Hand and limb reconstruction

We treat scars that adhere to underlying tissues or restrict movement, tissue loss, problems with soft tissue coverage, and changes in shape or function.

At Institut Ruiz Castilla (IRC), we work with orthopaedic surgery, rehabilitation medicine, physiotherapy, neurology, clinical neurophysiology or pain specialists according to your needs. Sometimes we join a team already involved in your care.

We want to understand which activities you find difficult, where you need help and which improvements would matter most to you. Getting dressed, holding a glass or picking up small objects may be priorities, alongside work and other activities.

We combine these priorities with our examination findings while protecting the abilities you retain. Healthy tissue is limited, and some decisions affect the options available for future surgery.

We review how the injury occurred and developed, and compare movement you can perform yourself with movement possible when the limb is assisted. Depending on the findings, we may request imaging or nerve function tests. Not everyone needs the same investigations.

We identify what may improve by releasing a scar and what requires other treatments. Some injuries cannot be fully repaired, while others require a sequence of operations.

We aim to choose the least invasive option that can improve function and provide lasting coverage. This may involve nearby tissue, a skin graft or a flap from another part of the body.

We show you where tissue would be taken from on your own body and use illustrations and photographs to explain scars, changes in sensation and possible limitations. These images help explain the procedure; they do not predict your result.

You may return to work gradually while continuing rehabilitation and physiotherapy. In selected cases, resuming adapted tasks forms part of recovery.

We assess strength, precision, repetitive movements and the demands placed on the affected limb. Working hours, duties or physical loads may need adjustment. Returning to work does not mean that all restrictions have ended.

Alongside movement, strength and sensation, we review which activities you can resume, which have become easier and where you still need assistance.

We revisit the goals agreed with you as rehabilitation progresses, adjusting the plan in response to improvements and difficulties.

Activity restrictions may be minor or require several weeks of protection. The area treated, any skin graft or flap, and the underlying structures involved determine positioning, wound care and movement recommendations.

We coordinate wound protection with rehabilitation medicine and physiotherapy. Movement, stretching and splints are adapted to tissue stability and healing progress.

Scarring of the skin and soft tissues can restrict movement, but tendons, muscles and joints may also have adapted to a longstanding limitation. Releasing the skin does not always restore function immediately.

Rehabilitation and the maturation of internal and external scars continue after surgery. Improvement may be partial and gradual.

Possible complications include delayed wound healing, infection, haematomas, seromas, and partial or complete loss of a skin graft or flap. The risks depend on the individual reconstruction.

Alongside explaining these risks, we discuss how they may be managed: wound care and observation for small affected areas, specific treatments, or further surgery when necessary. The available options depend on the cause, extent and tissues available.

Our nursing team provides wound care as often as needed. The medical team monitors healing and determines whether changes in treatment or further procedures are required.

Once there are no open wounds, pain is controlled and your general health allows, we can plan your return home and arrange continued follow-up, provided this is compatible with the next stages of treatment.

Sun protection, moisturising and scar massage are introduced once the team confirms that the wound has healed sufficiently. Silicone sheets or gel may be recommended depending on the area, the surgical technique and how healing progresses.

Care continues until the scars have matured clinically. Scars do not all mature at the same rate, even in the same person. If a scar becomes raised, firm, itchy or develops unfavourably, the Institut Ruiz Castilla (IRC) team will assess whether specific treatment is needed.

Contact us if you notice increasing pain, persistent bleeding, a rapid change in swelling, spreading redness or increasing warmth, fever, discharge, wound opening or any other change that concerns you. You do not need to decide whether it is a complication: the team will assess it.

Institut Ruiz Castilla (IRC) provides on-call medical support 24 hours a day, seven days a week. Medical and administrative contact numbers are included in your care instructions.

If you experience difficulty breathing, chest pain, fainting or another clear emergency, seek urgent medical attention rather than waiting for a scheduled appointment.