Azoury Saïd C, Stranix John T, Kovach Stephen J, Levin L Scott
Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Pennsylvania.
Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia.
J Reconstr Microsurg. 2021 Jan;37(1):42-50. doi: 10.1055/s-0039-1695753. Epub 2019 Aug 27.
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.
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.
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.
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.
无论先前的病因如何，下肢保肢与重建旨在避免截肢，恢复肢体功能，并改善生活质量。这一目标需要一个精通神经血管病理学、骨骼与软组织重建以及物理康复的治疗团队。
对导致矫形整形外科下肢重建发展的历史里程碑、当前管理原则以及支持矫形整形外科方法的证据进行了综述。基于现有证据和专家意见，作者进一步试图围绕多学科管理方案的重要性，深入探讨该领域的未来。
从历史上看，骨科医生和整形外科医生在面对涉及下肢骨骼和软组织重建的具有挑战性的重建病例时是分开工作的。随着时间的推移，许多人认识到他们看似不同的技能和知识可以通过协作的矫形整形外科方法统一起来，以便为患者提供最佳的成功机会。“矫形整形外科方法”这一术语最早由资深作者（LSL）在20世纪90年代初提出，在过去几十年里，骨科医生和整形外科医生在保肢方面的协作矫形整形外科方法产生了一个独特的重建外科领域。矫形整形外科方法的益处包括缩短达到确定性骨骼稳定/软组织覆盖的时间、住院时间、术后并发症、翻修手术的需求，并改善功能结果。
下肢重建的矫形整形外科方法是骨科医生和整形外科医生共同协作的模式，旨在加速并优化对需要下肢重建患者的治疗。实施促进这种方法的方案、系统和中心可改善这些患者的治疗结果。我们鼓励各中心在考虑保肢时采用矫形整形外科方法，因为截肢的决定是不可逆转的。
