Concepts and clinical practice of functional reconstruction of complex wounds

The paradigm of complex wound management has shifted from simple wound closure toward functional reconstruction. Nevertheless, a systematic framework defining complex wounds, outlining the principles of functional reconstruction, and addressing future directions remains unavailable. Based on a comprehensive review and critical synthesis of the current literature, this article proposes a multidimensional framework for defining complex wounds that incorporates four dimensions: abnormal healing trajectory, involvement of anatomical structures, coexistence of multiple risk factors, and complexity of clinical management. Furthermore, a four-tier conceptual framework for functional reconstruction of these wounds is summarized, emphasizing 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 review systematically summarizes the historical evolution of complex wound reconstruction, from skin grafting as the cornerstone of wound repair, through microsurgical functional reconstruction, to the emergence of multidisciplinary regenerative strategies, with particular emphasis on the original contributions of Chinese investigators in this field. Future advances driven by the deep integration of regenerative medicine, intelligent navigation, supermicrosurgery, and precision phenotyping are expected to facilitate the transition of complex wound reconstruction from anatomical repair to functional regeneration.