Mendenhall Shaun D, Ben-Amotz Oded, Gandhi Rikesh A, Levin L Scott
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States.
Department of Orthopaedic Surgery, Rambam Health Care Campus, Haifa, Israel.
Indian J Plast Surg. 2019 Jan;52(1):17-25. doi: 10.1055/s-0039-1688095. Epub 2019 May 2.
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.
正如在木工工艺中，稳定的基础和框架对于建筑物的最终功能绝对至关重要，但并不比使建筑物具备功能性、耐用性和宜居性的干墙、装饰线条及油漆更重要。下肢重建也是如此；一旦对无活力的骨骼进行了彻底清创，骨科医生必须对受损或患病的骨骼进行稳定固定，而整形或骨科软组织外科医生必须提供带血管的、稳定的覆盖。这两个组成部分相辅相成，都对肢体功能恢复的成败有影响。骨修复的稳定性将预测最终的功能状态，而带血管的包膜将促进骨和软组织的愈合生物学过程。当这两个组成部分都得到妥善处理时，结果往往是一个外观可接受的功能肢体。虽然不一定需要由同一位外科医生来完成这两项任务（尽管有些人可能会选择这样做），但参与此项治疗的骨科医生和整形外科医生必须清楚了解彼此的作用以及它们对于取得良好治疗效果的重要性。这就是我们所说的肢体重建整形外科方法，即同时应用两个专业的原则和实践来优化肢体重建的效果。在这篇综述文章中，我们将讨论整形外科手术的历史、整形外科手术的关键要素，以及通过精选病例对导致良好治疗效果的因素的思考。
