Extremity soft tissue coverage in the combat zone: use of pedicled flap transfers by the deployed orthopedic surgeon
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(2020) 7:51
RESEARCH
Open Access
Extremity soft tissue coverage in the combat zone: use of pedicled flap transfers by the deployed orthopedic surgeon Laurent MATHIEU1,2*, Soryapong PLANG1, Nicolas de l’ESCALOPIER1, James Charles MURISON1, Christophe GAILLARD3, Antoine BERTANI2,3 and Frédéric RONGIERAS2,3
Abstract Background: In theaters of operation, military orthopedic surgeons have to deal with complex open extremity injuries and perform soft-tissue reconstruction on local patients who cannot be evacuated. Our objective was to evaluate the outcomes and discuss practical issues regarding the use of pedicled flap transfers performed in the combat zone on local national patients. Methods: A retrospective study was conducted on data from patients treated by a single orthopedic surgeon during four tours in Chad, Afghanistan and Mali between 2010 and 2017. All pedicled flap transfers performed on extremity soft-tissue defects were included, and two groups were analyzed: combat-related injuries (CRIs) and noncombat related injuries (NCRIs). Results: Forty-one patients with a mean age of 25.6 years were included. In total, 46 open injuries required flap coverage: 19 CRIs and 27 NCRIs. Twenty of these injuries were infected. The mean number of prior debridements was significantly higher in the CRIs group. Overall, 63 pedicled flap transfers were carried out: 15 muscle flaps, 35 local fasciocutaneous flaps and 13 distant fasciocutaneous flaps. The flap types used did not differ for CRIs or NCRIs. Complications included one flap failure, one partial flap necrosis and six deep infections. At the mean follow-up time of 71 days, limb salvage had been successful in 38 of the 41 cases. There were no significant differences between CRIs and NCRIs in terms of endpoint assessment. Conclusions: Satisfying results can be achieved by simple pedicled flaps performed by orthopedic surgeons deployed in forward surgical units. Most complications were related to failure of bone infection treatment. The teaching of such basic reconstructive procedures should be part of the training for any military orthopedic surgeon. Trial registration: Retrospectively registered on January 2019 (n°2019–090 1-001). Keywords: Pedicled flaps, Limited resources, War surgery, Reconstruction, Training
* Correspondence: [email protected] 1 Department of orthopedic, trauma and reconstructive surgery, Percy Military Hospital, 101 avenue Henri Barbusse, 92140 Clamart, France 2 Department of surgery, French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party mater
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