Reconstruction may be considered after trauma, burns, tumour removal, chronic wounds, infection, congenital differences or complications of earlier surgery. Common goals include restoring durable skin coverage, filling a tissue deficit, releasing a contracture, protecting bone or tendon and improving movement or proportion. Scar revision surgery is only one part of this wider field.
The surgeon first defines what is missing or impaired: skin, fat, fascia, muscle, tendon, nerve, bone or several tissue layers. The plan also considers circulation, sensation, infection, prior radiation, smoking, diabetes, mobility and the patient's priorities. Reconstructive planning often follows a “ladder”, beginning with the least complex method capable of achieving stable repair rather than automatically choosing the largest operation.
| Method | Typical role | Key consideration |
|---|
| Direct closure or scar revision | Selected small defects or restrictive, painful or conspicuous scars | Does not erase a scar; it exchanges or repositions it |
| Skin graft | Covers a prepared wound using skin moved without its own blood supply | Needs a suitable wound bed and differs in colour, texture and contraction |
| Local or regional flap | Moves nearby tissue while retaining an attached blood supply | Creates both a reconstructed area and a donor-area scar |
| Free flap / microsurgery | Transfers tissue from another body area and reconnects small blood vessels | Requires specialist facilities, monitoring and a longer recovery |
Timing and technique must be coordinated with the oncology team so reconstruction does not compromise diagnosis, cancer treatment or surveillance. Breast reconstruction after lumpectomy or mastectomy has its own detailed guide covering implants, autologous tissue and immediate versus delayed timing. Read the breast reconstruction guide.
A mature scar may be revised when it restricts movement, repeatedly breaks down, causes symptoms or can reasonably be placed in a more favourable direction. Options can include excision and re-closure, geometric rearrangement, grafting or flap coverage. Burn reconstruction may also require contracture release and staged treatment. No operation can make a scar disappear, and immature scars may need time or non-surgical management before revision is considered.
Suitability depends on the underlying diagnosis, realistic reconstructive goals and the ability to heal. Active infection, unstable disease, poor circulation, uncontrolled medical conditions, smoking or inadequate nutrition may require treatment before elective reconstruction. Some urgent wounds need a different sequence. Complex cases may involve oncology, orthopaedics, hand surgery, vascular surgery, rehabilitation or wound-care specialists.
Preparation may include imaging, wound cultures, pathology review, blood tests, vascular assessment, photographs and coordination with other clinicians. Medicines, supplements, nicotine use and allergies must be disclosed. Patients should understand the donor site, possible staged operations, expected dressings or drains, activity limitations and the rehabilitation plan before consent.
Aftercare is determined by the tissues moved and the function being protected. It may include wound checks, flap monitoring, splinting, pressure relief, physiotherapy, occupational therapy or scar management. Swelling, bruising, tightness and altered sensation are common early effects. Return to work and exercise can range from days to months; the operating team provides individual clearance.
Risks include bleeding, infection, wound separation, delayed healing, fluid collection, visible scars, altered sensation, stiffness, asymmetry, contour difference, donor-site problems and anaesthetic complications. A graft or flap can partly or completely fail if its blood supply is inadequate, which may require urgent or additional surgery. Reconstruction aims to improve form or function but cannot restore tissue to exactly its pre-injury state.
Cost depends on diagnosis, procedure complexity, staging, anaesthesia, facility, hospital stay, dressings, rehabilitation and multidisciplinary care. A written quotation requires examination and a defined plan. When choosing a surgeon, verify recognized plastic-surgery training, active licensing, experience with the required technique, hospital privileges, complication arrangements and continuity of follow-up.
