title: Limb reconstructive surgery in austere settings: use of flaps in French forward surgical facilities.
abstract: BACKGROUND
  Military surgeons deployed abroad must achieve soft tissue coverage under austere conditions.
  
  
  OBJECTIVE
  A non-specialized surgeon can achieve soft tissue coverage with good results.
  
  
  METHODS
  This is a retrospective study of all patients who underwent soft tissue coverage in French forward surgical units between 2003 and 2013.
  
  
  RESULTS
  In all, 81 flaps were constructed. Open fractures (39%) were the leading indication, followed by osseous infections (35%). Most flaps were for legs (70%) and hands (25%). Only pedicle flaps were used. The success rate was 91%.
  
  
  CONCLUSIONS
  Flaps can be constructed by orthopedic surgeons who are not specialized in reconstructive surgery, in austere settings and with good results. This procedure must be part of a global strategy of limb reconstruction, especially in cases of bone and joint infection. Pedicle flaps, especially muscular, appear more reliable and are to be preferred. The training of the surgeons deployed abroad must include flap surgery.
authors.affiliation: HIA Bégin, Service de chirurgie orthopédique, 94160 Saint Mandé, France.
authors.forename: O
authors.initials: O
authors.lastname: Barbier
authors.affiliation: HIA Bégin, Service de chirurgie orthopédique, 94160 Saint Mandé, France.
authors.forename: D
authors.initials: D
authors.lastname: Ollat
authors.affiliation: Hôpital d'instruction des Armées Percy, Service de chirurgie orthopédique, 92240 Clamart, France.
authors.forename: S
authors.initials: S
authors.lastname: Rigal
authors.affiliation: HIA Bégin, Service de chirurgie orthopédique, 94160 Saint Mandé, France.
authors.forename: G
authors.initials: G
authors.lastname: Versier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005121:Extremities / Q000293:injuries* / Q000601:surgery*; D005602:France; D006801:Humans; D008875:Middle Aged; D008889:Military Personnel; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps; D055815:Young Adult
keywords: flap; role 2; training; war injury