Lloyd P. Champagne, MD

Reconstruction

Complex Wounds

Wounds of the hand and upper limb that will not close on their own and need both a reason and a plan.

A wound that has not healed in the expected time is not simply a slow wound. Something is preventing it - missing tissue, infection, poor blood supply, exposed structure, or a general factor affecting healing.

Reconstruction begins with identifying that reason. Coverage applied over an unaddressed cause tends to break down again.

What the problem looks like

  • A wound open for weeks despite dressings
  • Exposed bone, tendon or hardware
  • Wound breakdown after previous surgery
  • Recurrent infection at the same site
  • Wounds in tissue that is scarred or has been operated on before

Loading anatomy

Principles

How this kind of reconstruction is approached

These are the principles that guide planning. What any individual reconstruction involves depends on the specific problem.
  1. 01

    Find the reason

    Infection, dead tissue, poor blood supply, exposed structure and general health factors each prevent healing in different ways, and each needs addressing on its own terms.

  2. 02

    Prepare the bed

    Thorough removal of non-viable and infected tissue comes before closure. This is often the step that determines whether reconstruction holds.

  3. 03

    Treat the patient, not only the wound

    Glucose control, nutrition, smoking and circulation all affect healing, and optimising them is part of the surgical plan.

  4. 04

    Choose durable coverage

    The coverage has to survive where it is placed and withstand what the hand does. That, not simplicity, drives the choice.

Clinical detail

Assessment includes evaluation for osteomyelitis where bone is exposed or previously instrumented, and vascular assessment where perfusion is in question.

Negative-pressure wound therapy is used as a bridge and adjunct rather than as definitive management where structures are exposed.

Hardware exposure is managed according to fracture union, infection status and the stability required, with removal, exchange or coverage decided case by case.

Related conditions

All reconstruction categories · Revision & secondary surgery

Discuss complex wounds

Consultations begin with understanding your symptoms, what you can no longer do comfortably, and what has already been tried.

Request an AppointmentRefer a complex case