12.1 Introduction

Authors David A Volgas, Yves Harder

In addition to knowing how to perform reconstructive surgery on bone and soft tissues, the surgeon must develop an understanding of when and why to choose a particular option. In most cases, there are many feasible options and only few choices that are absolutely right or wrong. But in any given situation, there may be a solution that is most appropriate.

The following twenty cases depict frequent or exemplary soft-tissue problems of the extremities encountered by the orthopaedic trauma surgeon. However, it should be noted that not all cases require the same level of skills and not all procedures described can be performed by a trauma surgeon. Cases presented in the following section are grouped according to various skill levels. The degree of difficulty in performing the featured surgical procedures increases along with the skill level. Skill level I represents what a general orthopaedic surgeon could perform. Skill level II would be feasible for a trauma surgeon. Skill level III requires a surgeon with some training in soft-tissue coverage, whereas skill level IV requires a surgeon trained in microvascular surgical procedures. The level of required surgical skill is indicated in the table below and in each case.

The focus of these case presentations is on the surgeon′s train of thought and decision-making process rather than on surgical techniques. By following the experienced surgeon′s thoughts, the reader will learn to understand:

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  the process of identifying and selecting feasible options for a certain patient

  
  
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  the difference between feasible and best options

  
  
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  when to refer a case to—or ask advice from—a surgeon trained in more advanced reconstructive techniques.