Cruroplasty

Plastic surgery has become especially popular in recent years - both among women and men. After all, thanks to them, you can improve your appearance, correct your figure, get rid of many defects and flaws. However, such operations are performed not only on the face. In particular, cruroplasty is becoming increasingly widespread - a specific operation that allows you to model the shape, correct the external and internal contour of the shins, make your legs smoother. This type of plastic surgery is performed by placing implants with simultaneous lipofilling.

The result obtained in the process of cruroplasty is preserved for life. The rehabilitation period is not complicated, negative consequences are practically not observed.

Indications for the procedure

Many people dream of beautiful legs. However, there are many cases when desires and reality are far from each other, and it is not always possible to correct the problem with the help of physical exercises that train certain muscles in the legs.

Modern plastic surgery helps to cope with even rather complicated situations related to correction of the shape of the shins. Thus, the dream of many patients can really become a reality.

Indications for cruroplasty often include:

• too thin shins;
• insufficient development of the calf muscles, which is the result of the influence of genetic or intrauterine factors;
• atrophic processes in muscle tissue caused by primary diseases or injuries;
• curvature of the calf muscles due to age-related or other disorders;
• excessive curvature of the lower limbs caused by congenital or acquired factors;
• uneven thickness of the shins;
• incorrect leg contour.

In most cases, patients seek specialist advice on cruroplasty for aesthetic reasons. For example, the need for plastic surgery arises after rapid weight loss, after neurological problems accompanied by atrophy of individual muscle fibers, and also after injuries to the lower extremities.

Preparation

The patient should approach the cruroplasty procedure in a balanced manner, he should be calm - both mentally and physically. A week before the operation, it is recommended to do light gymnastics, take long walks in the fresh air, jog. Any surgical intervention is stressful for the body, so before the cruroplasty procedure, the patient should rest as much as possible, not forgetting about proper nutrition. If there is excess weight, then preparation for the operation should begin even earlier in order to correct body weight.

Smoking is considered a negative factor for the healing of postoperative sutures. Nicotine narrows blood vessels, worsens blood circulation, and increases the risk of complications. To avoid negative consequences, smoking patients are advised to abstain from nicotine at least a couple of weeks before cruroplasty surgery, as well as during the entire recovery period.

As for alcohol, it does not directly worsen the quality of healing, but it does negatively affect blood clotting processes. Therefore, it is necessary to observe moderation in the consumption of alcoholic beverages both before and after cruroplasty.

During the medical consultation before cruroplasty, you need to inform the doctor about the medications you are taking. It is advisable to stop taking medications, including oral contraceptives, 1-2 weeks before the operation. If this is not possible, you need to consult a doctor.

On the eve of the procedure, the patient should take a shower (preferably using antibacterial soap), without applying any creams, lotions or oils. All jewelry and valuable accessories should be left at home, and light and comfortable clothing should be worn. Shoes should be without heels.

Since cruroplasty most often involves the use of epidural anesthesia and intravenous anesthesia, it is important that the stomach is completely empty at the time of the operation. If there is liquid or food in it, it can get into the respiratory tract, which is dangerous for the patient during anesthesia. To avoid complications, it is necessary to have a light dinner in the evening, and the morning before the intervention, do not consume any food or water.

Many experts advise to exclude salty foods a week before cruroplasty surgery. This is due to the fact that salt can provoke swelling of the lower extremities, which is extremely undesirable at the postoperative stage.

If everything is done correctly, it is possible not only to prevent the development of complications after cruroplasty, but also to accelerate further restoration of tissues and the entire body.

Technique cruroplasties

Implants for cruroplasty can be different - both in size and density. Saline solution or gel-like silicone is usually used as a filler. The surface of the implant can also be different - from smooth to textured. The prosthesis itself should imitate the muscle shape as much as possible, be hypoallergenic and safe.

The most commonly used types of implants for cruroplasty are:

• symmetrical (prostheses with maximum average thickness);
• asymmetrical (prostheses that repeat the configuration of the gastrocnemius muscle).

The decision about which prosthesis will be used during cruroplasty is made by the doctor.

How does the intervention take place?

The patient is placed on the operating table (lying on his stomach). The surgeon treats the area of the proposed operation with an antiseptic, makes the necessary marks and makes a popliteal incision of approximately 3.5 cm.

