Current military conflicts in Iraq and Afghanistan have produced a significant number of complex injury patterns. Multiple extremity trauma and wide zones of injury mandate a flexible approach to these problems. We report our experience with periarticular elbow injuries with large soft tissue defects. Acute vascular reconstruction and multiple wound debridements throughout the evacuation chain set the stage for successful rigid fixation. The judicious use of pedicled thoracoabdominal flaps remains a viable solution when microvascular techniques are less appropriate.
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