[The acute orthoplastic patient : Definition and initial management recommendations: consensus statement of the Orthoplastic Surgery Working Group of the German Society for Trauma Surgery (DGU) and the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC)].

Abstract

Orthoplastic surgery combines the expertise of trauma and orthopedic surgery with plastic and reconstructive surgery for the management of complex musculoskeletal injuries associated with extensive soft tissue defects. Its primary aim is to provide early, coordinated interdisciplinary care to restore skeletal stability, achieve durable soft tissue coverage, and maximize long-term function. An acute orthoplastic patient is defined as an individual with complex musculoskeletal and soft tissue injuries requiring close interdisciplinary collaboration between trauma, plastic, and, where appropriate, additional surgical specialties. Furthermore, associated factors such as vascular injuries, infection, or relevant comorbidities may necessitate an orthoplastic treatment approach. The following recommendations were agreed upon: Patients who are hemodynamically stable and without an acutely threatened limb should be transferred to an orthoplastic competence center as early as possible, ideally within 24 h after injury. If immediate transfer is not feasible, early structured telemedical consultation with standardized transmission of clinical information, imaging, and photographic documentation of the soft tissue injury is recommended. Management should follow a standardized treatment pathway including prompt initiation of empirical antibiotic therapy, interdisciplinary radical debridement, restoration of bone stability, early vascular assessment, and timely definitive reconstruction. Whenever feasible, definitive fracture fixation and soft tissue reconstruction should be performed simultaneously or within a short time interval. These consensus recommendations provide the first structured framework for defining, triaging, and managing acute orthoplastic patients and aim to promote standardized orthoplastic care in specialized centers.