Plastic & Reconstructive Surgery
A North American leader
Plastic and Reconstructive Surgery is a diverse surgical subspecialty that involves surgery on all parts of the human body, interacting closely with all other medical and surgical specialties. Our division consists of eight full-time paediatric plastic and reconstructive surgeons making us the largest division of its kind in North America. Our staff have world recognized expertise in all areas of pediatric plastic surgery including craniofacial and cleft surgery, obstetrical brachial plexus palsy, peripheral nerve injury, congenital anomalies of the upper extremity, burns, facial reanimation, post-traumatic and post-oncologic reconstruction, ear reconstruction, microsurgery, vascular anomalies and skin disorders to name a few.
Interprofessional and family-centered care is an essential component of our team approach to managing the conditions seen in our clinics. Our nursing team, occupational therapists, physiotherapists, social workers, child life specialists, orthotists, speech and language pathologists and administrative support staff are all available to make your experience at SickKids a positive one.
In addition to patient care, we are an active teaching center associated with the training and education of some of the best and brightest students from the University of Toronto and around the world.
Training the next generation
Research is an important component of our division and all staff members have an active interest in promoting research in both basic science and clinical arenas. Research is an essential component of our division mission and is necessary to provide the answers to managing some of the difficult clinical problems that we face as clinicians. We support the training of Surgeon-Scientists in our division and have a busy summer studentship research program.
I hope that you enjoy browsing our website and experience the scope of Pediatric Plastic and Reconstructive Surgery at SickKids. If you have any questions or would like to contact or support us, please feel free to contact me at firstname.lastname@example.org
Thank you for visiting the Division of Plastic and Reconstructive Surgery website!
What is plastic surgery?
The term “plastic” is derived from the Greek word plastikos meaning to “change the shape or form of.” Plastic Surgery otherwise has nothing to do with implantation of biomaterials such as silicone, although many families may ask because of the intense lay press coverage of cosmetic plastic surgery.
Fundamentally, Plastic Surgery alters anatomy anywhere in the body in order to improve function, form, and often both simultaneously.
Paediatric plastic surgeons have a very diverse practice. The Division has multidisciplinary programs, however most of our surgeons specialize in certain areas, explained in more detail below.
Please expand the sections below to learn about our programs, services, clinics, registration protocols and more.
We treat conditions related to orofacial clefting, including that of the lips, palate and jaws, with the goal of restoring both form (facial appearance) and function (speech). We use the combined efforts of many specialists to provide optimum care for children with cleft lip and palate throughout their development.
The combined efforts of many specialists are needed to treat clefts of the lip and palate successfully. We believe that the team approach ensures the best possible care for our patients.
Craniofacial surgeons specialize in the correction of skull shape abnormalities, including craniosynostosis, congenital and acquired dysmorphic craniofacial abnormalities, as well as jaw abnormalities.
Over the last 30 years The Hospital for Sick Children has established an international reputation with regards to clinical excellence and research in the field of Craniofacial surgery. The Centre for Craniofacial Care and Research at SickKids is committed to providing comprehensive state-of-the-art treatment and care in all aspects of the management of children, young adults and their families with craniofacial disorders and to developing a pre-eminent internationally recognized centre for craniofacial research and education.
Since the 1970s, the Centre has been using the sophisticated techniques for craniofacial repair established by Dr. Paul Tessier, in Paris, France, that have been refined and enhanced over the years by the leaders in craniofacial surgery.
Dr. Christopher R. Forrest is the Medical Director of the SickKids Centre for Craniofacial Care and Research and coordinates all of the ongoing patient care and research related activities. Dr. John Phillips is the associate Craniofacial Surgeon and is also a Co-Director of the Vascular Malformation Clinic (VMC), which is the only pediatric VMC in Ontario.
The Burn Unit is located on Ward 8C within the Plastic Surgery Ward. We treat burns of all causes ensuring patients receive optimal care and focus on recovery. Parents and caregivers are supported through this journey. We work closely with the critical care unit with severe burn injuries to ensure all needs of these medically complex patients are addressed within a timely manner ensuring safe and effective care.
This specialized clinic provides interprofessional care to children who have sustained burn injuries and is led by a nurse practitioner with several years of paediatric burn experience, along with child life specialists, social workers, physiotherapists, occupational therapists, dietitians and a psychologist to ensure you receive the best care possible. We provide family-centred care and offer treatments and therapies based on the best evidence.
If you need to make an appointment or change an existing appointment time, please call the clinic clerk at 416-813-7654 ext. 204487. We will do our best to accommodate your requests.
