title: How to Cover Soft-Tissue Defects After Injuries to the Leg in Precarious Conditions.
abstract: BACKGROUND
  In precarious conditions, bone exposure on the leg is synonymous with amputation. The authors describe their experiences with such injuries in 15 patients.
  
  
  METHODS
  Fifteen patients were operated by the same surgeon in Afghanistan and Ivory Coast for bone exposure on the leg after war or roadcrash injuries. A flap was performed after an initial debridement and external fixation. The delay between the flap and the first injury was about 42 days.
  
  
  RESULTS
  The duration of hospitalization following the flap was about eight days. Cicatrization was complete after 25 days. Three patients had complications: one partial necrosis of the skin, one sepsis, and one patient had a leg amputation.
  
  
  CONCLUSIONS
  In precarious conditions, the management of bone exposure in local civilians and soldiers is limited by the conditions in their country or the conditions at the field hospital. The treatment must be simple and reliable because it may be difficult to perform patient follow-up. A pedicled flap provides new vascularized tissue with anti-infectious properties. Classical indications are: muscular flaps for the proximal and the middle part of the leg; sural flaps for the middle and the distal-third part. In substantial soft-tissue defects, amputation must be discussed.
  
  
  CONCLUSIONS
  The pedicled flap is an essential technique for fighting against infection, especially in cases where only poor technical and medicinal resources are available. This simple and reliable technique allows most tissue defects on the leg to be covered.
authors.affiliation: Hospital Chirurgie Orthopédique et Traumatologie, HIA Begin, 69 avenue de Paris, 94160, Saint Mandé, France. jpmarchaland@voila.fr.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Marchaland
authors.forename: Didier
authors.initials: D
authors.lastname: Ollat
authors.forename: Laurent
authors.initials: L
authors.lastname: Mathieu
authors.affiliation: Hospital Chirurgie Orthopédique et Traumatologie, HIA Begin, Saint Mandé, France.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Versier
keywords: Amputation; Free flap; Pedicled flap; Soft-tissue defects; War surgery
references.citation: Ann Plast Surg. 2007 Feb;58(2):200-6
references.pmid: 17245149
references.citation: J Bone Joint Surg Am. 2000 Dec;82-A(12):1681-91
references.pmid: 11130641
references.citation: Plast Reconstr Surg. 1988 Jan;81(1):74-81
references.pmid: 2892218
references.citation: J Bone Joint Surg Br. 1949 May;31B(2):228-35
references.pmid: 18145163
references.citation: Int J Low Extrem Wounds. 2006 Jun;5(2):101-4
references.pmid: 16698913
references.citation: Br J Plast Surg. 2004 Apr;57(3):266-9
references.pmid: 15006529