title: Reconstructive surgery including free flap transfers can be performed in low-resource settings: experiences from a wartime scenario.
abstract: BACKGROUND
  Severe wartime injuries often require microsurgical reconstruction or pedicle flap transfer. The aim of the study is to explore if such reconstructive surgery can be performed under low-resource conditions in a rural area.
  
  
  METHODS
  A clinical intervention study was performed at rural hospital in a war scenario in the Balkans.
  
  
  RESULTS
  Thirty-four patients underwent microsurgical postinjury reconstructions for land mine or blast injuries. Five different types of flaps were used. Three patients developed postoperative complications and was reoperated (8.3%, 95% CI 1.8-22.5%).
  
  
  CONCLUSIONS
  The actual intervention demonstrates that skilled surgical teams can perform advanced reconstructive surgery in low-resource settings. The experience is not only relevant for wartime scenarios, but also in civilian trauma where decentralization of microsurgical service may be feasible.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University Hospital Northern Norway, Tromsoe, Norway.
authors.forename: Nenad B
authors.initials: NB
authors.lastname: Tajsic
authors.forename: Hans
authors.initials: H
authors.lastname: Husum
mesh_terms: D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical; D000673:Amputation, Traumatic / Q000601:surgery; D001753:Blast Injuries / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D002648:Child; D002921:Cicatrix / Q000601:surgery; D003906:Developing Countries; D005061:Europe, Eastern; D005260:Female; D018409:Foot Injuries / Q000601:surgery*; D006230:Hand Injuries / Q000601:surgery*; D006295:Health Resources; D006780:Hospitals, Rural; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D023821:Limb Salvage; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D008889:Military Personnel; D010019:Osteomyelitis / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012878:Skin Neoplasms / Q000601:surgery; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply* / Q000294:innervation*; D016896:Treatment Outcome; D014857:Warfare