Please register at the Plastics Clinic on the Main Floor near Shoppers Drug Mart. The clinic is located close to the University Avenue entrance. From the Elizabeth Street entrance or parking garage elevators, walk all the way down Main Street towards Shoppers Drug Mart.
We treat a variety of patients with different congenital hand anomalies, including polydactyly, syndactyly, symbrachydactyly, duplicated digits, constricted band syndrome, congenital trigger thumbs as well as a host of rarer conditions. These patients are treated in close coordination with occupational therapists and physiotherapists.
What are Congenital Hand Differences?
Congenital hand conditions are differences (anomalies) in the hand and arm that occur when a child is developing before birth.
The anomaly may occur by itself or can be associated with problems with other body systems. The musculoskeletal (bones and muscles), cardiovascular (heart, arteries and veins), craniofacial (head and face) or neurological (brain, spinal cord and nerves) systems are most commonly involved. When a hand anomaly is part of a syndrome, a geneticist and/or other specialists may be involved with the child's care. Congenital hand anomalies may have genetic, environmental or unknown origin.
There are many different types of congenital hand conditions. Some of the more common anomalies include:
- having more or fewer than five fingers
- fingers that will not bend or will not straighten
- fingers that are joined together
- bones in the hand or arm that are too short or missing
Read more about Congenital Hand Differences on AboutKidsHealth.ca.
Watch the AboutKidsHealth YouTube video on Hand Differences.
How to make a referral
Referrals to the Congenital Hand Clinic can be made from Community Paediatricians, Family Physicians and Plastic Surgeons. All patients require a referral to visit our clinic.
We manage all types of extremity trauma, ranging from nonoperative hand fractures to those of devastating proportion. We also reconstruct cancer defects of the upper and lower limbs.
Dr. Fisher heads the Microtia program. Microtia is a term used to describe small malformed ears, a not so rare birth anomaly. We use a modification of Dr. S. Nagata's technique for microtia reconstruction.
Dr. Fisher holds a Microtia lecture twice a year at SickKids, discussing the surgical reconstruction procedure for small malformed ears. All referred children are encouraged to attend the lecture prior to being seen at the Plastic Surgery Clinic. These operations are usually performed by Dr. Fisher at St. Joseph's Hospital once the child is at least 10 years of age.
We see infants and children with congenital large disfiguring nevi, dermoid cysts and ganglion cysts who may undergo serial excision. We collaborate closely with dermatology to develop treatment plans for lesions that are concerning or malignant.
Referrals are received from family physicians, dermatologists, general surgeons and reconstructive surgeons for opinions, surgical discussions or complex management.
Many are small and easily addressed surgically. Others, however, are large or located in complex areas such as the face, and require careful consideration as to which management course is best for the individual child. We often collaborate with our dermatology colleagues on such cases to develop a plan for management.
A congenital nevus is a pigmented skin lesion consisting of pigment and nevus cells, which is present on the skin at birth or shortly after. The colour of congenital nevi ranges from light brown to black. The size varies from small (<1.5 cm), medium (1.5 – 19.9 cm), to large (20 – 49.9 cm) and giant (>50 cm), which usually involves the trunk (bathing trunk nevus). Increased hair growth is commonly associated with these lesions. Although the risk of malignant change in these congenital melanocytic nevi is low, they can be of concern aesthetically. Surgical excision is preferred but care must be taken not to create excessive scarring or distortions that may not only be cosmetically unacceptable, but may cause functional problems. Thus, careful planning is necessary.
Surgical excision of any type of skin lesion is carried out for lesions that are concerning regarding their malignant potential, in areas that are difficult to monitor, where there is a strong family history of malignant skin lesions or to improve aesthetics. This may involve simple excision and closure, the use of regional tissue to close the defect left after excision, or the use of tissue expanders, particularly in large lesions of the face or trunk.
Our division has had a particular interest and made significant contributions in the field of tissue expansion in children. In this technique, the normal tissue adjacent to the lesion is expanded so that it can be used to cover the defect left after excision of the lesion. A silastic balloon is placed beneath the normal adjacent tissue and with weekly injections it is expanded for three or four months. It is then removed at a second surgery, when the lesion is excised and the expanded tissue is used to cover the defect left by the excision. It is a very effective technique, but requires careful planning and execution. Even with this there are complications, so a full understanding on the part of the child and family is mandatory.
Our expertise with cross-specialties
At SickKids we have easy access to a wide variety of experts. With some skin lesions, we utilize these resources extensively, collaborating with dermatologists, pathologists, general surgeons, oncologists and interventional radiologists. We are well positioned to provide everything necessary for the child with virtually any type and any extent of skin lesion.
