title: Flap coverage outcomes following vascular injury and repair: chronicling a decade of severe war-related extremity trauma.
abstract: BACKGROUND
  Combat-related extremity injuries frequently require vascular repair within the combat theater before undergoing definitive reconstruction. This study examines the outcomes of early vascular repair with secondary soft-tissue extremity reconstruction over the past decade of war trauma.
  
  
  METHODS
  War-related extremity injuries necessitating a downrange vascular procedure followed by a definitive limb reconstruction were reviewed. Patient demographics, type and location of vascular injuries, vascular intervention, and soft-tissue reconstruction procedures were examined. Outcomes of vascular repair, tissue transfer, and limb salvage were analyzed.
  
  
  RESULTS
  From 2003 to 2012, 79 extremities in 78 patients had a vascular injury requiring in-theater intervention followed by 87 staged flap reconstructions performed distal to the vascular repair. Of the 74 arterial injuries requiring intervention, 27 were proximally located, with 73 percent requiring bypass. The early primary patency rate was 66 percent and the early primary-assisted patency rate was 93 percent for proximal artery repair procedures. The flap complication rate was 31 percent. Overall complications were examined by subtype and were not significantly different compared with flaps performed without a proximal vascular injury in the same limb. The flap success rate (93 percent) and the limb salvage rate (81 percent) were similar to the comparison cohort.
  
  
  CONCLUSIONS
  This represents one of the largest series of traumatic extremity injuries requiring secondary limb reconstruction with tissue transfer following a vascular intervention. The authors identified no significant difference in outcomes related to flap coverage or limb salvage for patients with or without vascular injuries. Reconstructive options in combat extremity trauma are not limited by proximal vascular injury.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Kandahar, Afghanistan; San Diego, Calif.; and Bethesda, Md. From the Department of Surgery, Kandahar Air Field NATO Role III, Multinational Medical Unit; the Division of Vascular Surgery, Department of General Surgery, Naval Medical Center San Diego; and the Department of General Surgery and the Plastic and Reconstructive Surgery Service, Walter Reed National Military Medical Center.
authors.forename: Kevin
authors.initials: K
authors.lastname: Casey
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sabino
authors.forename: Elliot
authors.initials: E
authors.lastname: Jessie
authors.forename: Barry D
authors.initials: BD
authors.lastname: Martin
authors.forename: Ian
authors.initials: I
authors.lastname: Valerio
mesh_terms: D000328:Adult; D005121:Extremities / Q000293:injuries* / Q000601:surgery*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D023821:Limb Salvage; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000379:methods; D057772:Vascular System Injuries / Q000601:surgery*; D014857:Warfare