Plastic Surgery Challenges in War Wounded I: Flap-Based Extremity Reconstruction.
Scope and Significance:Reconstruction of traumatic injuries requiring tissue transfer begins with aggressive resuscitation and stabilization. Systematic advances in acute casualty care at the point of injury have improved survival and allowed for increasingly complex treatment before definitive reconstruction at tertiary medical facilities outside the combat zone. As a result, the complexity of the limb salvage algorithm has increased over 14 years of combat activities in Iraq and Afghanistan.Problem:Severe poly-extremity trauma in combat casualties has led to a large number of extremity salvage cases. Advanced reconstructive techniques coupled with regenerative medicine applications have played a critical role in the restoration, recovery, and rehabilitation of functional limb salvage.Translational Relevance:The past 14 years of war trauma have increased our understanding of tissue transfer for extremity reconstruction in the treatment of combat casualties. Injury patterns, flap choice, and reconstruction timing are critical variables to consider for optimal outcomes.Clinical Relevance:Subacute reconstruction with specifically chosen flap tissue and donor site location based on individual injuries result in successful tissue transfer, even in critically injured patients. These considerations can be combined with regenerative therapies to optimize massive wound coverage and limb salvage form and function in previously active patients.Summary:Traditional soft tissue reconstruction is integral in the treatment of war extremity trauma. Pedicle and free flaps are a critically important part of the reconstructive ladder for salvaging extreme extremity injuries that are seen as a result of the current practice of war.
Department of Plastic and Reconstructive Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland.; Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Jennifer M
JM
Sabino
Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland.
Julia
J
Slater
Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.; Division of Burn, Wound, and Trauma, Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, Ohio.
Ian L
IL
Valerio
extremity reconstruction; extremity trauma; flap coverage; microsurgery; soft tissue injury; tissue transfer
J Trauma. 2011 Aug;71(2 Suppl 2):S235-57
21814090
Plast Reconstr Surg. 1981 Jul;68(1):73-82
7244003
Ann Plast Surg. 2014 May;72 Suppl 1:S38-45
24740023
Plast Reconstr Surg. 1990 Dec;86(6):1152-62; discussion 1163
2243859
Plast Reconstr Surg. 1986 Sep;78(3):285-92
3737751
J Plast Reconstr Aesthet Surg. 2007;60(7):760-8
17526442
Mil Med. 2006 Mar;171(3):246-52
16602525
J Trauma. 1987 Feb;27(2):109-14
3820346
J Bone Joint Surg Am. 1993 Oct;75(10):1431-41
8408131
Orthop Clin North Am. 2010 Apr;41(2):233-9
20399362
Br J Plast Surg. 1992 Nov-Dec;45(8):571-7
1493528
J Bone Joint Surg Am. 2000 Dec;82-A(12):1681-91
11130641
J Bone Joint Surg Am. 1991 Oct;73(9):1323-30
1918114
Plast Reconstr Surg. 2013 Jul;132(1):213-20
23508052
J Trauma. 2000 May;48(5):913-7
10823536
J Am Acad Orthop Surg. 2006;14(10 Spec No.):S62-5
17003210
Plast Reconstr Surg. 2009 Oct;124(4):1211-9
19935305
J Trauma. 2007 Jan;62(1):162-5
17215749
Mil Med. 2015 Mar;180(3 Suppl):24-8
25747626
Plast Reconstr Surg. 2006 Jun;117(7):2468-75; discussion 2476-7
16772958
Plast Reconstr Surg. 2015 Jan;135(1):301-8
25285678
Eur Cell Mater. 2009 Dec 31;18:96-111
20073015
Plast Reconstr Surg. 2015 Mar;135(3):895-902
25415277
Hand Clin. 2007 Feb;23(1):37-48
17478251
J Reconstr Microsurg. 2003 May;19(4):225-33
12858245
J Reconstr Microsurg. 2005 Nov;21(8):517-23
16292726
Plast Reconstr Surg. 2001 Sep 15;108(4):1029-41; quiz 1042
11547168
N Engl J Med. 2002 Dec 12;347(24):1924-31
12477942
J Surg Orthop Adv. 2010 Spring;19(1):29-34
20371004
Plast Reconstr Surg. 1992 Mar;89(3):478-87; discussion 488-9
1741471
Plast Reconstr Surg. 2006 Jun;117(7 Suppl):160S-174S
16799385
Plast Reconstr Surg. 2009 Jan;123(1):218-29
19116556
J Trauma. 1989 Aug;29(8):1086-94
2668545
Plast Reconstr Surg. 1993 Jul;92 (1):70-6
8516409
Mil Med. 2011 Jan;176(1):67-78
21305963
J Orthop Trauma. 2010 Nov;24(11):697-703
20926962
J Orthop Res. 2008 Sep;26(9):1238-44
18404722
Plast Reconstr Surg. 1986 May;77(5):785-94
3704001
J Trauma. 2006 Feb;60(2):397-401
16508502
Plast Reconstr Surg. 2004 Oct;114(5):1123-30
15457022
Acta Orthop Traumatol Turc. 2011;45(2):100-8
21610308
Acta Orthop Scand. 1998 Apr;69(2):177-80
9602779