We treat a variety of lesions, including hemangiomas, venous malformation, arteriovenous malformations and lymphatic malformations. Although the age limit for patients is from birth to 18 years of age, this clinic also assesses fetal vascular anomalies. If you wish to have an interpreter present please inform the Vascular Anomalies Clinic when making your appointment.
The purpose of the clinic is to:
- make a diagnosis
- decide if treatment is needed
- discuss treatment options
- undertake treatment
- provide follow up until 18 years of age
These cases are often jointly managed by Dr. Philip John, MD (interventional radiologist) and Dr. John Phillips (plastic surgeon). Joao Amaral, MD (interventional radiology) also staffs this clinic, which runs on Fridays.
In addition to the Vascular Anomalies Clinic there are two other multi-professional specialist clinics dealing with specific vascular malformations. These are the Klippel-Trenaunay Syndrome Clinic and the Bone Vascular Clinic. The Bone Vascular Clinic is dedicated to caring for children with joint involvement from their vascular malformation.
In some cases, patients may be seen through the hospital virtual care service. Further, the Vascular Anomalies Clinic is part of the Division of Plastic and Reconstructive Surgery and the Division of Diagnostic Imaging at SickKids. As part of the investigations you may visit other clinics at SickKids such as Dermatology, Clinical Genetics, Paediatric Medicine, Gynaecology, Orthopaedics, Otolaryngology, Haematology and Gastroenterology, Hepatology and Nutrition.
This will enable the team at the Vascular Anomalies Clinic to fully assess the condition. Investigations such as magnetic resonance imaging (MRI) or ultrasound scans may be required. If needed, treatment by interventional radiology (done in Image Guided Therapy), surgery (such as plastic surgery) or a combination of these may be undertaken.
Infants and children with birth related brachial plexus injury (“obstetrical brachial plexus palsy”) are seen in the Brachial Plexus Clinic on Wednesdays, headed by Dr. Clarke and Dr. Kristin Davidge. We work closely with our physiotherapist to monitor these patients throughout their childhood.
We also see patients with traumatic nerve injuries and nerve compression, who may require microsurgical repair.
Our Facial Paralysis Clinic is run by Dr. Karen Wong, who specialize in microsurgical repair. They use both nerve and muscle grafting for the repair of unilateral and bilateral facial paralysis. Our occupational therapist is heavily involved in the treatment plan.
The Facial Paralysis Program at SickKids provides state of the art microsurgical reconstruction to animate the paralyzed face. This will improve eyelid closure, oral continence, speech, facial symmetry and restore an even, beautiful smile. Facial paralysis in children may be congenital, meaning present at birth, or it may be acquired from head and facial injuries or a consequence of brain tumours and complex surgery. It may be one-sided (unilateral) as in developmental facial palsy, or involve both sides (bilateral) as in Moebius Syndrome. Whatever the cause, the SickKids team is ready to help, has unparalleled expertise, and is in the forefront of advanced clinical care and innovation for this condition. Our Facial Paralysis Clinic is staffed by Dr. Karen Wong who is an experienced pediatric plastic and reconstructive surgeon and microsurgeon. They use nerve transfers, nerve grafts, muscle transplants and innovative reanimation techniques to achieve the desired result.
Our coordinator, Aileen Almendarez, facilitates appointments and can be reached at 416-813-6447. We also have a specialist occupational therapist to help our patients maximize the benefits of surgery. Our clinics are held monthly and involve this multidisciplinary approach.
The Division of Plastic and Reconstructive Surgery has ten surgeons on staff as well as an extensive team consisting of a number of fellows, nurses and allied health professionals.
Dr. Christopher Forrest, MD, M.Sc., FRCS(C), FACS
Head, Division of Plastic and Reconstructive Surgery
Craniofacial and Plastic Surgeon, Cleft Lip and Palate Program
Medical Director, Centre for Craniofacial Care and Research
Chair and Professor, Department of Surgery, University of Toronto
Admin contact: Dyanne Bechard, email@example.com
Read more about our surgeons below.
Advancing the science of nerve regeneration, tissue healing and genetics
Paving the way for new discoveries in nerve regenerative science is the Borschel Lab under the leadership of Dr. Gregory Borschel and Dr. Tessa Gordon. Visit the Borschel Lab online to learn more about their activities. Other areas of basic science research being explored by the collaborative efforts of our Division members include tissue healing and genetics.
- For information on our burn and scar tissue research, contact Jennifer Zuccaro.
