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Private lower limb reconstruction in the UK, by an orthoplastic team.

Open fractures, bone loss, deformity, non-union and chronic infection are not orthopaedic problems or plastic surgery problems - they are both. The single strongest predictor of a good outcome is being treated by a combined orthoplastic team.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private lower limb reconstruction costs in the UK.

Indicative ranges across our partner orthoplastic centres.

In short

A free flap reconstruction: £15,000–£30,000, with 7–14 nights in hospital.

Procedure Indicative range
Orthoplastic consultation (joint) £400–£700
CT + CT angiography planning £900–£1,600
Circular frame application £12,000–£22,000
Free flap soft tissue reconstruction £15,000–£30,000
Non-union revision + bone grafting £10,000–£20,000
Chronic osteomyelitis debridement £9,000–£18,000

Reconstruction is almost always staged, so the total cost is the sum of several procedures over months rather than a single figure. Frame treatment adds months of outpatient review and radiographs. Severe open fractures and limb salvage are managed extremely well within the NHS major trauma network, which is usually the right route for acute injury - private care is more often used for reconstruction of long-standing problems, second opinions and deformity correction.

The problem

Bone and soft tissue have to be solved together.

The commonest reason a severe leg injury ends badly is that the bone was fixed before anyone planned how it would be covered. Orthoplastic care - one plan, both specialties, from the first operation - changed outcomes in the UK more than any single technique.

  • Fracture that has not healed?

    Non-union has a cause - infection, instability, poor blood supply or a gap. Identifying which one is the entire job before revising anything.

  • Facing an amputation?

    A second opinion at a specialist orthoplastic centre is always worth having. So is an honest discussion of when a good prosthesis beats a salvaged limb.

  • Long-standing infection in the bone?

    Chronic osteomyelitis needs radical debridement and dead space management, not another course of antibiotics on top of the last one.

When it helps

When reconstruction is the right route.

The problems that orthoplastic surgery solves, the ones where amputation gives better function, and the sign that means an emergency.

  • Open tibial fracture with soft tissue loss

    Gustilo IIIB and IIIC injuries where bone is exposed. These need skeletal stabilisation and flap cover planned together, ideally within 72 hours.

  • Non-union and malunion

    A fracture that has failed to heal, or healed in the wrong position. Treatment depends entirely on whether infection, instability or poor blood supply is the cause.

  • Segmental bone loss

    A gap in the bone after trauma, infection or tumour resection. Bone transport, the Masquelet technique or vascularised fibular transfer can bridge substantial defects.

  • Chronic osteomyelitis

    Long-standing bone infection with sinuses or sequestrum. Cure requires radical debridement and dead space management, not antibiotics alone.

  • Post-traumatic deformity

    Angular or rotational deformity and limb length discrepancy after injury, corrected acutely with osteotomy or gradually with a hexapod frame.

  • Congenital limb deformity

    Congenital short femur, tibial bowing, fibular hemimelia and similar conditions, usually managed through childhood and adolescence in staged procedures.

  • Limb salvage versus amputation

    Where the limb can be saved but function may be poorer than with a prosthesis. That is a decision for the patient, made with full information about both routes.

  • Red flag: compartment syndrome, dying flap

    Severe unrelenting pain out of proportion to the injury, pain on passive stretch, or a flap turning white or dusky - emergency surgery within hours, not a clinic call.

Procedure options

The techniques that make salvage possible.

What each technique involves - and which defect it is designed to solve.

  • Free tissue transfer (free flap)

    Muscle or skin with its own blood supply moved from elsewhere and joined to leg vessels under a microscope. The anterolateral thigh, gracilis and latissimus flaps are the workhorses.

  • Local and pedicled flaps

    Tissue moved from adjacent to the defect on its own blood supply - gastrocnemius, soleus and perforator flaps. Simpler than free tissue transfer where the defect allows.

  • Circular frame and bone transport

    An Ilizarov or hexapod frame gradually moves a segment of bone across a gap, growing new bone behind it. Roughly one month of frame time per centimetre transported.

  • Masquelet induced-membrane technique

    A cement spacer is placed in the defect to induce a biological membrane, then replaced with bone graft at a second stage six to eight weeks later.

  • Vascularised fibular transfer

    A segment of fibula with its own blood supply transplanted into a large bone defect. It heals as living bone rather than as a graft, and hypertrophies over time.

  • Deformity correction

    Acute correction by osteotomy and internal fixation, or gradual correction with a computer-assisted hexapod frame where the deformity is large or the soft tissues are tight.

  • Osteomyelitis debridement and dead space management

    Radical excision of infected bone, with local antibiotic-eluting carriers filling the dead space, alongside prolonged targeted systemic antibiotics.

  • Elective amputation with prosthetic planning

    Sometimes the better functional outcome. A well-performed amputation with modern prosthetics can beat a painful, stiff, repeatedly operated limb - and deserves honest discussion.

Safety and recovery

What reconstruction actually asks of you.

Limb reconstruction is a long road measured in months and multiple operations rather than a single procedure. The commitment it asks for is the thing most often underestimated, and it deserves stating plainly at the outset.

  • Flap failure

    Total free flap failure occurs in roughly 3 to 5 per cent, and partial failure more often. The first 48 to 72 hours are critical, which is why monitoring is hourly.

  • Infection and recurrence

    Deep infection is the commonest complication in reconstruction, and osteomyelitis can recur years later. Radical debridement rather than antibiotics is what determines cure.

  • Pin site infection with frames

    Almost universal to some degree during frame treatment. Most respond to pin site care and oral antibiotics; a minority need pin exchange.

