Orthoplastic extremity reconstruction – From replantation to transplantation

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For more than a half century, the use of the operating microscope for extremity surgery has led to remarkable advances in the management of orthopaedic trauma, tumours, infections and congenital differences. The microsurgical reconstructive ladder ascends from basic microsurgical procedures such as digital artery or nerve repair, to more complex procedures such as autologous tissue transplantation (free tissue transfer). Tissue transfers have also become more sophisticated with the evolution from simple myocutaneous flaps to perforator-based flaps. Functional muscle transfers, toe-to-hand transfers, and recently vascularised composite allotransplantation make up the highest rungs on this ladder. The development of the orthoplastic approach simultaneously integrates principles and practices of both orthopaedic surgery and plastic surgery for optimal care of extremities based heavily on the application of microsurgical techniques. We will describe our contributions and innovations in orthopaedic clinical practice using microsurgical techniques as well as highlight our clinical, anatomic and basic science research in reconstructive microsurgery that have led to improvements in limb salvage, reconstruction and restoration during the last 25 years.