[Concepts and clinical practice of functional reconstruction of complex wounds]

The repair of complex wounds has shifted from simple wound closure toward functional reconstruction. Nevertheless, a systematic exposition regarding their definition, the principles of functional reconstruction, and future directions is currently lacking. Based on a literature review and comprehensive analysis, this article proposes that the definition of complex wounds should incorporate four dimensions including abnormal healing timeline, involvement of anatomical structures, coexistence of multiple risk factors, and complex management requirements. Furthermore, the core concept of functional reconstruction for such wounds can be summarized into four-tiered principles: biological matching between donor and recipient sites, minimization of donor-site morbidity, restoration of aesthetic appearance and sensory function, and functional reconstruction of deep structures, including blood vessels, nerves, tendons, bones, and joints. This article systematically reviewed the developmental trajectory of complex wound reconstruction, from skin grafting as the cornerstone of wound repair, to microsurgery for functional reconstruction, and onward to the emergence of multidisciplinary regenerative strategies, highlighting the original contributions of Chinese investigators in this field. In the future, the deep integration of technologies such as regenerative medicine, intelligent navigation, super-microsurgery, and precision subtyping is expected to facilitate the transition of complex wound reconstruction from anatomical repair to functional regeneration.