  • Non-union of the docking site

    After bone transport, the point where the transported bone meets the other end often needs an additional procedure with bone grafting to unite.

  • Joint stiffness and muscle wasting

    Months of restricted weight-bearing and frame wear cause stiffness in the knee and ankle. Physiotherapy throughout treatment, not just at the end, is what limits it.

  • Chronic pain and nerve injury

    Neuropathic pain is common after severe limb trauma and reconstruction. Early involvement of a pain specialist changes outcomes more than late referral.

  • The time and psychological cost

    Frames worn for six to twelve months, several planned operations and long periods off work take a genuine psychological toll. Support is part of good care, not an extra.

  • Salvage may not beat amputation

    Some reconstructed limbs end up painful, stiff and less functional than a well-fitted prosthesis. Being told this honestly beforehand is essential to a real choice.

  • Red flags at any stage

    Severe unrelenting pain, a flap turning pale or dusky, spreading redness, fever, or discharge from a pin site or wound - contact the unit or go to A&E the same day.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whichever stage of reconstruction it covers, the note your surgical team writes keeps to the same shape.

A UK orthoplastic surgeon reviewing limb reconstruction imaging and operation notes with a patient

A quiet reminder

Surgical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the note before your review, just ask.

  1. 01 Header

    Injury, defect and staged plan

    The original injury or condition, the size and nature of the bone and soft tissue defect, and where this operation sits within the overall staged plan.

  2. 02 Technique

    What was done at this stage

    Debridement extent, fixation used, frame configuration, which flap was raised and to which vessels it was anastomosed, and any bone graft or antibiotic carrier placed.

  3. 03 Findings

    Intraoperative findings and microbiology

    The state of the bone and soft tissues, tissue viability, deep samples taken and the organisms identified, which determines the antibiotic plan.

  4. 04 Impression

    Recovery, weight-bearing and next stage

    Read this first: weight-bearing status, frame adjustment schedule, physiotherapy plan, and when the next stage of reconstruction is expected.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for limb reconstruction varies considerably. Insurers generally fund reconstruction following an acute covered injury, but complications of a pre-existing condition, staged procedures over many months and long rehabilitation are frequently limited or excluded. Severe open fractures are treated within the NHS major trauma network, which is the appropriate route for acute injury.

Frequently asked

Everything we get asked about lower limb reconstruction.

Quick answers on how long it takes, frames, salvage versus amputation, and what recovery really looks like.

  • How long does limb reconstruction take?

    Typically six to eighteen months across several planned stages, and sometimes longer. Bone transport alone takes roughly one month of frame time for each centimetre of bone being moved, plus a consolidation period afterwards. This is a programme rather than an operation, and understanding that at the outset makes the process considerably easier to live with.

  • What is an orthoplastic team and why does it matter?

    It is orthopaedic and plastic surgeons planning and operating together rather than sequentially. In severe open fractures, deciding how the bone will be covered before fixing it - rather than after - measurably reduces infection, non-union and amputation rates. UK guidance now recommends this model for severe open lower limb injury, and it is the single most useful thing to ask about.

  • How much does private lower limb reconstruction cost?

    A free flap reconstruction runs £15,000–£30,000 and a circular frame application £12,000–£22,000. Non-union revision with bone grafting is £10,000–£20,000 and osteomyelitis debridement £9,000–£18,000. Because reconstruction is staged, the total is the sum of several procedures.

  • What is it like living with a circular frame?

    Demanding but manageable. The frame is worn for months, needs daily pin site cleaning, and makes sleeping, dressing and driving awkward. Most people can weight-bear and walk in it, and many return to sedentary work. Pin site infection is near-universal to some degree and usually settles with pin care and antibiotics.

  • Is saving the limb always better than amputation?

    No, and any surgeon who says otherwise is not giving you a real choice. Some reconstructed limbs end up painful, stiff and less functional than a well-fitted modern prosthesis, after years of operations. The honest comparison is between function, pain, time and number of procedures on each route - and the decision belongs to you.

  • Why has my fracture not healed?

    Non-union always has a cause, and identifying which one matters more than the revision technique. The four to look for are infection, mechanical instability, poor blood supply and a gap too large to bridge. Deep tissue sampling, CT and careful clinical assessment establish which is operating before anything is revised.

  • Can chronic bone infection be cured?

    Yes, in most cases, but only with radical surgical debridement of all infected and dead bone, proper management of the resulting dead space with antibiotic carriers or bone graft, and targeted systemic antibiotics guided by deep tissue samples. Repeated antibiotic courses without surgery suppress it temporarily and rarely cure it.

  • Will I be able to walk normally afterwards?

    It depends heavily on the injury, the joints involved and how much muscle and nerve was lost. Many people return to independent walking without aids, though a limp, some stiffness and reduced stamina are common. Reconstruction aims for a functional, pain-free, infection-free limb rather than a limb identical to the original.

  • Should this be done on the NHS?

    For acute severe open fractures, almost certainly yes - the UK major trauma network delivers orthoplastic care to a very high standard and has specific time targets for debridement and flap cover. Private care is more useful for reconstruction of long-standing problems, deformity correction, second opinions, and choosing a particular surgeon.

  • When should I seek emergency help?

    Severe unrelenting pain out of proportion to the injury, or pain on passive stretching of the toes, can mean compartment syndrome - an emergency needing surgery within hours. After a flap, any change to pale, dusky or cold tissue needs immediate contact with the unit. Fever, spreading redness or wound discharge all need same-day assessment.

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