Concierge ortho-plastic reconstruction · UK
Reconstruction after trauma - rebuilding what an accident took.
Soft-tissue coverage, bone reconstruction, nerve repair, staged flap and fixation work - after road traffic collisions, industrial accidents, sports injuries, dog bites and burns. Plastic and orthopaedic surgeons on the same case, planning the whole arc.
Why patients choose us
- 01
A plastic surgeon and an orthopaedic surgeon in the same room
A named consultant plastic surgeon working shoulder-to-shoulder with orthopaedics - the ortho-plastic model that changes limb-salvage outcomes.
- 02
Acute or delayed - the timing is a decision, not a default
Some wounds need coverage in 72 hours. Some need washing, waiting and staging. We tell you which camp you sit in before you commit.
- 03
Independent, and free
We are paid by no clinic, so whether a local flap suffices or a free flap is worth the extra theatre time is an impartial call.
Indicative pricing
What trauma reconstruction costs privately in the UK.
Ranges scale with complexity - soft-tissue coverage alone, full ortho-plastic limb reconstruction, or a staged rebuild across months. We quote per stage and give a running total.
In short
Full ortho-plastic limb reconstruction: £28,000–£55,000, stay 10–21 nights.
| Procedure | Indicative range | Typical duration | Stay |
|---|---|---|---|
| Debridement and temporary coverage (single stage) | £8,000–£15,000 | 60–150 min | 2–4 nights |
| Local or regional flap reconstruction | £12,000–£22,000 | 2–4 hours | 3–7 nights |
| Free-flap reconstruction (single flap) | £20,000–£38,000 | 6–10 hours | 7–14 nights |
| Ortho-plastic limb reconstruction (fix and flap) | £28,000–£55,000 | 6–12 hours | 10–21 nights |
| Peripheral nerve repair or grafting | £6,500–£18,000 | 2–5 hours | 1–3 nights |
| Staged burn reconstruction (per stage) | £7,500–£22,000 | 2–5 hours | 2–7 nights per stage |
| Consultation and MDT plan | £300–£600 | 45–60 min | Same visit |
Complex staged reconstructions can exceed £40,000 in aggregate over 12–24 months. Where an accident or third-party liability is involved, we help you present the plan to your insurer or solicitor so cover is not the bottleneck.
The problem
The wrong specialty first, the wrong timing second.
Trauma reconstruction is where single-specialty referrals fail. Orthopaedics without plastics, or plastics without orthopaedics, produces slower healing, more infection and worse function. The whole point is joint working from day one.
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Ortho-plastic, not silo working
Fixation planning and coverage planning happen together. The BOAST standard for open fractures is joint working within 12 hours of arrival - we hold to the same bar privately.
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Timing is a clinical decision
Fix and flap inside 72 hours where it fits. Debride and delay where it does not. A default is not a plan.
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Rehab starts before the last stitch
Hand therapy, physiotherapy and prosthetics are booked into the plan alongside the operations - not bolted on when discharge looms.
The journey
From acute injury to full rehab - what happens, in order.
One MDT from first call through staged theatre visits, therapy, revision and refinement across the following twelve to twenty-four months.
Phase 1 · Before surgery
Referral, imaging, MDT plan
Phase 2 · Theatre and stay
Fixation, coverage, critical care
Phase 3 · After
Rehab and revision
- 01
Before
You send us the story
Mechanism (RTC, industrial, sports, dog bite, burn), date of injury, images so far, current dressings, and any surgery already done. Same day if acute.
- 02
Before
We come back with the plan
Within one working day for delayed cases, within hours for acute: the right MDT (plastics, ortho, vascular, ENT, hand), the right timing, and an indicative cost band.
- 03
Before
Imaging, angiography and MDT
CT angiography for potential free-flap donor and recipient vessels, MRI for soft-tissue and nerve mapping, and a joint ortho-plastic MDT before consent.
- 04
Before
Staged plan on paper
A written plan - debridement, fixation, coverage, secondary refinement - with realistic dates. Timing of nerve grafting, bone grafting and revisions built in from the start.
- 05
In hospital
Theatre - often more than once
Debridement and fixation first. Definitive coverage (local, regional or free flap) within 72 hours where possible. Longer, staged reconstructions across weeks or months for complex cases.
- 06
In hospital
Critical-care, HDU or ward
Free-flap patients spend the first 24–48 hours on flap observations every 30 minutes. Fixation-only patients recover on the ward. Length of stay 3–21 nights depending on complexity.
- 07
After
Rehab, revision, refinement
Hand therapy, physio, prosthetics or speech and language as needed. Scar revisions, tendon transfers and secondary reconstructions across the following 12–24 months.
