The interest of “ortho-plastic” collaboration in management of complex limb injury

Constantly evolving knowledge on fracture management, soft tissue coverage, microsurgery and vasculo-nervous repair now permits salvage of limbs that previously would have had to be amputated. Management of complex limb injuries of which the severity inevitably entails functional and esthetic sequelae calls for mastery of the full spectrum of bone and soft tissue reconstruction. Such mastery is rarely attainable by a single surgical specialty; individually and isolatedly, an orthopedic or plastic surgeon cannot ensure optimal management of the above-mentioned patients. While the orthopedist performs a key function in provisional or definitive fixation, the plastic surgeon's expertise is essential to restoration of the cutaneous envelope. Collaboration between the two specialties from the outset and throughout treatment characterizes the modern-day concept of “ortho-plastic” surgery. Through unification of the theoretical competence and practical skills of orthopedists and plastic surgeons, it provides a patient with the best possible functional and esthetic results in a wide range of clinical situations. In this article, we present a review of the literature illustrating the interest of “ortho-plastic” collaboration in management of complex limb injury; concrete examples will be given through evocation of clinical cases encountered by the team that was put together in August 2015 at the university hospital (CHU) of Lille. Les connaissances actuelles – en constante évolution – dans la gestion des fractures, la couverture des parties molles, la microchirurgie et la réparation vasculonerveuse permettent aujourd’hui le sauvetage de nombreux membres autrefois voués à l’amputation. La prise en charge des lésions complexes des membres, dont la gravité est telle que les séquelles fonctionnelles et esthétiques sont inévitables, demande une maîtrise de tout le spectre de la reconstruction osseuse et des parties molles. Celle-ci est difficilement accessible à une seule spécialité chirurgicale, et le chirurgien orthopédiste ou plasticien n’est pas en mesure de garantir individuellement la gestion optimale de ces patients. L’orthopédiste joue un rôle primordial dans la fixation osseuse, provisoire ou définitive, tandis que l’expertise du plasticien est essentielle dans la restauration de l’enveloppe cutanée. La collaboration entre ces deux spécialités dès le stade initial de la prise en charge du patient et tout au long de celle-ci définit le concept moderne de chirurg