[The Role of Topical Negative Pressure Therapy/Vacuum Therapy in Orthoplastic Surgery: NPWT, NPWTi-d and ciNPT]

Today, wounds of the extremities are often initially treated with localised negative pressure therapy (vacuum therapy) before bone and soft tissue reconstruction is performed. The aim is to preserve the limb and restore function and quality of life. The interdisciplinary collaboration in the treatment of neurovascular pathologies, reconstruction, and rehabilitation is known as orthoplastic reconstruction.This paper outlines the milestones that have led to the development of the orthoplastic concept in limb reconstruction. In addition, the fundamental principles of modern treatment strategies, including wound bed conditioning with vacuum therapy, are discussed on the basis of relevant literature and illustrated with representative examples.A review of the literature shows that orthoplastic surgery developed at different times in different countries. It was only with the advent of modern techniques for skeletal stabilisation and soft tissue reconstruction that interdisciplinary concepts, including topical vacuum therapy, found their way into everyday clinical practice. Advantages of the orthoplastic approach include faster stabilisation, early soft tissue coverage, shorter hospitalisation times, reduced complication rates, and better long-term functional outcomes.Today, localised negative pressure therapy is an indispensable tool in the orthoplastic approach. Close collaboration between plastic-reconstructive and trauma-orthopaedic surgery is essential for the timely management of reconstructive limb injuries. This approach has proven effective at specialised centres in determining the optimal time for reconstruction and improving outcomes. The earlier assumption that amputation is often more favourable has been refuted by successful orthoplastic reconstructions achieving long-term limb preservation. Today, the aim is to preserve the limb whenever possible.