Trauma reconstruction is plastic surgery that repairs the lasting effects of injury — from road traffic accidents, falls, dog bites, lacerations and sports injuries to burns and previous surgery that has healed poorly. At her Harley Street practice in London, Ms Anna De Leo treats patients whose scars restrict movement, cause pain or itching, or have altered the appearance of the face, hands, arms, chest or abdomen.
Once the acute injury has healed, many people are left with scars that are tight, raised, widened or uncomfortable, or with areas where tissue is missing altogether. These problems are not simply cosmetic: a contracted scar across a joint can limit movement, and a sensitive scar on the hand can make everyday tasks difficult. Trauma reconstruction aims to replace damaged, inelastic scar tissue with better-quality tissue, restoring function first and improving appearance alongside it.
01What Is Trauma Reconstruction?
When skin is injured, the body repairs it with scar tissue. Scar is strong but lacks the elasticity, texture and colour of normal skin, and in some people — or in some locations — it behaves badly. Trauma reconstruction is the branch of plastic surgery concerned with correcting these secondary effects of injury, once the emergency phase is over and the wound has closed.
Problems commonly treated
- Scar contractures: tight bands of scar, often after burns, that pull on surrounding skin and restrict movement of the neck, armpit, elbow, hand or fingers.
- Hypertrophic and widened scars: raised, red or stretched scars that remain uncomfortable or conspicuous.
- Keloid scars: scars that grow beyond the original wound and need specialist, combined management.
- Contour defects: depressions or missing tissue where fat, muscle or skin was lost at the time of injury.
- Facial scars: scars after lacerations or dog bites that distort the eyelids, lips or nose.
- Hand and upper-limb injuries: scarring that affects grip, dexterity or sensation.
Burns and severe injuries in the acute phase are managed by NHS emergency and regional burns services. Ms Anna De Leo's role is in the later, reconstructive phase, when the aim is to improve how the healed area looks, feels and works.
02Non-Surgical Scar Management Comes First
Scars continue to change for 12 to 18 months after an injury, becoming flatter, paler and softer over time. For this reason, conservative treatment is usually the first step and surgery is rarely recommended in the first few months unless function is at risk.
- Scar massage with a simple moisturising cream, performed daily, helps soften and mobilise scar tissue.
- Silicone gel or sheets are among the best-evidenced treatments for improving raised scars.
- Pressure garments are often used after burns to reduce scar thickening.
- Steroid injections can flatten raised hypertrophic or keloid scars.
- Splinting and hand therapy help maintain movement across joints.
- Laser treatment, including fractional CO2 and erbium lasers, can improve the texture and thickness of selected scars.
At ADLSynergy, Tika — our theatre practitioner with more than thirty years in plastic surgery — has particular expertise in scar massage and lymphatic care, and red light therapy is available as part of our post-operative recovery and scar therapy programme.
03Your Consultation on Harley Street
Your assessment takes place at 64 Harley Street in Marylebone, in the heart of London's historic medical quarter. Ms Anna De Leo will ask how and when the injury happened, how it was treated, what has been tried since and, most importantly, what troubles you most — whether that is restricted movement, pain, itching, appearance or all of these.
She will examine the scar's maturity, thickness and mobility, the range of movement in nearby joints, sensation, and the quality of the surrounding skin that might be used for reconstruction. Photographs are taken for your records and to monitor progress. Some patients find it reassuring to discuss scars on intimate or visible areas with a female surgeon, and you are always welcome to bring a family member or friend.
If you are pursuing a personal injury claim, please let us know, as clear documentation of your condition and treatment plan may be helpful. Factors that influence the cost of a personalised trauma reconstruction plan include the size and location of the scar, the technique required, the anaesthetic, whether staged surgery is needed and the extent of scar therapy afterwards.
04Trauma Reconstruction Techniques
Trauma reconstruction follows the principle of the "reconstructive ladder": choosing the simplest technique that will reliably achieve the goal, and moving to more complex options only when needed.
