Abstract
Just as in the craft of carpentry, a stable foundation and framework are absolutely
essential to the final function of a building, but no more important than the drywall,
trim, and paint that make the building functional, durable, and livable. Reconstruction
of the lower extremity is similar; the orthopaedic surgeon must obtain stable fixation
of the damaged or diseased bone once a thorough debridement of nonviable bone is performed,
while the plastic or orthopaedic soft tissue surgeon must provide vascularized, stable
coverage. These two components are complementary and both contribute to the success
or failure of functional limb restoration. The stability of bone repair will predict
the ultimate functional status, while the vascularized envelope will enhance the biology
of bone and soft tissue healing. When both components are properly attended to, the
result is often a functional limb with an acceptable appearance. While a single surgeon
need not perform both of these tasks (although some may choose to do so), the orthopaedic
and plastic surgeon involved in this care must have a clear understanding of each
other's role and their importance for a good outcome. This is what we call the orthoplastic
approach to reconstructive surgery of the extremities, that is, the application of
principles and practice of both specialties applied simultaneously to optimize the
outcomes in limb reconstruction. In this review article, we discuss the history of
orthoplastic surgery, the key elements of orthoplastic surgery, and thoughts on factors
that lead to good outcomes through select cases.
Keywords
orthoplastic - open fracture - limb salvage - soft tissue coverage - reconstructive
microsurgery - soft tissue reconstruction - bone reconstruction