Next, the doctor uses special scissors to separate the soft tissue from the connective tissue sheath of the gastrocnemius muscle, forming a place for inserting the endoprosthesis. This place must correspond to the size of the implant, as it completely models the natural configuration of the muscle.

The silicone prosthesis is placed below the muscle fascia, or submuscularly (the subfascial or submalar technique is used accordingly). After this, the doctor sutures the fascia, places several sutures on the subcutaneous fat tissue and performs the final skin suture. The wound is treated, an aseptic fixing bandage is applied.

The entire period of cruroplasty surgery takes on average one and a half hours.

Contraindications to the procedure

Since cruroplasty is a full-fledged surgical intervention, it requires a serious attitude and a balanced approach, both from the patient and the surgeon. The doctor collects all the information about the patient's health in advance, analyzes the existing indications and contraindications for the operation. Laboratory tests are mandatory, a full medical examination is performed.

Cruroplasty, like any other plastic surgery, cannot be prescribed if the following contraindications are present:

• acute course or exacerbation of chronic infectious and inflammatory diseases, pathologies of the cardiovascular system;
• diabetes mellitus;
• severe renal or hepatic insufficiency;
• pregnancy and breastfeeding;
• obesity (including endocrine etiology);
• malignant tumor processes;
• blood diseases, tendency to thrombosis, blood clotting disorders, varicose veins;
• mental disorders.

Cruroplasty is not performed in cases of decompensated hypertension, since such patients have a greatly increased risk of developing bleeding from damaged vessels.

Another important contraindication is keloidosis. This is a systemic connective tissue pathology in which growths form at the site of a postoperative scar. A real keloid scar constantly increases, regardless of the initial size and depth of skin damage.

If the doctor has found that cruroplasty cannot be performed for one reason or another, additional examinations can be carried out. In some cases, contraindications are relative, and the question of performing the operation is decided on an individual basis.

Consequences after the procedure

As with any other surgery, cruroplasty has its own risks of developing negative consequences. Complications are rare, but they do happen, and each patient should be informed about this.

• Hemorrhages and hematomas occur as a result of damage to blood vessels during surgery. Light hematomas gradually resolve on their own, while massive hemorrhages may require additional intervention with suturing or coagulation of the damaged vessel.
• A purulent inflammatory process can develop if the rules of asepsis and antisepsis are not followed during the procedure. In some cases, the infection can enter the wound hematogenously, in particular, from foci of infection already present in the body. To prevent this, it is necessary to cure all infectious diseases before cruroplasty. [ 1 ]
• Impaired sensitivity and paresthesia may occur as a result of damage or compression of nerve endings. Such disorders usually disappear on their own as tissues recover.
• Endoprosthesis contouring occurs when the implant is selected incorrectly. This unpleasant consequence requires surgical correction, which is performed in two stages. First, the endoprosthesis is removed, and after several months, another, more suitable implant is installed.
• Lower extremity edema is a thickening of the lower leg due to fluid accumulation in the tissues. This phenomenon usually resolves on its own approximately 2 weeks after cruroplasty.
• Deformation of the operated limb may occur due to mechanical trauma to the endoprosthesis. In such a situation, it is necessary to replace the implant with a new one.
• Scars are a relatively rare consequence after cruroplasty, which occurs in patients with an individual tendency to form keloid scars, or if the wound healing period is too long (for example, if this period was complicated by the development of infectious inflammation).

Edema after cruroplasty

Edema may occur as a result of direct surgical damage to the tissues of the lower limb. In addition, vascular permeability increases, which leads to the release of plasma from the smallest vessels. During the operation, both the blood and lymphatic vascular network are invariably damaged, which leads to the formation of edema.

In general, swelling after cruroplasty is considered normal. After some time, it goes away on its own, but this process can be accelerated with medication.

Most often, to prevent and eliminate swelling after cruroplasty, it is recommended to wear special compression underwear. Such underwear helps the venous vessels in the legs to function properly, namely, to lift and transport blood upward.

In some cases, the problem with swelling can be solved with the help of lymphatic drainage massage, which should be performed by a specialist. If such a massage is done incorrectly, then not only can it not help, but also harm the patient.

To reduce swelling after cruroplasty, heparin ointment is used, which is applied only to undamaged areas of the skin. Lyoton gel is also suitable for this purpose, improving blood circulation and having a mild anti-inflammatory effect. Troxevasin, Troxerutin, and Heparoid Zentiva are external preparations that prevent excess fluid accumulation. Detralex, Troxevasin, Aescusan, etc. are the most suitable medications for internal use. Diuretics such as Lasix, Triampur, etc. can be used as prescribed by a doctor.