Acute intervention: hours to 72 hours. Full functional recovery: 12–24 months.
When it helps
The injuries we most often reconstruct.
The eight commonest referrals we see, plus the one red flag that means a major trauma centre right now - not private admission.
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Road traffic collision injuries
Open tibial fractures, degloving of the leg or forearm, facial fractures with soft-tissue loss - the classic ortho-plastic caseload.
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Industrial and crush injuries
Roller, press and blast injuries - often multi-tissue, often needing early debridement, staged coverage and later refinement.
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Sports trauma
Complex fractures, ligament and tendon injuries, high-energy contact sports and cycling collisions. Aim: return to function, not just healing.
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Dog and animal bites
Face and hand bites carry high infection risk. Wash, delay closure where prudent, and reconstruct with an eye on cosmetic result and nerve preservation.
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Burns - acute and delayed
Deep partial and full-thickness burns needing grafting, plus late reconstruction of scar contractures, hair-bearing areas and functional joints.
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Amputation and stump revision
Whether to salvage or amputate is an MDT call. When amputation is right, we plan a well-shaped, prosthetic-ready stump - not a last-minute salvage.
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Nerve and brachial plexus injury
Peripheral nerve repair, grafting, nerve transfers and, for plexus injuries, a specialist plexus team - timing matters, weeks not months.
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Red flag: threatened limb or exposed vessel
A cold, mottled or pulseless limb, or bone or vessel visible in the wound, is an emergency - this is a blue-light transfer to a major trauma centre, not a routine referral.
Procedure options
The reconstructive ladder - from simple to microsurgical.
What each technique involves, and when to reach for it. The right rung is the simplest one that reliably solves the problem - not the most technically impressive.
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Local flap
Tissue moved from immediately adjacent to the wound - rotation, advancement or transposition flaps. Fastest and simplest; best where nearby skin quality is good.
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Regional flap
Tissue moved on a known blood supply from further away - pedicled latissimus, gastrocnemius, sural or radial forearm. Robust for medium-sized defects.
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Free flap
Tissue harvested with its artery and vein, transferred to the defect and re-anastomosed under microscope. ALT, DIEP, fibula, gracilis - chosen to match the tissue lost.
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Bone reconstruction
Autograft, allograft, vascularised fibula, distraction osteogenesis (Ilizarov/TSF) or induced-membrane (Masquelet). The right choice depends on defect length and infection status.
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Nerve repair and grafting
Direct microsurgical repair when nerve ends meet without tension. Sural nerve graft, nerve conduits or nerve transfers when a gap or delay makes primary repair impossible.
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Tendon and ligament repair
Primary repair when possible; tendon graft or transfer when delayed. Ligament reconstruction for high-energy joint injuries - often staged with cartilage work.
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Skin grafting
Split-thickness or full-thickness grafts for smaller defects where vascularity is good and cosmesis less critical. Often used to close flap donor sites.
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Staged reconstruction
For destructive injuries: debride and stabilise, then cover, then refine. Two, three or four planned theatre visits across weeks and months, agreed with you before the first.
Our vetted UK network
A small panel of ortho-plastic teams, we picked them.
Consultant plastic and orthopaedic surgeons across London and the major UK cities, with microsurgery volume and a hand-therapy pathway on site.
Selection criteria
How we choose every surgeon and team in our network.
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Consultant plastic surgeons with microsurgery and free-flap volume
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Ortho-plastic MDT working - plastics and orthopaedics on the same case, same day
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Access to major trauma centres for limb-salvage emergencies
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On-site hand therapy, physiotherapy and prosthetics for the recovery arc
Safety and recovery
What to expect afterwards - honestly.
Trauma reconstruction is a long game. The specific risks - flap failure, non-union, nerve recovery - are the ones worth planning for, not general reassurance.
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GA in a theatre set up for microsurgery
Free-flap cases run 6–10 hours under a stable GA with active warming, arterial line and often HDU or critical care postoperatively. This is not a day-case environment.
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Flap failure is the specific risk
Total or partial flap loss occurs in around 2–5 percent of free flaps in experienced units. The first 48 hours of flap observations exist to catch and salvage a compromised flap in theatre.
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Bleeding, haematoma, infection
Standard surgical risks apply, higher in contaminated trauma wounds. Prophylactic antibiotics, active drainage and a low threshold for return to theatre are all normal.
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Donor-site morbidity
Every flap costs the donor site something - a scar, sometimes a functional deficit (weakness, sensory change). Choice of flap balances what the recipient needs against what the donor can afford.
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DVT, PE and mobilisation
Prolonged surgery plus lower-limb injury raise thrombosis risk. Chemical prophylaxis, compression and structured early mobilisation are the standard mitigation.
