Reconstructive Surgery
Surgery to restore form and function after injury, disease, congenital conditions or previous surgery
What is reconstructive surgery?
Reconstructive surgery rebuilds tissue that has been lost, damaged or never fully formed, with the aim of restoring how a part of the body works and how it looks, in that order. The tissue may be missing after an injury, after a burn, after an infection, after the removal of a tumour, or after an operation that did not heal as planned.
Surgeons think about it as a ladder. The simplest option that will give a good result is chosen first: closing the wound directly, then a skin graft taken as a thin sheet from elsewhere, then a flap of skin and fat moved from next door while keeping its own blood supply, and at the top a free flap, in which tissue is detached completely from a distant part of the body and its artery and vein are joined to vessels at the new site under a microscope. Each rung asks more of you and offers more in return.
Most reconstruction is planned in stages over months. A first operation restores the structure and coverage, and later, smaller operations refine the shape, release tightness and improve the scars. Knowing that the plan has stages from the beginning makes the middle of it much easier to live through.
What it involves
The operation is done under general anaesthetic, so you are asleep throughout. You will be seen by the anaesthetist beforehand and asked not to eat for about six hours.
How long it takes depends entirely on which rung of the ladder you are on. A skin graft may take under an hour; a local flap one to three hours; a free flap with microsurgery commonly six to ten. Where tissue is taken from elsewhere, that donor site is closed at the same operation and is often sorer afterwards than the reconstructed area itself. Drains are frequently left in for a few days, and the reconstructed part may be splinted or immobilised.
This is Inpatient surgery. After a free flap the circulation in the transferred tissue is checked every hour for the first two to three days, day and night, because a blocked vessel found early can be rescued in theatre and one found late cannot. Expect several nights in hospital after a straightforward reconstruction and up to two weeks after a complex one.
Recovery
Recovery runs in months, and it separates into three parts that heal at different speeds. The wounds close in two to three weeks. The deeper healing, during which the tissue tolerates being used, takes six to twelve weeks. The scars mature, softening and fading from red to pale, over twelve to eighteen months, and the appearance at three months is not the appearance you will end up with.
Expect the donor site to demand more attention than you anticipated, particularly a skin graft donor area, which stings and weeps for one to two weeks. Follow the instructions on positioning, splints and elevation exactly; swelling is what most often delays things.
Therapy is part of the treatment and not an add-on, especially for reconstruction of a hand, a limb or the face. Most people return to desk work between two and six weeks depending on the site, and to heavy or manual work at around three months. Scar massage and sun protection begin once the wounds are fully closed and continue for a year.
Questions about reconstructive surgery
Will this be done in one operation?
Usually not. Reconstruction is generally planned in stages over months: a first operation to restore the structure and cover the defect, then smaller ones to refine the shape, release tightness, thin bulky tissue and improve the scars. Two to four stages is common and complex cases take more. That is a plan and not a sign anything has gone wrong, and knowing it from the outset makes the middle of the process far easier to live through. Ask your surgeon to sketch out the whole sequence at the first consultation, with rough timings and what each stage is for, so you can plan work and family life around it.
Why take tissue from somewhere else on my body?
Because some wounds have nothing left to close over them. A thin skin graft survives by soaking up nutrients from the bed beneath it, so it needs a healthy, well-supplied surface and will not take over exposed bone, tendon or metal. A flap brings its own blood supply with it, either by staying attached to nearby tissue or, in a free flap, by being detached completely and having its artery and vein stitched to vessels at the new site under a microscope. That makes it tough enough to cover anything and to tolerate radiotherapy. Your surgeon chooses the simplest option that will actually work, since every donor site has a cost of its own.
How bad will the scars be?
There will be scars, at the reconstructed area and at the donor site, and a surgeon's skill shows in where they are placed more than in whether they exist. They follow a predictable course: firm, raised and red for two to three months, then softening and fading over twelve to eighteen months, so what you see at three months is not the result. Massaging them with a bland moisturiser for a few minutes twice a day once the wounds are fully closed, silicone sheets or gel, and keeping them out of the sun for the first year all measurably help. Thickened or keloid scars are commoner in darker skin and are treatable, so raise it early instead of waiting.
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InpatientTalk to a care coordinator about reconstructive surgery
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one