If your child is born with a disfiguring condition or has an injury that leaves permanent damage, your doctor will help you determine the best treatment available. In some cases, reconstructive surgery may be the best option for restoring the mobility, functionality and appearance to the part of your child’s body affected by his or her condition or injury.
The timing of your child’s surgery and the number of surgeries necessary will depend on your child’s condition. Options may include surgery within the first year of life, delaying surgery or treatment over a series of surgeries.
Why choose Johns Hopkins?
At Johns Hopkins, our reconstructive pediatric surgeons have done hundreds of surgeries on children of all ages to restore appearance and functionality. They have learned about and, in many cases, taught the latest and most effective surgical techniques. In addition, because they work at Johns Hopkins, they can call on any other kind of medical expertise needed right at the facility, from pediatricians and orthopaedists to ear, nose and throat specialists (otolaryngologists) and dermatologists.
Conditions We Treat
- Obstetric brachial plexus injuries, often occurring after an abnormal or difficult birth
- Breast anomalies (e.g., extra nipples, juvenile hypertrophy, gynecomastia, Poland’s syndrome)
- Cleft Lip and Palate
- Congenital hand and foot anomalies (e.g., syndactyly, polydactyly, amniotic band syndrome, hypoplastic thumb, trigger thumb, cleft hand)
- Genitourinary reconstruction
- Genital reconstruction for infants born with genital defects requiring surgery
- Melanocytic nevi
- Pediatric cranial reconstruction
- Spinal anomalies (e.g., myelomeningocele)
- Tumor reconstruction (e.g., neurofibromatosis)
- Vascular anomalies (e.g., hemangiomas, vascular malformations, lymphatic malformations)
- Wounds (e.g., bites, burns)
Cleft Lip and Palate
To repair a cleft lip, the plastic surgeon uses a special technique to suture the two sides of the lip together, leaving a scar that blends into the lip. To repair a cleft palate, the plastic surgeon uses tissue from either side of the mouth to fill in the gap, rebuilding the palate.
Surgery is generally done within the first 12 months after birth. Our reconstructive surgeons can often repair the lip or palate with one surgery, though in some cases, two may be required.
Reconstructing the ear to make it a normal size will likely require three surgeries over a period of time. In some cases, a child may need an artificial or prosthetic ear, which also requires several surgeries.
Repairing the ear can take anywhere from two to four surgeries. The reconstructive surgeon may recommend using the child’s ribs to reconstruct the ear or may decide that an alloplast — synthetic material — would be best.
For a child born with a small jaw or receding chin, a reconstructive surgeon can correct the condition through several kinds of surgery. Most commonly, the reconstructive surgeon will cut the jawbone, a procedure known as an osteotomy, to reposition it using titanium screws and plates, eliminating the need to wire the teeth together.
Another technique, distraction osteogenesis, splits the jawbone and then moves the jawbone slowly by inserting a screw either inside the mouth or outside and turning it periodically over a few weeks. The advantage of the distraction technique is that it simultaneously increases bone length and the volume of the soft tissue around the bones.
The plastic surgeon may also create a new jawbone structure using bone grafts from the ribs, hips or skull, or alloplastic grafts, which are created from synthetic materials.
Obstetric Brachial Plexus Injury
In infants, brachial plexus injury most often occurs during an abnormal or difficult birth, causing damage to the brachial plexus nerves (shoulder dystocia). Depending on the injury, a baby may be diagnosed with different kinds of palsy, including Erb’s palsy and Klumpke’s palsy. In about one in 10 cases, the child will need some kind of surgery to repair the nerves. Generally, surgeons recommend that the surgery be done when children are between the ages of 4 and 9 months.
Pediatric Genital Reconstruction
Several of our reconstructive surgeons specialize in working with children. When an infant is born with genital defects that require surgery, our surgeons will work with parents and the referring physician to determine if surgery is needed. They also consult and work with other specialists, such as urologists and gynecologists. A number of innovative techniques are available to reconstruct genital defects, including tissue transfer.Visit our Health Library to learn more about genital reconstruction.
Our Pediatric Reconstructive Surgeons
Professor of Pediatrics
Co-Director, Brachial Plexus Clinic, Kennedy Krieger Institute
Director, Cleft Lip and Palate Center
Director, Facial Paralysis and Pain Center
Director, Pediatric Plastic Surgery
Clinical Director, Genitourinary Transplant Program