There's actually quite a bit of work available for those willing to do reconstructive surgery, hand surgery, and wound care. Alot of that has to do with the poor reimbursement with alot of that kind of work, especially given the large amount of non-reimbursed post-op care many of these patients demand. You can make a fairly nice living doing this work, but you really have to do a large volume of small procedures to get ahead doing it. Less and less really complicated reconstructive work is being done outside tertiary referral centers these days. Very few people outside of teaching programs will do free-flaps, replants, complex facial fractures, and (in some areas) autologous breast reconstruction