Complex injuries/Reconstruction

Injuries to individual structures such as tendons, bones or nerves, have a predictable recovery pattern. However, when these structures are all injured at the same time, the situation becomes more complicated.

For instance, if you have a broken bone, the treatment would usually be to rest the injured part in a plaster cast to prevent movement and allow healing in a good position. A cut tendon, alternatively, can be surgically repaired and then moved at an early stage to reduce the chances of scar tissue. If these two injuries occur at the same time, the surgeon must decide between moving or immobilising the hand. That means that different decisions may need to be taken (in this example, the fracture would be fixed with pins or screws to allow early movement). This makes the situation, the treatment and the outcome much more complex and prone to further complications.

As a result, surgeons will often opt to perform an operation more frequently in these circumstances, in order to gain some control over the rehabilitation plan.

In some more serious injuries, tissues are actually no longer present. Either the injury has removed them, or they are so badly damaged that the surgeon must remove them to prevent infection. In these cases, a decision is made about whether or not it is possible to either replace the tissue (from elsewhere in the body) or replace the function of the tissue (if it was critical).

Skin can be replaced by taking skin from a donor area elsewhere in the body. A thin layer of healthy skin can be shaved off part of the thigh and laid on a clean open area. This is called a split skin graft. Should the wound be much deeper, or should that particular area of the body need a thicker, softer piece of skin, then a piece of skin with its underlying layers can be taken from specific sites in the body and moved, still attached to its blood supply, to fill the defect. This called a pedicled graft. On occasions, no such tissue is available near the injured area and a piece of tissue from a distant site in the body (called a free tissue transfer) is removed with its blood vessels. These vessels are then joined to vessels in the injured area by microsurgery, so that the donor piece of tissue retains its healthy blood supply and allows healing to continue.

Bone is a dynamic and living structure which needs a healthy blood supply to survive. Lost bone can be replaced by a bone graft - either taken as pieces from the hip area and placed in the defect, or even as a vascularised bone graft, transferred with its own blood supply.

There are a number of 'spare' tendons in the body, whose lost function will not be missed. These can be used to replace pieces of tendon lost in the injury.

Unfortunately, there are no 'spare' nerves. Taking a nerve graft will always result in a deficiency in the area it came from. There are, however, a number of areas where loss of feeling is less conspicuous, and these regions would be selected if a nerve graft was required.