Burns reconstruction (Reconstructive surgery for burn injuries and scarring)

What is burns reconstruction?

Burns reconstruction is surgery to improve areas damaged by a burn, after the original wounds have healed. It is usually about function and comfort first, and appearance alongside, tackling problems such as tight scars that limit movement, scars that pull on the eyes, mouth or nose, and skin that is fragile, uncomfortable or very different in colour and texture.

It covers a range of operations, from releasing a tight scar and adding skin, to moving healthy tissue as a flap, to fine adjustments of the face and hands. It is often staged, meaning several procedures over months or years as scars mature and needs change.

Reconstruction improves rather than erases burn injury. Scars remain, and the aim is meaningful gains in movement, comfort and appearance, planned together by a team that usually includes surgeons, specialist nurses, therapists and psychologists.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Options at a glance

These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.

Preparing for your surgery

• Discuss your priorities clearly: what limits you most, whether it is movement, comfort, appearance or a specific area such as a hand or the face.
• Understand that reconstruction is often staged, and ask roughly how many procedures might be involved and over what timescale.
• Ask which technique is planned, and whether it uses a graft, a flap, tissue expansion or scar revision.
• Tell the team about your general health, smoking, diabetes and medicines, as these affect healing and graft or flap survival.
• Plan for time off, help at home and access to scar therapy and rehabilitation afterwards.
• Talk about the emotional side; psychological support is a normal and important part of burns care.
• Follow fasting and other instructions for general anaesthetic where it is used.

What happens

What happens depends on the operation, but most reconstruction is done under general anaesthetic. For a contracture release, the surgeon cuts through the tight scar to free movement, then fills the gap, often with a skin graft or a flap of nearby tissue.

Grafts are taken from a donor area, which leaves its own wound to heal. Flaps move skin and deeper tissue with their blood supply and may need careful monitoring afterwards. Tissue expansion is done in stages, with an expander gradually inflated over weeks before a second operation.

Depending on the procedure you may go home the same day or stay several days. You will usually have dressings, sometimes a splint, and a plan for therapy to protect and mobilise the area as it heals.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

Burns reconstruction is improvement, not erasure, and the most important things to understand are that scars remain, grafts can tighten and contractures can recur, often needing more than one operation. Healing depends heavily on your general health, smoking and on rehabilitation. These operations are best done within a specialist burns service. Ask how many stages are likely, what the realistic gain is for your priority area, and what therapy and support are included.

Published figures to discuss

Burns reconstruction covers very different operations, and outcomes depend on the procedure, the site, scar maturity, your health and rehabilitation, so a single set of figures cannot capture it. Reported rates of graft take, flap survival and contracture recurrence vary between studies and patients. The points below are cautious, qualitative patterns; your surgeon can give figures for your specific operation.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Recovery depends on the operation, from a couple of weeks for a small revision to longer for grafts and flaps. Across all of it, scars keep maturing for a year or more, and rehabilitation, therapy and scar management are as important as the surgery for the final result.

• A sore, swollen area and a separate healing wound at any graft donor site
• Grafted or flap skin that looks different and changes appearance as it settles
• Tightness as grafts and scars mature, eased by therapy and stretching
• A long timescale, with scars improving over many months
• Needing to wear pressure garments or use silicone for a period

Aftercare

• Keep dressings clean and dry and protect grafts or flaps exactly as instructed.
• Follow the rehabilitation and therapy plan closely, as it strongly affects function and scar quality.
• Use silicone, scar massage and pressure garments as advised over the following months.
• Protect healing and grafted skin from the sun, which worsens discolouration.
• Keep the area moving or splinted as directed to prevent contractures returning.
• Watch for signs of infection or, after a flap, changes in colour or temperature, and report them.
• Attend all follow-up and therapy appointments and engage with psychological support if offered.

• Time off work and help at home arranged
• Dressings and any prescribed supplies ready
• Silicone, scar cream or pressure garments organised if advised
• Therapy and rehabilitation appointments noted
• Sun protection for healing and grafted skin
• Transport to appointments, especially if a hand or leg is affected
• Burns team contact number saved for any problems

Scars and how they heal

Scarring is central to burns reconstruction. Surgery aims to improve scars and the problems they cause, but new scars are created at operated and donor sites, and grafted or flap skin usually differs in colour and texture from surrounding skin. Scars take a year or more to mature, softening and fading over time, and are actively managed with massage, silicone, pressure garments and sun protection. The goal is improvement and better function, not scar-free skin.

