Severe limb injuries, unhealed fractures, limb deformities, bone infection, discrepancies in limb length are within the scope of modern limb reconstruction surgery. It can be argued that these were part of the mainstay of Orthopaedic surgery before the introduction of the Ilizarov method but the latter took the capabilities and results of treatment to a much higher level.

In late 1996 Mr. Nayagam, a Consultant was appointed and tasked to start a service within the Orthopaedic departments of both Alder Hey Children’s (AHCH) and the Royal Liverpool and Broadgreen University (RLBUH) hospitals that catered for limb reconstruction. Mr. Nayagam took the appointment with the understanding that the service be supported by dedicated nurses and therapists (Allied Health Professional – AHP) so as to enable the majority of treatment be carried out in the outpatient setting. This was unlike that in the Ilizarov Institute in Russia and some other places where patients were expected to remain in or nearby to the hospital for a period of 6 months or longer. That model was not transferrable to the NHS owing to the costs of inpatient stay, but it was thought possible to deliver equivalent results of treatment if there was a team sufficient to cater regularly for patients as outpatients.

Thus, the first team assembled comprised, in addition to Mr. Nayagam, Norma Holt and Rosemary Davies (specialist nurses at RLBUH and AHCH respectively), Megan Harrison Brown and Don Feather (theatre nurses at RLBUH and AHCH respectively), Fiona Daglish, Paula Whittaker, Giles Stamps (physiotherapists RLBUH), Sharon Atherton (physiotherapist AHCH), and Madeleine Mooney (Occupational therapist). The initial stage of building and establishing the team was setting about workflows that allowed for collaborative and independent working of the team members whilst maintaining regular communication to ensure the patient’s journey through treatment was coordinated. This continues to this day even though the team has nearly trebled in size.

As with the beginnings of any new service, much time was also devoted to learning from others. A fact-finding trip to the Ilizarov Institute in Kurgan, Siberia occurred in 1998. Whilst many overseas surgeons had made this trip previously (once this technique had become known in the West) this visit was the first time ever by a multidisciplinary team (surgeons, nurses and therapists). Subsequently visits were made by team members to Verona (Italy), Baltimore (US), Cologne (Germany) and Kurgan again. Each visit was to learn more to bring back to Liverpool and to enable some bench-marking of the developing service against more established ones.