title: Soft tissue management of war wounds to the foot and ankle.
abstract: This article details the experiences of United States military reconstructive surgeons in the soft tissue management of war wounds of the foot and ankle resulting from the conflicts in Iraq and Afghanistan. War wounds from this conflict are commonly caused by blast and fragmentation, and are characteristically extensive, heterogeneous, and severe. Multiple serial débridement episodes are routinely necessary because of deterioration of the wounds over time, which is in contrast to civilian trauma wherein fewer débridement episodes are generally required. Wound therapy adjuncts, such as subatmospheric wound dressing and synthetic dermal replacement, have been used extensively with favorable results. Pedicled flaps, such as the distally based sural neurofasciocutaneous flap, are reliable, and avoid the risks and technical demands associated with microsurgery. Free tissue transfer, such as the anterolateral thigh flap, the latissimus dorsi muscle flap, and the rectus abdominis muscle flap, are powerful reconstructive tools, and have been extensively used in the reconstruction of war wounds of the foot and ankle.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center, Washington, DC 20307, USA. martin.baechler@us.army.mil
authors.forename: Martin F
authors.initials: MF
authors.lastname: Baechler
authors.forename: Adam T
authors.initials: AT
authors.lastname: Groth
authors.forename: Leon J
authors.initials: LJ
authors.lastname: Nesti
authors.forename: Barry D
authors.initials: BD
authors.lastname: Martin
mesh_terms: D016512:Ankle Injuries / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D001753:Blast Injuries / Q000150:complications / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018409:Foot Injuries / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D018570:Risk Assessment; D016038:Skin Transplantation / Q000009:adverse effects / Q000379:methods*; D017768:Skin, Artificial; D017695:Soft Tissue Injuries / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D014857:Warfare; D014945:Wound Healing / Q000502:physiology