Swansea surgeons work together like nowhere else in Wales to save limbs after serious accidents

Surgeons in Morriston Hospital are working together in a way that is unique in Wales to save people’s limbs after serious accidents.

The orthoplastic service brings the expert skills of orthopaedic and plastic surgeons and their support teams together – avoiding the need for patients to have separate operations.

Morriston has a highly accomplished team of orthopaedic specialists and is home to the Welsh Centre for Burns and Plastic Surgery.

Picture shows some of the orthoplastic team: (L-r): Orthopaedic nurse practitioner Sian Francis; plastic surgery fellow Eva O Grady; consultant orthopaedic surgeon Rhys Clement; consultant orthopaedic trauma and limb reconstruction surgeon Piers Page; and consultant plastic surgeon Nick Marsden.

The combined approach was undertaken on an ad-hoc basis for many years. However, it was formalised with the launch of the South Wales Trauma Network in 2020.

It saw University Hospital of Wales (UHW) in Cardiff become the region’s major trauma centre for adults and children. Morriston was designated a trauma unit with specialist services, including plastic surgery.

This availability of both plastic and orthopaedic expertise, working collaboratively, is what makes the orthoplastic service possible.

The team comprises 10 surgeons, evenly split between orthopaedic and plastics – all with a sub-specialty interest in limb reconstruction – along with other highly trained staff.

Consultant orthopaedic surgeon Rhys Clement said: “The acute work is mostly open fractures. These are fractures where the bone has come out through the skin and caused devastating bone and soft tissue injuries.

“We need both teams to work together to fix the bones and cover the bones with soft tissue reconstruction to salvage the limb.

“Most of the open fractures we see are from road traffic collisions, motorbike accidents, falls from heights and people falling from horses.

“Occasionally we see sporting accidents, but road traffic accidents are the most common, followed by fall from heights. People up ladders, scaffolding, rock climbers falling off cliffs – that sort of thing.

“As we’re near the South Wales coast we do get quite a few rock climbers coming here.”

Mr Clement said if the casualty had an isolated limb injury they would go straight to Morriston. With multiple injuries they would go to UHW to have life-threatening injuries managed first. Those requiring further work to salvage limbs would then transfer to the Swansea hospital.

Morriston’s five plastic surgeons between them provide daily cover at the UHW Major Trauma Centre, so are involved in these cases from the start.

“It avoids a situation where patients have an orthopaedic procedure and then get referred for plastic surgery,” said Mr Clement. “The idea is to bring it together and do it as a joint procedure.”

Consultant plastic surgeon Nick Marsden said: “Once the bony injury has been fixed, it is essential we provide immediate robust soft tissue coverage of the bones and metalwork.

“This reduces the risk of infection and increases the chance of the bone healing and saving the limb. It is why we work simultaneously together in theatre.

“Most of these patients require complex soft tissue reconstruction, whereby we take healthy tissue from another part of the body that is expendable and transplant it to the limb to cover the defect.

“This involves reattaching the blood vessels of the transplanted tissues into blood vessels in the leg using microsurgery.

“The patients are then monitored in specialist areas within the plastic surgery unit in Morriston, by highly trained nurses and allied professionals.”

The service has its own dedicated operating theatre lists every Monday, Wednesday and Friday, during which orthopaedic and plastic surgeons and the wider team work together in a way that is unique in Wales.

Orthopaedic nurse practitioner Sian Francis said: “It’s just the one theatre but it’s dedicated to us on those three days.

“As they can be lengthy procedures, if you were to put them on a general trauma theatre list, nobody else would get their operation that day.”

Another important aspect of the orthoplastic service is the specialist follow-up of these injuries.

The team has two combined orthoplastic clinics each week to ensure patients have the appropriate follow-up. Complications like bone infection or fractures not healing can be identified and appropriately managed.

The team also receives referrals from across South Wales for patients with bone or fracture-related infections needing specialist orthoplastic input.

“Our aim as a multidisciplinary team is to try to get these patients to as close to their pre-injury state as possible, so they can return to work and go back to living normal lives,” said Mr Marsden.