Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0039-1688095
A Review on the Orthoplastic Approach to Lower Limb Reconstruction
Publication History
Publication Date:
02 May 2019 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00042863/201901/lookinside/thumbnails/10-1055-s-0039-1688095_00101-1.jpg)
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.
-
References
- 1 Levin LS. Reconstructing Soft Tissue Defects of the Foot and Ankle: The Orthoplastic Approach. 2012 https://www.aofas.org/PRC/meeting/Documents/ReconstructingSoftTissueD.pdf Accessed July 25, 2018
- 2 Lerman OZ, Kovach SJ, Levin LS. The respective roles of plastic and orthopedic surgery in limb salvage. Plast Reconstr Surg 2011; 127 (Suppl. 01) 215S-227S
- 3 Carrel D. [Operative Technic Of Vascular Anastomoses And Visceral Transplantation]. Lyon Med 1964; 212: 1561-1568
- 4 Jacobson JH, Suarez E. Microsurgery in anastomosis of small vessels. Paper presented at: Surgical forum. 1960
- 5 Tamai S. History of microsurgery. Plast Reconstr Surg 2009; 124 (06) Suppl e282-e294
- 6 Shores JT, Malek V, Lee WPA, Brandacher G. Outcomes after hand and upper extremity transplantation. J Mater Sci Mater Med 2017; 28 (05) 72
- 7 Sosin M, Rodriguez ED. The face transplantation update: 2016. Plast Reconstr Surg 2016; 137 (06) 1841-1850
- 8 Levin LS. The reconstructive ladder. An orthoplastic approach. Orthop Clin North Am 1993; 24 (03) 393-409
- 9 Levin SL. Orthoplastic reconstruction of the hand. Curr Opin Orthop 1993; 4 (04) 10-13
- 10 Heitmann C, Levin LS. The orthoplastic approach for management of the severely traumatized foot and ankle. J Trauma 2003; 54 (02) 379-390
- 11 Tintle SM, Levin LS. The reconstructive microsurgery ladder in orthopaedics. Injury 2013; 44 (03) 376-385
- 12 Boriani F, Ul Haq A, Baldini T. et al. Orthoplastic surgical collaboration is required to optimise the treatment of severe limb injuries: a multi-centre, prospective cohort study. J Plast Reconstr Aesthet Surg 2017; 70 (06) 715-722
- 13 Stammers J, Williams D, Hunter J, Vesely M, Nielsen D. The impact of trauma centre designation on open tibial fracture management. Ann R Coll Surg Engl 2013; 95 (03) 184-187
- 14 Fernandez MA, Wallis K, Venus M, Skillman J, Young J, Costa ML. The impact of a dedicated orthoplastic operating list on time to soft tissue coverage of open lower limb fractures. Ann R Coll Surg Engl 2015; 97 (06) 456-459
- 15 Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 1984; 24 (08) 742-746
- 16 Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 1976; 58 (04) 453-458
- 17 Gopal S, Majumder S, Batchelor AG, Knight SL, De Boer P, Smith RM. Fix and flap: the radical orthopaedic and plastic treatment of severe open fractures of the tibia. J Bone Joint Surg Br 2000; 82 (07) 959-966
- 18 Bhandari M, Guyatt GH, Swiontkowski MF, Schemitsch EH. Treatment of open fractures of the shaft of the tibia. J Bone Joint Surg Br 2001; 83 (01) 62-68
- 19 Bosse MJ, MacKenzie EJ, Kellam JF. et al. A prospective evaluation of the clinical utility of the lower-extremity injury-severity scores. J Bone Joint Surg Am 2001; 83-A (01) 3-14
- 20 Ly TV, Travison TG, Castillo RC, Bosse MJ, MacKenzie EJ. LEAP Study Group. Ability of lower-extremity injury severity scores to predict functional outcome after limb salvage. J Bone Joint Surg Am 2008; 90 (08) 1738-1743
- 21 MacKenzie EJ, Bosse MJ. Factors influencing outcome following limb-threatening lower limb trauma: lessons learned from the Lower Extremity Assessment Project (LEAP). J Am Acad Orthop Surg 2006; 14 (10) Spec No. S205-S210
- 22 Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg 1975; 55 (05) 533-544
- 23 Jupiter JB, Gerhard HJ, Guerrero J, Nunley JA, Levin LS. Treatment of segmental defects of the radius with use of the vascularized osteoseptocutaneous fibular autogenous graft. J Bone Joint Surg Am 1997; 79 (04) 542-550
- 24 Hayashi A, Maruyama Y. The medial genicular artery flap. Ann Plast Surg 1990; 25 (03) 174-180
- 25 Sakai K, Doi K, Kawai S. Free vascularized thin corticoperiosteal graft. Plast Reconstr Surg 1991; 87 (02) 290-298
- 26 Kazmers NH, Thibaudeau S, Steinberger Z, Levin LS. Upper and lower extremity reconstructive applications utilizing free flaps from the medial genicular arterial system: a systematic review. Microsurgery 201;8 38 (03) 328-343
- 27 Deng AD, Innocenti M, Arora R, Gabl M, Tang JB. Vascularized small-bone transfers for fracture nonunion and bony defects. Clin Plast Surg 2017; 44 (02) 267-285