⚠ Get urgent help if…

• Spreading redness, heat, swelling or discharge around a wound (signs of infection)
• A graft or flap that turns pale, dusky, blue or cold, or a flap that becomes very swollen
• Bleeding that will not settle
• A wound that opens up or a graft that lifts away
• Fever or feeling generally unwell
• Sudden increase in pain, or new numbness or loss of movement
• Signs of a blood clot, such as a hot, swollen, painful calf or sudden breathlessness

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result is meaningful improvement in the things that matter most to you: more movement where scars were tight, more comfortable and durable skin, and a better appearance, achieved over months as scars mature. For function, such as releasing a contracture over a joint, the gain can be substantial.

Reconstruction cannot restore skin to normal or remove scars, and results develop slowly and may need more than one stage. A good team is honest about what each operation can realistically achieve and plans the journey with you, rather than promising a single transformative fix.

Many reconstructive gains, such as a released contracture or a durable flap, last well, but burn scars are a long-term condition. Scars keep maturing for a year or more, grafts can tighten, and contractures, especially over growing joints in children, can recur and need further surgery. Ongoing scar management and therapy help maintain results, and the plan is often reviewed over years.

Combining with other procedures

Burns reconstruction is frequently combined and staged: a contracture release with a graft or flap, surgery alongside laser and non-surgical scar treatments, and procedures sequenced so that one area settles before the next is tackled. Surgical and non-surgical treatments work together, and the team coordinates these around scar maturation and your priorities.

Follow-up & long-term care

Follow-up is usually long term and multidisciplinary, with wound and graft or flap checks early on, regular therapy and scar-management reviews, and planning for any further stages as scars mature. Children are followed as they grow, because contractures can recur with growth. Report signs of infection, flap problems or a returning contracture promptly rather than waiting for the next appointment.

• Continue scar massage, silicone and pressure garments for as long as advised.
• Keep up rehabilitation exercises and stretches to maintain movement and prevent contractures returning.
• Protect healing and grafted skin from the sun long term.
• Attend long-term reviews, especially for children whose contractures can recur with growth.
• Report early signs of a returning contracture or skin breakdown so they can be addressed.

Revision and secondary surgery reality

• Reconstruction is commonly staged, so further operations are expected rather than a sign of failure.
• Grafts can tighten and contractures, especially in children, can recur and need repeat release.
• Scar revisions are often refined over time as scars mature.
• Flap or graft problems may need further surgery to correct.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

• A coordinated multidisciplinary plan, including surgery, therapy, scar management and psychological support.
• Early monitoring of grafts and flaps, with a named contact route and clear warning signs.
• A structured rehabilitation and scar-management programme over months.
• Long-term follow-up, including review for recurrence, especially in children as they grow.
• Honest, staged planning that sets realistic expectations for each operation.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• The specific procedure and its complexity, from a small revision to a flap or tissue expansion
• The number of stages likely to be needed over time
• The surgeon's fee and the length of the operation
• General anaesthetic and theatre time, and any hospital stay
• Dressings, splints, pressure garments and scar treatments
• Therapy and rehabilitation, which can be extensive
• Follow-up appointments and any imaging over a long period

• The specific procedure and the surgeon's fee
• The anaesthetist, theatre or facility fee and any hospital stay
• Pressure garments, splints and scar-management products
• Therapy and rehabilitation sessions
• Follow-up appointments over the expected timescale
• How further stages would be planned and costed
• What happens, and what it costs, if a graft fails, a contracture recurs or a complication occurs

On the NHS? Burns care and reconstruction are core NHS services, delivered through specialist burns units and networks with multidisciplinary teams; specialist expertise is concentrated in these services rather than in general private clinics.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a surgeon safely

• Check your surgeon is on the GMC Specialist Register for this area.
• Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
• You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
• Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good surgeon will welcome every one of these.

• What limits me most, and which problem will this operation address first?
• Will you use a graft, a flap, tissue expansion or scar revision, and why?
• Roughly how many stages might my reconstruction involve, and over what timescale?
• What is the realistic improvement for my priority area, and what will the scars be like?
• What rehabilitation, scar management and psychological support are included?
• What is the chance a contracture returns or a graft tightens, and what then?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the surgeon who carries out my operation, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this operation not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified surgeon for burns reconstruction

Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.

How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: British Burn Association BAPRAS — Information about plastic surgery Burns reconstruction — overview (PMC) Post-burn scars and scar contractures — review (PMC) Surgical treatment algorithms for post-burn contractures — PMC NHS — Burns and scalds British Burn Association — National Standards for the Provision of Adult and Paediatric Burn Care NICE CKS — Burns and scalds

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.