue handling.
- Ability to anticipate surgeon needs during flap elevation, grafting, and micro‑anastomosis.
- Skilled in setting up and troubleshooting microscopes and micro‑instrument trays.
- Competence with suturing, fine needle handling, and cosmetic closure techniques.
- Ability to maintain sterile technique during long, delicate reconstructive procedures.
- Effective communication with surgeons, anesthesia, and nursing teams.
- Precision in handling implants, grafts, and biologic materials.
Common Procedures
- Breast reconstruction (implant‑based or autologous flap)
- Skin grafting (split‑thickness and full‑thickness)
- Local and free flap reconstruction
- Hand surgery (tendon repair, nerve repair, fracture fixation)
- Facial trauma repair (lacerations, fractures, soft‑tissue reconstruction)
- Scar revision and contracture release
- Abdominoplasty and body contouring
- Rhinoplasty and septorhinoplasty
- Blepharoplasty (eyelid surgery)
- Otoplasty (ear reconstruction)
- Mohs reconstruction
- Burn reconstruction procedures
Instruments and Equipment
Instruments
- Microsurgical instruments (forceps, scissors, needle holders)
- Dermatome and skin graft mesher
- Hand surgery sets (tendon, nerve, fracture tools)
- Facial and craniofacial instruments
- Breast reconstruction sets (implant tools, retractors)
- Fine suturing instruments and micro‑needle holders
- Liposuction cannulas and fat grafting tools
- Small bone instruments for hand and facial fractures
- Delicate retractors (skin hooks, Ragnell, Senn)
Equipment
- Operating microscope or surgical loupes
- Dermatome and graft meshing equipment
- Electrosurgical generators
- Suction and irrigation systems
- Warming devices for graft viability
- Fat processing systems for fat grafting
- Tourniquet systems for hand surgery
- Smoke evacuation systems
- Positioning devices for facial, breast, and extremity procedures
Workflow and Case Progress
- Room setup with microsurgical instruments, graft tools, and reconstructive equipment.
- Patient positioning based on facial, breast, hand, or soft‑tissue procedure.
- Prepping and draping with attention to delicate tissue exposure.
- Initial incision and dissection using fine instruments.
- Tissue preparation, graft harvesting, or flap elevation.
- Microsurgical anastomosis or reconstruction using microscope or loupes.
- Hemostasis and cosmetic closure with fine sutures.
- Dressing application and graft/flap protection.
- Final counts and transfer to recovery with detailed handoff.
Sterile Technique Considerations
- Maintain sterility during microsurgery and delicate tissue handling.
- Protect the sterile field during microscope repositioning.
- Handle grafts and flaps with strict sterile technique to preserve viability.
- Maintain sterile technique during long, multi‑stage reconstructive procedures.
- Manage small, delicate instruments without losing track during counts.
- Ensure sterile technique during high‑fluid liposuction or fat grafting procedures.
Career Pathways
- Plastic & Reconstructive Surgical Technologist
- Microsurgery Specialist
- Hand Surgery Technologist
- Burn Reconstruction Technologist
- Plastic Surgery First Assist (with additional training)
- Clinical educator for reconstructive instrumentation
- Device representative for cosmetic and reconstructive platforms
- Craniofacial or aesthetic surgery technologist
How to Prepare
- Study soft‑tissue, nerve, and vascular anatomy in detail.
- Learn microsurgical instrument names, functions, and handling techniques.
- Practice graft preparation, fine suturing, and delicate tissue handling.
- Review workflows for breast reconstruction, hand surgery, and facial trauma repair.
- Observe reconstructive cases to understand pacing and precision requirements.
- Strengthen sterile technique for microsurgery and graft viability.
- Build familiarity with cosmetic and reconstructive equipment.