A special diet with limited salt will speed up the disappearance of edema. You should also add foods containing potassium to your diet - these are bananas, baked potatoes, raisins.

After cruroplasty, it is advisable to raise your legs more often while lying down – for example, by placing a bolster or pillow underneath. You should also not forget about wearing compression stockings or tights.

Complications after the procedure

Each patient should familiarize themselves with the list of possible complications after cruroplasty in advance. On the Internet, you can probably find unpleasant reviews and photos that make many patients doubt the operation. However, the overwhelming majority of complications occur when patients themselves do not follow the doctor's recommendations. What should you pay attention to in order to prevent the development of postoperative problems?

Before deciding on plastic surgery, you need to first collect all the information about the clinic and the doctor who will perform cruroplasty. It is important that the clinic is in demand, has modern equipment, high-quality consumables and drugs. Doctors must provide the patient not only with high-quality surgery, but also competent diagnostics, regular consultations (before and after cruroplasty), comfortable conditions, anesthesia and compression underwear, sufficient postoperative care.

However, it is necessary to take into account even the minimal risk of complications, which are most often associated with:

• with individual characteristics of the body and its unexpected reactions;
• with failure to comply with postoperative rules and doctor's orders.

Important: any concerns about your well-being or the postoperative period are a reason to contact your doctor.

Complications can be divided into two groups:

• Common complications caused directly by the cruroplasty operation:
  • pain syndrome;
  • swelling;
  • hematomas;
  • elevated body temperature;
  • formation of keloid scars;
  • changes in skin sensitivity.
• Specific complications associated with the endoprosthesis and anatomical features of the lower limbs:
  • limb deformities;
  • implant damage;
  • prosthesis contouring;
  • other rare complications (allergy to the endoprosthesis material, tissue atrophy, calcium deposits in the implantation area).

Since the overwhelming majority of complications are caused by improper care and management of the rehabilitation period after cruroplasty, it is important to carefully follow all doctor’s instructions and follow his recommendations.

Care after the procedure

Physiological swelling after cruroplasty should disappear on its own within 2 weeks after the operation. If this does not happen, then the following reasons for this phenomenon can be assumed:

• irregular or short-term use of compression garments;
• exposure to hot water or ultraviolet rays during the early postoperative period;
• early practice of physical activity.

Temperature may increase slightly (up to 38°C) in the first 2-3 days after cruroplasty. You should worry and see a doctor in the following cases:

• if the temperature suddenly “jumped”;
• if the fever lasts more than a week;
• if the indicators returned to normal and then increased sharply.

As the inflammatory process develops, the patient may develop the following symptoms:

• redness of the skin in the area of surgery;
• sharp pain when palpated;
• the release of serous or purulent fluid from a postoperative scar.

In case of severe intoxication, the body may react quite violently: nausea, vomiting, dizziness, loss of appetite, etc. are possible. In such situations, you should contact a doctor immediately.

To prevent loss of skin sensitivity, the doctor may prescribe B vitamins and physiotherapy.

After cruroplasty, complete tissue recovery occurs within approximately 2-3 months. Before this period, the patient may experience some discomfort, swelling and slight pain.

The duration of disability varies depending on the type of occupation:

• for office workers this period is approximately 2-4 weeks;
• for people engaged in physical labor - 4 weeks more.

The operated limbs begin to hurt in the evening on the day of the intervention, when the effect of the anesthetic wears off. To reduce pain, tablets are prescribed, at the discretion of the doctor. Pain can be reduced by applying ice packs - for 20 minutes 4 times a day. Most often, the pain subsides within 2-3 days.

To prevent and reduce swelling after cruroplasty, you should:

• Immediately after the operation, put on compression garments and wear them throughout the entire rehabilitation period;
• During the first three days, keep your legs higher than your body (use a special bolster or several pillows).

The legs are gradually accustomed to loads. If necessary, apply a bag of ice. Until all unpleasant symptoms disappear, it is recommended to wear soft shoes without heels. For 2 months, physical activity should be limited, and thermal effects should be avoided (hot shower, bath, sauna, ultraviolet radiation).

Cruroplasty is generally considered a relatively simple and safe plastic surgery. The recovery period does not take much time, and the result begins to please patients almost immediately.