Scar revision
A poor scar can be excised and re-closed with meticulous, layered suturing, aligning it where possible with natural skin creases so that it heals finer and less conspicuously.
Z-plasty and W-plasty
These geometric techniques re-orientate a scar and borrow length from the surrounding skin. A Z-plasty is particularly effective for releasing a tight band across a joint or web space, while a W-plasty breaks a long straight scar into a less noticeable zig-zag. Multiple Z-plasties can be used along a longer contracture.
Skin grafts
When a contracture is released, a defect may open up that needs to be covered. Full-thickness or split-thickness skin grafts, taken from a discreet donor site, provide new skin cover.
Local and regional flaps
Flaps move skin and underlying tissue with their own blood supply, providing durable, well-matched cover over joints, tendons and areas that need padding.
Tissue expansion
A temporary expander placed beneath healthy skin is gradually inflated over several weeks, creating additional skin of matching colour and texture to replace a large area of scar.
Microsurgery and free flaps
For larger or more complex defects, tissue can be transferred from another part of the body and reconnected to blood vessels under the microscope. Ms De Leo holds a European Master's Degree in Reconstructive Microsurgery and a Diploma in Microsurgical Techniques.
Fat grafting and laser
Fat transfer can restore lost volume and soften tethered scars, and fractional laser can refine texture as a stand-alone treatment or after surgery.
A scar tells the story of an injury — reconstruction aims to let it stop dictating how you move, feel and live.
ADLSynergy · Harley Street
05Recovery After Scar and Trauma Surgery
Recovery varies widely. A small scar revision under local anaesthetic may need only a few days of care, while a contracture release with grafting or a flap may require a short stay in an accredited London hospital, splints and several weeks of hand therapy or physiotherapy.
- Stitches are usually removed between five and fourteen days, depending on the area.
- Grafts and flaps are protected carefully for the first one to two weeks while they establish a blood supply.
- Scar massage, silicone and sun protection begin once the wound has healed and continue for many months.
- Review appointments at our Harley Street clinic monitor healing and guide the next steps.
- Movement exercises are essential after release of joint contractures to maintain the improvement.
The ADLSynergy team supports patients through this phase with scar therapy, lymphatic drainage and breathing techniques that help manage discomfort and stress, as well as oxygen therapy as part of a wider wellbeing approach.
06Trauma Reconstruction Risks and Realistic Expectations
It is important to be honest: surgery cannot erase a scar. Any operation creates a new scar, and the aim is to exchange a problematic scar for one that is more comfortable, more mobile and less noticeable. Risks include bleeding, infection, wound breakdown, partial or complete loss of a graft or flap, altered sensation, recurrence of tightness, and the new scar thickening or becoming keloid. Smoking significantly increases the risk of healing problems.
Results vary from person to person and depend on skin type, age, location and the original injury. Before and after photographs of similar cases are discussed at consultation so that expectations are realistic. Many patients need a combination of treatments over time to reach the best achievable outcome, and trauma reconstruction is often best thought of as a journey rather than a single operation. Follow-up appointments on Harley Street allow each stage to be reviewed and adjusted.
07Why Choose Ms Anna De Leo on Harley Street
Ms Anna De Leo is a GMC-registered Plastic, Reconstructive and Aesthetic Surgery Consultant with more than twenty years of experience in reconstructive surgery, including trauma care. Her training and international experience include Chelsea and Westminster Hospital and the Royal Free Hospital in London, Oxford University Hospitals, and João XXIII Hospital in Belo Horizonte, Brazil — a major trauma centre. She is a Fellow of the European Board of Plastic, Reconstructive and Aesthetic Surgery (FEBOPRAS), holds a European Diploma in Hand Surgery, and is a member of BAPRAS.
As a female plastic surgeon with expertise spanning microsurgery, hand surgery and aesthetic surgery, Ms De Leo brings both technical range and a careful eye for detail to scars that matter deeply to the people who carry them. If you are searching for the best scar revision surgeon in London, you are welcome to book a consultation on Harley Street to discuss trauma reconstruction.
