JAAOS - 2026-06-24 - Journal Article
Orthoplastic Surgery: A Practical Approach to Limb Salvage.
Barrera J, Levine J, Levin LS, Hacquebord J
Topics
Key Takeaway
Orthoplastic protocol implementation reduces time to skeletal stabilization and soft tissue coverage, decreases infection risk, improves functional outcomes, and lowers cost compared to non-protocol care.
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Summary
This review addresses how combined orthoplastic protocols—integrating orthopaedic and plastic surgical principles from initial ED presentation through definitive reconstruction—optimize limb salvage outcomes. The authors present a protocol-driven framework emphasizing early joint evaluation, meticulous debridement, fixation selection informed by the reconstructive plan, and coordinated soft tissue coverage. Reported outcomes of orthoplastic programs include reduced infection rates, faster time to coverage, improved function, and lower overall cost of care, though specific numerical benchmarks are not provided in the abstract.
Key Limitation
No primary outcome data or comparative cohort are presented, so the claimed benefits of orthoplastic protocols cannot be quantitatively evaluated from this article alone.
Original Abstract
Complex extremity wounds, if not addressed properly, are a leading cause of major limb amputation. Chronic wounds in salvaged extremities contribute to long-term morbidity in the extremity. Orthoplastic surgery treats limb-threatening conditions through the combined application of orthopaedic and plastic surgical principles, applied to clinical problems simultaneously. Key components include early stakeholder evaluation of the limb and patient and open collaborative communication between orthopaedic and plastic surgeons. Meticulous débridement at the time of presentation and careful selection of fixation informed by the overall reconstructive plan should be executed when the patient presents to the emergency department. Implementation of Orthoplastic protocols results in quicker time to skeletal stabilization and soft tissue coverage, reduced risk of infection, improved functional outcomes, and less cost for care. This review presents a protocol-driven guide for establishing an Orthoplastic program and optimizing limb salvage outcomes across diverse practice settings.