REVIEW   

Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2025 January-February;184(1-2):83-100

DOI: 10.23736/S0393-3660.24.05631-6

Copyright © 2024 EDIZIONI MINERVA MEDICA

language: Italian

Orthoplastic approach for the treatment of leg and foot acute open fractures in Trieste

Luigi MURENA ¹, Vittorio RAMELLA ², Giovanni VICENTI ³, Michele MARUCCIA ⁴, Martin IURILLI ² ✉, Sara SABLONE ⁵, Donato DE MARTINIS ⁵, Veronica SCAMACCA ¹, Luca DI LENARDA ¹, Francesco INTRONA ⁵, Biagio MORETTI ³, Giovanni PAPA ²

¹ Clinica Ortopedica Traumatologica, Department of Medical and Surgical Sciences and Health, Università degli Studi di Trieste, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy; ² Unit of Plastic Surgery, Department of Medical Sciences and Health, University of Trieste, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy; ³ Section of Orthopedics and Traumatology, Department of Medical Sciences, Neurosciences and Sense Organs, Aldo Moro University of Bari, Bari, Italy; ⁴ Unit of Reconstructive Plastic Surgery and Burn Center, Department of Precision and Regenerative Medicine, Aldo Moro University of Bari, Bari, Italy; ⁵ Section of Legal Medicine, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy

Orthoplasty is defined as the course of diagnosis and treatment of exposed fractures, particularly those of the leg and foot in which orthopedists and plastic surgeons are involved. It can be seen as a model of multidisciplinary collaboration between the services of the plastic surgery and orthopedic departments that can provide a trauma readiness service. The orthoplastic approach to the treatment of exposed fractures of the leg and foot is a model of multidisciplinary collaboration between plastic surgery and orthopedics and traumatology departments, 24 hours active, aimed at ensuring a treatment pathway managed in a consensual, simultaneous and shared manner by trauma surgeons and plastic surgeons, from the centralization of the patient in the referral orthopedic center to their discharge. Thus, the treatment of exposed fractures needs, according to this model, a well-defined and standardized multidisciplinary pathway that takes care of the patient through all phases of care through the simultaneous involvement of all relevant figures (orthopedic and plastic surgeons) to achieve a shared treatment plan, optimize therapeutic interventions in the light of the most modern acquisitions of both disciplines. The pathway needs the collaboration of two teams consisting of orthopedic surgeons experienced in trauma and bone defect reconstruction techniques and plastic surgeons experienced in reconstructive surgery and microsurgery, respectively. For this reason, it is necessary to identify referral centers for orthoplastic treatment where to centralize patients affected by these exposed fractures, and Level I and II hospitals must be appropriately linked in a trauma network. Multidisciplinary treatment of patients with exposed lower extremity fractures starts at the site of injury and includes from initial patient framing to eventual referral to the nearest Level II center. In cases initially treated in a Level I hospital, referral may be deferred but should be performed as soon as possible taking into account the patient’s general and local clinical situation. In the Level II hospital, collegial evaluation of all specialists, sequencing of treatments and adherence to their timelines play a crucial role in achieving the best recovery in the shortest time, best outcomes and reduced costs. This paper describes the steps of orthopedic multidisciplinary approach for the treatment of exposed leg and foot fractures.

KEY WORDS: Plastic surgery; Orthopedic procedures; Guidelines as topic; Open fractures; Tibia; Surgical flaps