- For collaborations on genetics of craniofacial and congenital hand conditions, contact Emily Ho.
Developing surgical simulators and applying computational science
Under the team of Dr. Christopher Forrest, Dr. David Fisher, and Dr. Karen Wong, U of T surgeon scientist trainee, Dr. Dale Podolsky has become a world-leader in the research and design of surgical simulators in Plastic Surgery. This team of innovators has developed cutting-edge high-fidelity simulators for palatoplasty, cleft lip repair and rhinoplasty.
In collaboration with the Anna Goldenberg Lab, our surgeon-scientists and clinical research team are developing new innovative ways to apply computational science to improve diagnostic care in children with craniofacial and upper extremity conditions.
For more information on how computational science is being applied in plastic surgery research, contact Ahsan Rai.
Leading the way in developing patient-reported outcome measures
Measuring what matters most to children and their families is a priority in the SickKids Division of Plastic and Reconstructive Surgery. As such, our surgeon-scientists are leaders in the development of patient-reported outcome measures to evaluate the child and family’s health related quality of life. In collaboration with Dr. Anne Klassen and Dr. Andrea Pusic, the CLEFT-Q, FACE-Q Kids, EAR-Q, and SCAR-Q measures have been developed.
For information on patient reported outcomes research, please contact Emily Ho.
Supporting excellence in clinical care with research evidence
Clinical evaluative science is the strength of the research activities of the Division. Our surgeon-scientists and clinicians are leaders critically appraising observer-reported measures to systematically evaluate outcomes of our clinical practices. The Active Movement Scale (AMS) and Brachial Plexus Outcome Measure (BPOM) are two valid and reliable observer reported measures created by researchers in our Division.
Through establishing reliable and valid disease-specific clinical measures, a foundation for rigorous evidence-based research to support our clinical interventions is established. Explore the current work of our researchers that play an important role in advancing the care of children with facial paralysis, craniofacial conditions, cleft lip and palate, brachial plexus birth injuries, congenital hand differences, burn and hypertrophic scars, and peripheral nerve conditions.
For more information on our clinical research initiatives, please contact Emily Ho.
Investing in translational work and education
We are dedicated to educating the next generation of plastic and reconstructive surgery trainees through developing educational resources and programs. For more about our translational work and educational programs please contact Emily Ho.
The Division of Plastic and Reconstructive Surgery is one of the busiest departments at SickKids caring for chronic and acute conditions to the most complex patients with musculoskeletal disease.
In addition to patient care, we are an active teaching center associated with training some of the best and brightest students from the University of Toronto and around the world. Resident doctors training to become plastic and reconstructive surgeons spend time on rotation at SickKids. In addition, each year, we train four to six fellows (qualified surgeons) from all points of the globe who are interested in pediatric sub-specialization. Finally, between 80 to 100 visiting surgeons and students visit our unit each year.
We believe that interdisciplinary care, collaborative research and valuable teaching will give fellows the skills required to undertake the most important issues in children's musculoskeletal disease.
The Division offers education and learning opportunities for fellowships, residency and observerships, explained in detail over on the University of Toronto's Plastic, Reconstructive & Aesthetic Surgery portal.
More information regarding fellowships:
Medical Student Electives
This Rotation is typically reserved for third- and fourth-year Medical Students during a 2 week period. Students interested in spending elective time at the Hospital for Sick Children must submit a request to the division including potential training dates and CV. Once a date is confirmed with the division the student must submit a request to be approved by the University. More Information can be found through the University of Toronto Electives portal.
All Plastic surgery residents who wish to complete their electives with The Division of Plastic and Reconstructive Surgery must submit a request to be approved to the Division including potential training dates and CV before submitting their application the university. More Information can be found through the University of Toronto's Residency Application site.
The Plastic Surgery Clinic is located on the Main floor of SickKids, just off Main Street. Follow the SickKids footprints, located on the floor, toward the library. We are between the Specialty Food Shop and Shoppers Drug Mart.
Burns & Plastic Surgery Clinic
The Hospital for Sick Children (SickKids)
555 University Avenue
Dyanne Bechard, Administrative Supervisor
Assistant to Dr. Christopher Forrest, Dr. Johanna Riesel
Room 5430, Hill Wing (5th floor)
Phone: 416-813-8659 Ext. 208659
Heather Sellars, Surgical Administrative Coordinator for Dr. Howard Clarke and Dr. Dale Podolsky
Room 5424, Hill Wing (5th Floor)
Phone: 416-813-6444 Ext. 206444
Michael Perrino, Education and Fellowship Coordinator
Room 5432, Hill Wing (5th floor)