Repair of traumatic injuries: what to do and what to expect

Reconstructive surgery repairs what injury has damaged: skin, tendons, nerves, vessels and bone, and the function that depends on them. Unlike aesthetic surgery, most of this work is urgent — for several of these injuries the result depends on hours, not weeks.

What we repair

• Hand and forearm injuries: cut tendons, divided nerves, crush injuries
• Amputated fingers and limbs — replantation with microsurgery, when the injury allows it
• Deep cuts and tissue loss needing grafts or flaps
• Burns, and later the scars and contractures they leave
• Facial soft-tissue injuries
• Wounds that will not heal, including pressure sores

Why timing matters

A cut tendon retracts; a divided nerve begins to change at its far end; an amputated part survives on a clock. Some repairs that are straightforward on the first day become far harder — or impossible — weeks later. If you have an injury of this kind, the emergency department is the right place, not an outpatient appointment.

What to do at the scene

• Bleeding: press firmly on the wound with a clean cloth and raise the limb. Do not apply a tourniquet unless bleeding cannot be controlled any other way.
• An amputated finger or limb part: wrap it in clean, slightly damp gauze, put it in a sealed plastic bag, and place that bag on ice. Never put the part directly on ice or in water — direct contact with ice damages the tissue and can make replantation impossible. Bring it with you.
• Burns: cool with running lukewarm water for about twenty minutes. Do not apply toothpaste, yoghurt or ointment. Do not burst blisters.
• Embedded objects: leave them in place and come as you are.
• Note the time of injury and, for machinery or dirty wounds, bring any information about the mechanism. Your tetanus status will be asked.

If bleeding is heavy, a limb is cold or pale, or consciousness is affected, call 112. Ambulance teams begin treatment on the way.

Assessment

Examination establishes which structures are injured — a wound that looks small can hide a divided tendon or nerve. Imaging is performed in our own radiology unit, and surgery follows in the same building when it is needed urgently.

Repair and recovery

Repairs range from careful wound closure to microsurgery under a microscope for vessels and nerves. Recovery is not finished when the wound closes:

• Tendon repair: splinting and a supervised hand-therapy programme for weeks; moving too early ruptures the repair, moving too late stiffens the hand.
• Nerve repair: regrowth is slow — roughly a millimetre a day — so sensation returns over months, and not always completely.
• Replantation: survival of the part is the first goal; useful function comes later, with therapy, and is rarely identical to before.
• Burns and scars: pressure garments, silicone and time; scar revision is considered only once the scar has matured, usually after a year.

Honest expectations

Reconstruction restores function and appearance as far as the injury allows. It does not return the hand or face to exactly what it was. A surgeon who promises that is not describing surgery. What we can promise is an honest assessment of what is repairable, and the therapy that decides how much of it you get back.

Questions worth asking your surgeon

• Which structures are injured, and which of them can be repaired now?
• What function should I expect at three months, and at a year?
• What does the therapy programme involve, and where will I do it?
• Will further operations be needed, and when would they be considered?
• If I travel from abroad: who supervises my therapy once I am home?

Reconstructive and trauma surgery at Medinova is performed within our Plastic, Reconstructive and Aesthetic Surgery department by Surgeon Dr. Deniz Güneş, with our Emergency Department open 24 hours a day.