Extremity Reconstruction

Wound coverage involves bring in healthy tissue to cover a wound left behind by cancer, injury, or infection. This can be accomplished with a variety of procedures. Skin grafts are very thin shavings of skin take from a healthy area which are then grafted onto the wound. Initial dressing is left in place for 5 days, followed by daily dressing changes for a few weeks. This is usually performed at home with the assistance of a HomeCare nurse. Skin flaps are usually small pieces of skin and fat that are moved to cover an injured area. Free flaps and pieces of tissue that is transplanted from body area to another. These are used to reconstruct the most complex of problems.

Bone injuries are repaired by allowing the bone to heal. It must be held in place (immobilized) with a cast, or pins, or plate and screws. Plates and screws usually are not removed after the wound heals, while pins/wires are pulled out at four weeks.

Nerve repairs usually require careful suturing under microscopic magnification. Sometimes a nerve graft is used to bridge a gap/defect. In such situations the nerve graft is usually taken from the leg where it leaves a very small area of numbness. It is then grafted into a defect and allowed to heal. Depending on your healing potential (age, smoking, diabetes etc), the injured nerve endings can regrow to recover feeling and movement in your extremity. Nerves usually grow back at 1mm per day, so it usually takes a long time for the nerve function to return.

Tendon are 'strings' that span from the muscle to bone and help muscle create movement. Tendons can be cut or torn, disconnecting muscle from the bone they are supposed to move. This leads to loss of movement. If caught early, it is often possible to simply reattach the separated ends. If there is a delay in treatment, the tendons ends tend to separate permanently and then a tendon graft needs to be harvested from another body area to span the gap. Following this tendon repair, everything has to be immobilized for about 4 weeks. Subsequently, physiotherapy will be required to regain movement and strength. Rehabilitation can take months. Tendons can also get caught in scar tissue, leading to 'adhesions'. In these cases, although they are intact, they cannot move and thus once again lead to loss of movement. Tendon release followed by immediate movement exercises (to prevent re-adhesion from forming) is required to correct this problem.

Hands in particular are very sensitive to even relatively minor injuries. They often require prolonged recovery and patience. Severe injuries in older patients leave permanent deficits.