About the Limb Reconstruction Unit

The Limb Reconstruction Unit forms part of the Orthopaedic and Spine Surgery department at Great Ormond Street Hospital (GOSH). It is a tertiary referral service specialising in unusual or difficult cases of upper and/or lower limb deformity or length difference. Each year, we see about 600 children and young people in outpatients, and perform about 250 limb reconstructive operations a year. The team has always been multidisciplinary – made up of surgeons, nurses, physiotherapists, occupational therapists, orthopaedic practitioners, orthotists, psychologists and play specialists.

GOSH was one of the first hospitals to introduce modern limb reconstruction techniques for children in the UK about 30 years ago. Nowadays, the multidisciplinary team work closely together to support children in all aspects of their care – from their first assessment, during treatment, and throughout their recovery. Because GOSH has a large range of specialties on one site, a holistic approach is taken for each child throughout the entire patient journey, from referral to treatment to follow up, through to transition to adult health services if required. We work alongside other specialist teams at the hospital, including anaesthetics, plastic surgery and spinal surgery, to offer a highly expert, experienced and comprehensive service. This is important to ensure the child has the best outcome both in terms of their clinical results and their personal experience.

Patients treated in this service are seen in dedicated limb reconstruction outpatient clinics. We use the latest EOS biplanar X ray technology. This reduces the radiation dose on your child, allowing computer generated models to plan our operations. We work closely with our plastic surgery colleagues, and offer joint orthopaedic/plastic surgery consultations in appropriate cases. Complex cases are discussed at our regular case conferences, and we frequently perform procedures with two consultants operating together to achieve the best outcome. All treatment modalities for upper and/or lower limb deformity or length difference are available, which we often use in combination. They include:

• circular external fixation – circular ring and hexapod deformity correction systems
• PediPlates™ or epiphysiodesis for guided growth strategies
• external fixator assisted internal fixation
• bespoke 3D printed deformity correction instrumentation
• orthotics and prosthetics
• free fibula transfer and other plastic surgical procedures

Full support is offered to all children and young people from allied health professionals in the team, including physiotherapy, occupational therapy, psychology, therapeutic play, orthopaedic practitioners as well as clinical nurse specialists and physicians’ associates. 

We work as a team to plan what input in required at our dedicated preoperative assessment clinics, and communicate with local services to ensure the best outcomes, both clinically and experientially.