Limb reconstruction
What is limb reconstruction?
Limb reconstruction aims to maximise the function of a damaged or deformed limb. Limb reconstruction may be required after severe trauma, removal of tumours, or for treatment of chronic wounds and infections. It is a difficult and complex area of orthopaedic and plastic surgery because multiple structures may be involved, including bone, muscle, blood vessels, nerve and skin.
In my practice, limb reconstruction most commonly involves treating open fractures (where the broken bone ends puncture the skin) and complications arising from injuries and their treatment:
Infection, including chronic osteomyelitis
Non-union, where the bones fail to heal
Mal-union, where the bones heal in the wrong position
Exposed metal pins, plates and artificial joints.
Team working
Limb salvage is often a long and complex process for both surgeons and patients. I work in a team with like-minded plastic and orthopaedic surgeons, infection doctors (microbiologists), physiotherapists and occupational therapists to manage these problems holistically.
As a reconstructive plastic surgeon, I can help by transplanting a piece of bone from one part of the body to an area of poor healing, and restoring the blood supply by reconnecting the blood vessels using microsurgery. My microsurgery expertise also helps me reconstruct the peripheral nerves and blood vessels if needed.
If there is bad scarring that breaks down repeatedly, or a wound that hasn’t healed after many months despite standard skin grafts, more advanced plastic surgery techniques may be required.
It is possible to transplant a piece of skin, muscle or bone from one part of the body to the problem area and reconnect its blood supply using microsurgery; this is called ‘free tissue transfer’ or ‘free flap surgery’. This technique brings fresh, healthy tissue to the wound and encourages healing.
Free flap surgery
Free flap reconstruction is major surgery that takes many hours to complete due to the technical challenges involved in handling the tiny blood vessels that have to be dissected out and reconnected. After surgery, it is important to monitor the blood flow within the transplanted piece of skin so that any problems are picked up immediately.
The point at which the blood vessels are rejoined can clot and block blood flow, however it may be possible to re-establish blood flow if the clot is removed within a few hours. If flow cannot be re-established, the transplanted piece of tissue does not survive, and an alternative reconstruction will need to be planned. This is a rare occurence, affecting less than 5% of cases.
Many of the problems that require a free flap are limb-threatening problems, and in that context the surgery is known as limb salvage. Limb salvage is high-risk surgery and if the reconstruction fails, then a well-planned amputation can give a better functional result than keeping a stiff, painful, infected limb.
“The repair to my ankle is unbelievable… I am now back fully fit and active.”
— Peter, 38. Microsurgical reconstruction patient