Where did limb reconstruction come from?
Limb reconstruction, as a specialty, is generally attributed to Ilizarov, a Russian Jew who worked in isolation in Kurgan, a city east of the Urals from the late 1940s until his death around 1990.
He developed techniques for creating new tissues (histogenesis) using an apparatus which applied slow steady tension (distraction) to injured tissues. He discovered a new biological principle (the Law of Tension Stress) by means of which adult cells could create new tissue. His work was the first example of what we might now call tissue engineering.
His patients were the war wounded of whom there were huge numbers. His astonishing work was not widely known in Russia until it was almost fully developed and reached the West, via Italy, in the late 1970s. It was adopted in the UK in the late 1980s. Ilizarov techniques were first used at King’s in 1993.
Other techniques are also used in the Limb Reconstruction Service, but the service has come to be defined by the Ilizarov method.
How has the Limb Reconstruction Service at King’s developed?
Graeme Groom began the service in 1993 when he was appointed at King’s. Six patients with Ilizarov frames came with him from his previous consultant appointment at the Queen Elizabeth Military Hospital.
In 1996 Sister Phil Steen was appointed as Clinical Nurse Specialist and Sarah Phillips was appointed with an interest in limb reconstruction in 1998. Mark Phillips and Om Lahoti joined us in 2003. Both came from other consultant appointments. Debbie Bond replaced Phil Steen in 2003.
For the NHS, the Limb Reconstruction Service brings to an end the cycle of prolonged morbidity, multiple interventions and conspicuously large consumption of NHS resources. It is undoubtedly a cost limiting service. For the economy, the Limb Reconstruction Service restores working age adults to the workforce.
What is the demand for the Limb Reconstruction Service?
Demand is growing, with the annual number of referrals rising from 40 in 1996 to 175 in 2006.
Why are numbers increasing?
Patients who have previously been advised to accept disability are now more aware of reconstructive possibilities; there is a greater awareness of the service at King’s; and the number of surgeons with an interest in limb reconstruction has increased from one to four.
Is demand likely to change?
The trend is clearly increasing. Changes in the training of orthopaedic surgeons, which will be shorter in training posts and hours spent per year, will mean that complex trauma will be referred to specialist centres much more frequently.
Patient expectations change and increase all the time. Disability that was formerly accepted is now accepted much less often. Awareness of reconstruction techniques is more widespread and more information is available on the internet.
How other units address this need
There are very few limb reconstruction units in the UK. King’s may now be the largest, but was not the first. There were initially two, at St Peter’s Hospital in Chertsey and in Sheffield. King’s and Bristol followed. There are also surgeons working in isolation in other hospitals.
The British Orthopaedic Association Survey reveals that fewer than 10% of all consultant orthopaedic surgeons declare trauma as a special interest. Limb reconstruction is a subspecialty within trauma, and an even smaller number of surgeons are available to address the needs of limb reconstruction patients.