Lloyd P. Champagne, MD

Reconstruction

Rebuilding a working hand.

Reconstructive surgery addresses what an injury, a disease process or a previous operation has left missing or not working - usually across more than one tissue system at once.

The approach

The hand is more than bone.

Hand surgery is practised by surgeons from orthopaedic, plastic and general surgical backgrounds, each bringing a different emphasis. Dr. Champagne's training is in plastic surgery, hand surgery and microsurgery - which means the covering, the blood supply and the small structures are considered alongside the skeleton from the outset.

  1. Skin

    The covering has to be durable where the hand grips and thin where it bends. Coverage is not cosmetic - it determines what can be done underneath.

  2. Soft tissue

    The fat and fascia that let skin glide over tendon. When this layer scars, a hand stiffens even where everything else was repaired well.

  3. Tendon

    Power transmitted from the forearm. A tendon has to be intact and free to glide; either alone is not enough.

  4. Nerve

    Sensation and muscle control. Nerves recover slowly and on their own timetable, which shapes when other reconstruction is worth doing.

  5. Blood vessels

    Everything else depends on this. No reconstruction survives on tissue without a blood supply.

  6. Bone

    The frame the rest works against. Stability early is what allows movement early.

  7. Function

    The point of all of it. A hand that has healed but cannot do anything has not been reconstructed.

Loading anatomy

Categories

Areas of reconstructive practice

Each page explains the principles behind that kind of reconstruction in plain language, with clinical detail available underneath.

Reconstruction case studies

How a complex problem is approached

Case studies are presented as clinical reasoning - the problem, what made it difficult, the reconstruction and the recovery. They are published only with documented patient consent.
  • Problem
    The presenting injury or condition.
    Challenge
    What made this reconstruction difficult.
    Reconstruction
    The approach taken, and why.
    Recovery
    The rehabilitation course and timeline.
  • Problem
    The presenting injury or condition.
    Challenge
    What made this reconstruction difficult.
    Reconstruction
    The approach taken, and why.
    Recovery
    The rehabilitation course and timeline.
  • Problem
    The presenting injury or condition.
    Challenge
    What made this reconstruction difficult.
    Reconstruction
    The approach taken, and why.
    Recovery
    The rehabilitation course and timeline.

No case material, photography, radiograph or outcome appears on this site unless it is real and consented. Nothing on this page is illustrative of a specific patient.

Reconstruction is usually staged

A severe injury is rarely reconstructed in a single operation, and that is not a sign that something has gone wrong. After serious trauma the extent of tissue damage declares itself over days, and each stage of reconstruction needs to be built on tissue that is healthy and stable.

Staging also allows the sequence to be chosen deliberately: circulation before skeleton, skeleton before tendon and nerve, and durable coverage before movement is pushed. Later procedures - releasing scar, freeing a tendon, reconstructing a nerve - are planned as part of the arc rather than treated as failures of the first operation.

What any individual reconstruction involves, how long it takes and what it can achieve depends entirely on the specific injury. Request a consultation to discuss a particular problem.

Discuss a complex reconstruction

For patients and for referring physicians with a complex hand or upper-extremity problem.

Request an AppointmentRefer a patient