Orthoplastic surgery as we define it is "the principles and practices of both specialties orthopaedic and plastic surgery applied to a clinical problem, either by a single provider, or teams of providers working in concert for the benefit of the patient."5,6,7
More than 37 years after Tamai's report that generated interest from surgeons around the world, care of the mutilated hand with microsurgical technique is standard practice.
The training of orthopaedic surgeons has shifted gradually toward performing microsurgery, whereas traditionally, mainly plastic surgeons have done microsurgery, depending on nationality. Hand and microvascular fellowships may or may not adequately prepare young surgeons to perform the full spectrum of reconstructive microsurgery, which is vitally important in orthoplastic reconstruction.
Over the past 50 years, burn care, aesthetic surgery, craniofacial surgery, and hand surgery have all become subspecialties of plastic surgery. Similarly, orthopaedic specialization has stimulated the development of separate societies concentrating on pediatric orthopaedics, trauma, musculoskeletal oncology, and hand surgery. Orthopaedics is a specialty that mainly concentrates on functional biomechanics, bone, and joints. Plastic surgery is a specialty that concentrates on aesthetics, form, and soft tissue reconstruction. The blending of these two specialties, "orthoplastic surgery," simultaneously applies the principles and practices of both specialties to clinical problems.
Historically, process-based outcome analyses, such as healing, range of motion, biomechanics, and flap success were common. Now, more emphasis is placed on patient-based outcomes as they relate to factors such as pain, functional outcome, satisfaction, and quality of life. When the outcomes movement began, the challenge was to demonstrate that this highly variable and very expensive and complicated surgery for limb salvage (orthoplastic surgery) was cost-effective and could make patients better. According to Keller, in the Journal of the Academy of Orthopaedic Surgeons in 1990, if surgeons cannot demonstrate this cost-effectiveness, their services could no longer be paid for!8,9
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