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Re: Bugosa hernia: a hernia of the conjoint tendon

We read with interest the article by Wagels et al. chronicling lower limb trauma reconstruction. While it is evident that significant advances have been made particularly over the last 40 years in lower limb reconstruction, we’d like to include the notion of a united multidisciplinary approach as a forerunner for the recent successes. Following Marco Godina’s pioneering work in microsurgical reconstruction in complex extremity trauma, much work has been done to further advance our knowledge and approaches in this field. The British Association of Plastic Reconstructive and Aesthetic Surgeons together with the British Orthopaedic Association have been producing evidence-based guidelines for the optimal management of complex lower limb injuries since 1993. Their principal recommendation includes a multidisciplinary approach led by a team of Orthopaedic and Plastic Surgeons (with sub-specialty interest in the management of lower limb trauma) for the treatment of complex lower limb fractures for improved functional recovery. Furthermore, in clinical practice, it is this very ‘Ortho-Plastic’ team approach that has led to coordinated surgical planning and thus has enabled efficient and optimal patient care. In recent years, this has been extended to include allied health professionals such as physiotherapists, occupational therapists and social workers who facilitate the functional recovery following the medical stabilization. This progression to a multidisciplinary team approach has now become the cornerstone of complex lower limb trauma management and as such has improved outcomes for patients on a biopsychosocial scale.