Areas of Interest

Plastic surgeons operate all over the body from the head to the toes and almost everywhere in between. Broadly speaking this includes removing skin cancers and the reconstruction of bodily defects following other speciality surgery. We routinely operate as part of a multidisciplinary team for the care of complex patient’s cases to restore function and form following injury or disease.

Upper Limb (Hand & Wrist Surgery)

Unfortunately Mr Sullivan is unable to accept NEW complex hand and wrist referrals at this time

Hand surgeons manage a wide range of upper limb conditions with our other colleagues in hand therapy, radiologists, rheumatologists and neurologists. Not all conditions require surgical intervention and appropriate care will be tailored to the individual based on their clinical needs. These include the following common conditions -

Conditions such as hand and wrist arthritis, joint pain, requiring injection, replacement, realignment and stabilisation.
Wrist and finger fractures including sports injuries in athletes.
Management of soft tissue infection in the upper limb.
Treatment of nerve compression requiring surgery at the elbow, wrist or hand such as Carpal Tunnel Syndrome.
Other complex peripheral nerve problems.
Treatment of tendon and ligament injury resulting from trauma, sports injury or repetitive strain, such as de Quervain’s tenosynovitis.
Assessment and treatment of Dupuytren’s disease, a condition which results in progressive thickening of the skin on the palm of the hand resulting in contracted fingers, which may require surgical intervention.

Trauma / Injuries

Patients experiencing trauma will often have several simultaneous problems and whole teams of surgeons and physicians may be involved in their successful treatment. Many patients first experience with a plastic surgeon will be following an injury ranging from something relatively minor (such as a cut finger tip) through to the opposite end on the scale like a serious polytrauma road traffic accident. Typical examples of cases we manage include the following:

Simple and complex facial, upper and lower limb trauma; conditions treated include acute tendon, nerve, bone, joint and ligament injuries.
Chronic injuries and delayed diagnoses requiring re-evaluation and further surgical intervention including scar management as well as functional and aesthetic reconstruction.

Skin Cancers and Benign Skin Lesions

In general, skin cancers are named after the normal cell type which has become malignant. The commonest skin cancer occurring in northern European caucasians is basal cell carcinoma (BCC) constituting almost 2/3 of the skin cancers. Squamous cell carcinoma SCC is the next commonest skin cancer diagnosed in Ireland. Whilst it's most diagnosed in paler-skinned patients, either can occur in sallower skinned and darker skinned patients also. Whilst often in the news, Malignant Melanoma, a potentially quite serious type of skin cancer, makes up a relatively small percentage of the patients that see, but one in which the diagnosis and treatment can often be more complex. Advances in the treatment of skin cancers are occurring all the time and newer targeted medications including immunotherapy and more advanced forms of radiotherapy have shown great promise in appropriate patient groups.

Approximately 1 in 3 patients will present with more than one skin cancer at their first appointment and quite often they will not be aware that they have more than the single lesion which they initially presented with to their GP. There are also some gender differences in the way that patients present with skin cancers between males and females. These occur due to clothing choices, hair coverage, occupation, hobbies and from exposure to UV sunbeds (these increase the risk of skin cancer by 100% even with a single use). Very occasionally skin cancers can occur in areas that would not have seen much in the way of sunshine or where people forget to look like on the soles of the feet, between the toes or in relatively frequent site - the back! Common areas for skin cancers are checked routinely checked at clinic once one malignant lesion is noted to ensure they are also included in the plan.

BCC

Once diagnosed correctly either clinically (experienced dermatologists or plastic surgeons can recognise many by their appearance) or with a biopsy (a small sample piece is removed at a minor procedure), surgery is the mainstay of treatment. Following a full surgical excision (with an appropriate margin of normal tissue around the edges and underneath) and providing there are no other high-risk features on the final lab report, spread outside the origin area is extremely rare. Unfortunately, many BCC's can have grown quite large by the time they are diagnosed and treated; indeed, a few of these can even grow into local structures, blood vessels, nerves or lymphatics. Suspicion and a timely diagnosis can be difficult as these often do not appear very worrisome nor do they cause much in the way of pain but tell-tale signs such as gradual progressive growth, a waxing and waning appearance but gradually getting bigger and bleeding on minor contact can be signs of a problem. Very occasionally additional (adjuvant) radiotherapy is needed after surgery to reduce the risk of recurrence.

SCC

Squamous cell carcinoma occurs from a different cell in the skin and the main issues with it relate to how aggressively it acts. The mildest form (well differentiated) tends to act similarly to a BCC, and in most cases is managed by simple surgery alone. At the other end of the spectrum the poorly differentiated type (a more aggressive form) of the disease does have the potential to spread beyond the original site into the lymphatic glands and even beyond around the body but this is only in a small percentage of patients.

Malignant Melanoma

Malignant Melanoma is a type of skin cancer occurring from the pigment cells within the skin “melanocytes”. There are multiple different forms of Melanoma and sometimes they present in quite different ways. Some patients will have had a long-standing lesion/mole which suddenly changes, for others, a new lesion will grow very rapidly where there was nothing to be seen before. Whilst most melanomas are pigmented/colored, usually with shades of brown or even black, some subtypes are in fact not particularly dark and may mimic other skin lesions. The precancerous form of Melanoma, Melanoma-in-situ (Mis), is managed with a surgical excision including a margin of normal skin to ensure that no cells remain which could recur. Once the tumor has reached the point of being considered “invasive”, internationally agreed guidelines are utilized to manage the treatment (including further surgery, specialised tests and potential medical management). Key information needed to guide treatment includes the tumour depth and aggressiveness as well as involvement of lymph glands or spread further to other parts of the body.

Less Common Skin Cancers

There are many other less commonly encountered skin cancers including Merkel cell, pleomorphic dermal sarcoma, atypical fibrous xanthoma, cutaneous angiosarcoma and a host of other extremely rare tumors. Occasionally other systemic tumors can spread to the skin also.

More serious or complex skin cancers are managed in conjunction with a multi-disciplinary team if appropriate. A “skin MDT” framework is where dermatologists, plastic surgeons, oncologists/immunotherapists and our colleagues in radiology and pathology discuss cases and plan tailored treatment using the most up to date international recommendations. Essentially each patient receives several second opinions from experienced specialists in skin cancer without having to actually attend.

Medicolegal Assessments

Mr Sullivan provides independent medicolegal assessments requested by solicitors appropriate to his specialist interests.

All patients attending for a medicolegal assessment will be emailed a form to return prior to their appointment. It is essential that this is completed to ensure that a full account of any injury is obtained, leaving time for a detailed functional examination and thereby avoiding unnecessary delays.

Aesthetic Practice

As a trained plastic surgeon Paul provides assessment, and where appropriate surgical and non-surgical treatment, for a range of aesthetic conditions.

These include, but are not limited to the following:

Congenital conditions, eg prominent ears, facial or body deformities in both adults and children.
Aesthetic breast surgery – breast reduction, augmentation and correction of breast asymmetry.
Post weight loss skin surgery (including post bariatric surgery) – abdominoplasty, brachioplasty, body and thigh surgery.
For other conditions please enquire by email or phone.