Azoury Saïd C, Kovach Stephen J, Levin L Scott
From the Division of Plastic Surgery, Department of Surgery and the Department of Orthopaedic Surgery, University of Pennsylvania Philadelphia, PA.
J Am Acad Orthop Surg. 2022 Aug 15;30(16):735-746. doi: 10.5435/JAAOS-D-21-01081.
The senior author first coined the "orthoplastic" approach to traumatic lower extremity reconstruction, by which multidisciplinary surgeons and specialists work together for optimal patient success. The goals of lower extremity salvage are to optimize limb appearance, restore unrestricted pain-free ambulation, and improve quality of life. Composite traumatic defects require an organized approach, and the reconstructive ladder is used for strategies of varying complexity for repair of soft-tissue wounds. The lower rungs of the ladder include simpler reconstructive options such as the use of skin grafts and local flaps, and the higher rungs represent complex techniques such as free tissue transfer. Although there is no notable difference between muscle and fasciocutaneous/perforator flaps in reconstructive outcomes, there has been a trend toward perforator flaps to minimize donor site morbidity.
资深作者首次提出了创伤性下肢重建的“整形修复”方法，多学科外科医生和专家通过该方法共同努力，以实现患者的最佳治疗效果。下肢保肢的目标是优化肢体外观、恢复不受限制的无痛行走能力并提高生活质量。复合性创伤缺损需要有组织的治疗方法，重建阶梯用于针对软组织伤口修复采用不同复杂程度的策略。重建阶梯的较低层级包括较简单的重建选择，如使用皮肤移植和局部皮瓣，而较高层级则代表复杂技术，如游离组织移植。尽管肌肉瓣和筋膜皮瓣/穿支皮瓣在重建效果上没有显著差异，但使用穿支皮瓣以尽量减少供区并发症的趋势已经出现。
