Abstract
Background Regardless of the antecedent etiology, lower extremity salvage and reconstruction
attempts to avoid amputation, restore limb function, and improve quality of life outcomes.
This goal requires a treatment team well versed in neurovascular pathology, skeletal
and soft tissue reconstruction, and physical rehabilitation.
Methods A review was performed of historical milestones that lead to the development of orthoplastic
extremity reconstruction, principles of current management and the evidence that supports
an orthoplastic approach. Based on available evidence and expert opinion, the authors
further sought to provide insight into the future of the field centered around the
importance of a multidisciplinary management protocol.
Results Historically, orthopaedic and plastic surgeons worked separately when faced with
challenging reconstructive cases involving lower extremity skeletal and soft tissue
reconstruction. With time, many embraced that their seemingly separate skill-sets
and knowledge could be unified in a collaborative orthoplastic approach in order to
offer patients the best possible chance for success. First coined by the senior author
(LSL) in the early 1990s, the collaborative orthoplastic approach between orthopaedic
and plastic surgeons in limb salvage for the past several decades has resulted in
a unique field of reconstructive surgery. Benefits of the orthoplastic approach include
decreased time to definitive skeletal stabilization/soft tissue coverage, length of
hospital stay, post-operative complications, need for revision procedures and improved
functional outcomes.
Conclusion The orthoplastic approach to lower extremity reconstruction is a collaborative model
of orthopaedic and plastic surgeons working together to expedite and optimize care
of patients in need of lower extremity reconstruction. The implementation of protocols,
systems, and centers that foster this approach leads to improve outcomes for these
patients. We encourage centers to embrace the orthoplastic approach when considering
limb salvage, as the decision to amputate is irreversible.
Keywords
lower extremity - reconstruction - orthoplastic - flap - free flap
