For microsurgical reconstruction, look for a plastic surgeon with specific microsurgery training who does this work regularly, in a hospital where the flap can be monitored around the clock and where you can be taken back to theatre urgently at any hour. Those last two points are as important as the surgeon's hands. A flap in difficulty is often saved by how quickly it is noticed and reopened, and that depends on the whole system rather than on one person. Ask about the system as directly as you ask about the surgeon.
What training should the surgeon have?
The base qualification is M.Ch. Plastic Surgery or DNB in plastic surgery, taken after general surgical training. On top of that, microsurgery is a distinct skill learned through dedicated training and maintained by regular practice. Ask where the microsurgical training was done and how long ago, and ask whether the surgeon still performs this work routinely rather than occasionally. Dr. Ashutosh Shah holds M.Ch. Plastic Surgery from The Maharaja Sayajirao University of Baroda and DNB from the National Board of Examinations, New Delhi, has microvascular and replantation training, and has more than 22 years of surgical experience.
Does the amount of microsurgery a surgeon does matter?
It matters a great deal. Microsurgery is technically demanding and the skill is maintained by doing it regularly. A surgeon who joins vessels most weeks is in a different position from one who does it twice a year. Rather than asking for a number in isolation, ask how often the unit performs free tissue transfer, what types of flaps are done there, and whether replantation and emergency microsurgery are part of the work. Dr. Ashutosh Shah has performed the highest volume of replantations among his cohort in Gujarat, and he has trained more than 90 surgeons in hands on workshops.
What should you ask about the hospital and the team?
This is the part families forget. Ask specifically:
- Who checks the flap overnight, how often, and how they are trained to do it.
- Whether an operating theatre and an anaesthetist can be arranged urgently at night if the flap is in trouble.
- Whether intensive care or high dependency beds are available after the operation.
- Whether blood products can be arranged quickly.
- Who covers the surgeon if they are unavailable in the days after surgery.
- How physiotherapy and rehabilitation are organised afterwards.
A confident, specific answer to each of these tells you more than any brochure.
What does a good consultation look like?
Expect the surgeon to examine both the area needing reconstruction and the possible donor areas, to look at your imaging, to ask about diabetes, smoking, heart and kidney problems and previous surgery in that region, and to arrange investigations of the blood vessels where needed. Expect a clear explanation of which flap is proposed and why, what the donor scar will be, roughly how long the operation takes, how long you are likely to stay in hospital and how many stages are anticipated. Expect the possibility of flap failure to be raised without you having to ask.
What are the warning signs?
Take another opinion if you meet any of the following. A surgeon who does not mention that a flap can fail. A plan with no discussion of the donor site. A quotation given before an examination. Pressure to fix a date immediately. Vagueness about who will monitor the flap overnight. Reluctance to say how often the unit does this operation. Before and after images presented as what your result will be. And any conversation that treats reconstruction after cancer or trauma as a purely cosmetic exercise.
It is also fair to ask who exactly will be performing the microsurgical part of the operation, and who will be assisting. In a teaching unit trainees are involved, which is normal and appropriate, but you are entitled to know who leads the case and who is joining the vessels. Ask what happens if that surgeon is away in the days immediately afterwards.
Should you take a second opinion?
For an operation of this size, yes. It is especially worth doing when you have been told nothing can be done, when amputation has been proposed, or when two units have suggested very different plans. Carry your imaging, discharge summaries and operation notes so the second surgeon is looking at the same information. No reasonable surgeon objects to this, and the reaction to the request is itself informative.
How should timing affect your choice?
Sometimes the right surgeon is simply the one who can see you soon. Exposed bone, tendon or an implant deteriorates while you wait, an amputated part has a short window, and reconstruction planned alongside cancer surgery usually works better than reconstruction arranged months later. Weigh a long wait for one unit against an earlier appointment at another that also meets the criteria above. Ask each how quickly they could realistically operate, and ask what the consequence of waiting would be in your particular case, because that answer differs enormously between a settled old scar and an open wound with bone showing.
How should cost be discussed?
Ask for a written estimate before admission, and ask what it includes. Free flap surgery involves a long theatre session, intensive monitoring, a hospital stay of a week or more and often further stages, so an estimate that covers only the operation is incomplete. Ask what would change the figure and what the likely additional costs are. This clinic gives written estimates before admission, and enquiries go to WhatsApp, which makes it straightforward to send imaging and reports in advance if you are travelling from outside Surat.
What if you live far away?
Ask how long you would need to remain in the city after discharge, who would manage a complication once you are home, and how follow up and physiotherapy would be arranged locally. These answers should be given before you travel, not after. A unit that has thought carefully about patients from out of town will answer them without hesitation.
The clearest signal, in the end, is a surgeon who describes the difficult parts of this operation as plainly as the good parts, and a hospital where somebody is genuinely watching the flap at three in the morning. Everything else follows from those two things.