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Nerve recovery is slow and partial
Peripheral nerves regenerate at roughly 1 mm per day. Sensation and power return over 12–24 months, and recovery is rarely complete. Expectations set early prevent disappointment later.
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Bone healing and non-union
Complex fixations and long segmental defects carry meaningful non-union rates. Staged bone grafting, vascularised bone and distraction techniques exist for exactly these cases.
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Psychological load is real
Trauma reconstruction is a marathon. Access to a clinical psychologist is not an add-on - it is part of good care, particularly for facial injury, amputation and paediatric cases.
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Red flags after surgery
A cool, dusky or pale flap, unexpected bleeding, fever above 38.5°C, severe uncontrolled pain, calf pain or breathlessness need the same-day team or A&E - not a routine call.
Reading your operation note
Your reconstruction note in four parts. Read the last one first.
Whichever surgeon leads the case, the note that lands in your inbox keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly - we translate it for you.
If you would like us to walk you through the operation note and the staged plan, just ask.
- 01 Header
Mechanism, tissues lost, timing
Injury mechanism, which tissues were lost or damaged, whether coverage was acute (within 72 hours) or delayed, and the staged plan.
- 02 Technique
Fixation, flap and microvascular detail
Fixation used, flap chosen and why, donor site, artery and vein anastomosed, ischaemia time, use of vein grafts, and any nerve or bone work done at the same sitting.
- 03 Findings
Perfusion, viability, next stage
Intra-operative flap perfusion, any concerns, immediate post-op flap check, and the planned interval to the next stage of reconstruction.
- 04 Impression
Rehab, follow-up, revision timeline
Read this first: hand therapy or physio start date, weight-bearing status, expected timeline for scar revision, nerve regeneration monitoring and further surgery.
Recognised by major UK insurers
Trauma reconstruction is usually covered when medically indicated. Personal accident and third-party liability policies may carry higher limits. We confirm cover before booking.
Frequently asked
Everything we get asked about trauma reconstruction.
Straight answers on timing, technique, cost, insurance and the long recovery arc.
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Should the reconstruction happen straight away or later?
It depends on the wound. High-energy open fractures and clean facial injuries do best with early coverage - the "fix and flap" model within 72 hours reduces infection and non-union. Contaminated, ischaemic or borderline wounds are better washed, staged and covered in a planned second or third theatre visit. The right timing is decided by the ortho-plastic team, not by a default protocol.
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What is the difference between a local, regional and free flap?
A local flap moves tissue from immediately next to the wound. A regional flap moves tissue on a known blood supply from a bit further away - for example a gastrocnemius flap for a knee wound. A free flap harvests tissue with its own artery and vein and re-anastomoses them under a microscope at the recipient site. Free flaps are the most versatile but the longest and highest-stakes operation.
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How much does trauma reconstruction cost privately in the UK?
Single-stage debridement and coverage sits around £8,000–£15,000. A local or regional flap is £12,000–£22,000. A single free flap is £20,000–£38,000. A full ortho-plastic limb reconstruction - fix and flap plus critical care - is typically £28,000–£55,000. Complex staged reconstructions across multiple visits can exceed £40,000 in aggregate.
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Will private medical insurance cover it?
Trauma reconstruction is usually covered when medically indicated, particularly following an accident that is documented with imaging and A&E records. Personal accident and travel insurance policies sometimes carry higher limits. We check cover, precedence and any excess directly with the insurer and quote self-pay for anything outside the policy.
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How long is recovery?
Free-flap patients spend 7–14 nights in hospital, weeks with restricted activity, and 6–12 months regaining full function. Nerve regeneration continues at roughly 1 mm per day, so power and sensation return over 12–24 months. Scar and functional revisions may be planned into the second year. Return to work depends entirely on the injury and the job.
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When is amputation the right answer?
When limb salvage would leave a limb that is more painful, less functional or less durable than a well-shaped stump with a modern prosthesis. Scoring systems (MESS, NISSSA) inform but do not decide it - the decision belongs to a joint ortho-plastic team, with input from prosthetics and the patient. When amputation is chosen early it can restore mobility faster than a years-long salvage.
Related treatments
Looking for something else?
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Nerve reconstruction
Peripheral nerve repair, grafting and transfers.
Learn more -
Hand and wrist ligament reconstruction
Restoring hand function after ligament injury.
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Ear reconstruction
Auricular reconstruction after trauma or bite injuries.
Learn more -
Craniofacial surgery
Facial skeletal reconstruction after complex injuries.
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Hand surgery for Dupuytren’s disease
Hand contracture surgery - a different pathway.
Learn more -
All tests & procedures
Every test and procedure we arrange.
Learn more