[Functional Extremity Reconstruction: Just a Modern Term or Reconstruction 2.0?]

Orthoplastic surgery is increasingly establishing itself as an essential interdisciplinary approach in the treatment of complex limb reconstructions. Since the beginning of the first collaboration between orthopedics and reconstructive plastic surgeons initiated by Sir H. Gillies and colleagues through to modern limb transplants, numerous new techniques have been developed over the past six decades, focusing on functional limb reconstruction. In modern orthoplastic surgery, it is no longer sufficient to simply close a defect without addressing all tissues and their functions. This includes not only the reconstruction of the skin and subcutaneous envelope, but also of bone, functional muscle units, nerves, blood vessels, including the lymphatic system, together potentially laying the foundation for a modern "reconstruction 2.0" paradigm. A key element in this context is an early case presentation in interdisciplinary board meetings, in which treatment plans are established that respect the basic principles of both disciplines and address functional endpoints such as pain relief, infection control, mobility, and professional reintegration. However, there is still no international definition of the term "functionality". The aim of this review is to evaluate individual techniques and concepts of modern microsurgery and plastic surgery in the context of orthoplastic limb reconstruction as a whole and, based on the literature and our own clinical experience, to translate this into a potentially applicable overall concept.