Download PDF
Open Access
CC BY 4.0 · Indian J Plast Surg 2025; 58(05): 327-330
DOI: 10.1055/s-0045-1812317
Editorial

Orthoplastic Surgery: A Shining Example for ‘Collaborate and Flourish’ in Multidisciplinary Care

Authors

  • Hari Venkatramani

    1   Department of Plastic Surgery, Hand & Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
Further Information
Also available at
  Permissions and Reprints

“In the long history of humankind, those who learned to collaborate and improvise most effectively have prevailed.”

- Charles Darwin

For centuries, “Life before limb,” has been the guiding principle in trauma care. Even during the Second World War, a major open fracture with skin and soft tissue loss was considered a life-threatening condition, because the perceived risks to life were enormous and the chances of limb salvage was small. Infection was the main cause of morbidity and mortality, and the inability to cover major gaps in tissues was the cause for the low success rates of limb salvage. The advent of microsurgery made it possible to cover large gaps in both soft tissues and bone. At about the same time, encouraged by the newfound capability of covering large soft tissue gaps, surgeons performed radical debridement. Infection rates dropped, and a new chapter in trauma reconstructive surgery was thus born.

Besides techniques, what really caused the dramatic improvement was the synergistic alliance between plastic and orthopaedic surgeons, which was aimed at optimizing outcomes in limb reconstruction and this discipline was called “orthoplastic surgery.”[1] Bratton and Tumin once proposed the stark dictum “collaborate or perish,” but in modern practice this has evolved into a more optimistic adage: “collaborate and flourish.”[2] Credit for this alliance must be given to institutions like the Kleinert Institute in Louisville, United States, where surgeons from orthopaedic, plastic, and general surgical backgrounds all worked together. Each did what they could do best, and everyone sought the help of the other if needed, and ultimately, the patient had good outcomes. Some names who have to be honored are Marko Godina, a Slovenian surgeon who was a fellow in Louisville in 1978. He went back to his war-ravaged country and had an opportunity to introduce the early soft tissue cover for open fractures. A few years later, he came back to Louisville and presented his enormous experience. The Kleinert team encouraged him to write it up. He stayed for a few weeks and wrote the draft. Unfortunately, on return he was killed in a tragic road traffic accident in 1986 at the age of 43. Lister and Kleinert took the responsibility of translating his work from Slovenian to English and wrote up a limited edition called “The Thesis.”[3]

Godina stressed that the cause for the poor outcome was the artificial separation of the two specialties, orthopaedic and plastic surgery, which made them see the patient sequentially and not together. The system of orthopaedic and plastic surgeons, simultaneously seeing the patient, gradually became the recommended standard of care. Scott Levin, who was a fellow in Louisville in 1986, is credited for coining the term “orthoplastic surgery.”

Recently, an international journal has been started called “Orthoplastic Surgery” to promote advances in this discipline. An International Congress for Orthoplastic Surgeons is going to be held in New York from May 14 to 16, 2026.[4]

Patients' Consent

Informed consent was obtained from all the participants of the study.




Publication History

Article published online:
31 October 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India