Plastic & Reconstructive Surgery

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. 

Visit the Cleft Palate Clinic.

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. 

Visit the Craniofacial Clinic.

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. 

Learn more about the Burn Program

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.  

See the Referring a Patient page for details. 

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. 

Pigmented lesions 

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 

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: 

1. make a diagnosis 
2. decide if treatment is needed 
3. discuss treatment options 
4. undertake treatment 
5. 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.  

Visit AboutKidsHealth to learn more about the Brachial Plexus Operation, and the causes, risk factors, diagnosis and treatment of Brachial Plexus Palsy. 

Facial Paralysis 

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.