A Decade of Conflict

Sabino, Jennifer; Polfer, Elizabeth M.; Tintle, Scott M.; Jessie, Elliot; Fleming, Mark E.; Martin, Barry; Shashikant, Mark; Valerio, Ian L.

doi:10.1097/prs.0000000000001025

Cited by 51 publications

(23 citation statements)

References 18 publications

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“…Autologous tissue transfer with either pedicled or free flaps has remained the pillar of treatment for definitive reconstruction in recent conflicts. Sabino et al [ 18 ] reported 10 years of experiences at Walter Reed National Military Medical Center where 359 flaps were performed for war-related extremity trauma (143 free and 216 pedicled flaps), including poly-extremity trauma and reconstruction, with outcomes comparable to other military and civilian lower extremity reconstruction. In this series, 55 % of flaps were muscle flaps, and 42 % were fasciocutaneous flaps.…”

Section: Reviewmentioning

confidence: 99%

“…Flap failure, hematoma, chronic pain, non-union, osteomyelitis, heterotopic ossification, and delayed amputation represent the major complications reported in war-related extremity reconstructions [ 5 , 18 ]. Overall, the success rate for flap coverage exceeds 90 % [ 2 – 4 , 18 ]. Sabino et al [ 18 ] reported flap failure leading to amputation in only four out of 359 cases of flap coverage (1 %).…”

Section: Reviewmentioning

confidence: 99%

“…Overall, the success rate for flap coverage exceeds 90 % [ 2 – 4 , 18 ]. Sabino et al [ 18 ] reported flap failure leading to amputation in only four out of 359 cases of flap coverage (1 %). There was no difference in the overall complication rate between muscle and fasciocutaneous flaps.…”

Section: Reviewmentioning

confidence: 99%

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Changing paradigms in lower extremity reconstruction in war-related injuries

2016

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BackgroundBallistic high-energy trauma has substantially increased the severity of non-fatal extremity injuries incurred in modern warfare. Expedient medical care, refinement in surgical techniques, and soft tissue coverage have brought about a paradigm shift in the management of lower extremity wounds during the last decade with an increased emphasis on limb salvage.MethodsA literature-based study was conducted to analyze reconstructive modalities based on the location, depth, and severity of wounds, as well as mechanism of injury, concomitant vascular injuries and open fractures, choice of flap, timing of definitive reconstruction, and complications.ResultsExtremity injuries account for over 60 % of injuries in the recent conflicts in Iraq and Afghanistan, with the majority secondary to explosive devices. The severity of these injuries is profound compared with civilian registries, and conventional injury scoring systems have failed to accurately predict outcomes in combat trauma. The mainstay of treatment is serial debridement, negative pressure therapy, fracture stabilization, and treatment of concomitant injuries by the forward medical teams with subsequent definitive reconstruction after transport to an advanced military treatment facility. Autologous reconstruction with free tissue transfer and pedicled flaps remains the primary modality for soft tissue coverage in limb salvage. Adjunct innovative modalities, such as external tissue expansion, dermal substitutes, and regenerative matrices, have also been successfully utilized for limb salvage.ConclusionLower extremity injuries account for the vast majority of injuries in modern warzones. Explosive devices represent the most common mechanism of injury, with blast impact leading to extensive soft tissue injuries necessitating complex reconstructive strategies. Serial debridement, negative pressure therapy, and autologous reconstruction with free tissue transfer and pedicled flaps remain the mainstay of treatment in recent conflicts.

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Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

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Changing paradigms in lower extremity reconstruction in war-related injuries

2016

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“…1,2,4 Skin and soft tissue losses are especially challenging in patients with multiple extremity and/or amputee injuries.…”

Section: Discussionmentioning

confidence: 99%

“…1 Regenerative modalities offer novel options for complicated reconstructions. 2–4 Herein, our case report outlines the first military nonburn-related trauma patient treated by a combination of a dermal regenerate template (DRT) followed by application of spray skin and 6:1 meshed skin grafts to address a more than 600-cm 2 abdominal skin and soft tissue deficit.…”

mentioning

confidence: 99%

A Case Report of the First Nonburn-related Military Trauma Victim Treated with Spray Skin Regenerative Therapy in Combination with a Dermal Regenerate Template

Valerio

Hammer

Rendón

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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Summary:Massive soft tissue and skin loss secondary to war-related traumas are among the most frequently encountered challenges in the care of wounded warriors. This case report outlines the first military nonburn-related trauma patient treated by a combination of regenerative modalities. Our case employs spray skin technology to an established dermal regenerate matrix. Our patient, a 29-year-old active duty male, suffered a combat blast trauma in 2010 while deployed. The patient’s treatment course was complicated by a severe necrotizing fasciitis infection requiring over 100 surgical procedures for disease control and reconstruction. In secondary delayed reconstruction procedures, this triple-limb amputee underwent successful staged ventral hernia repair via a component separation technique with biologic mesh underlay although this resulted in a skin deficit of more than 600 cm2. A dermal regenerate template was applied to the abdominal wound to aid in establishing a “neodermis.” Three weeks after dermal regenerate application, spray skin was applied to the defect in conjunction with a 6:1 meshed split thickness skin graft. The dermal regenerate template allowed for optimization of the wound bed for skin grafting. The use of spray skin allowed for a 6:1 mesh ratio, thus minimizing the donor-site size and morbidity. Together, this approach resulted in complete healing of a large full-thickness wound. The patient is now able to perform activities of daily living, walk without a cane, and engage in various physical activities. Overall, our case highlights the potential that combining regenerative therapies can achieve in treating severe war-related and civilian traumatic injuries.

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A comparative analysis of fasciocutaneous versus muscle free flaps in peripheral vascular disease patients

et al. 2023

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Objective: Chronic lower extremity (LE) wounds are common in patients with peripheral vascular disease (PVD). Free tissue transfer (FTT) provides healthy soft tissue for wound coverage and additional blood supply to promote wound healing. Given previous studies demonstrate increased complications in LE fasciocutaneous flaps, it was hypothesized that low vascular resistance in muscle flaps may be more advantageous for wound healing in PVD patients. Therefore, this study compared outcomes in PVD patients undergoing LE reconstruction with fasciocutaneous versus muscle free flaps. Methods: Retrospectively reviewed PVD patients undergoing FTT between 2011 and 2021. Patients were stratified into fasciocutaneous and muscle free flap groups. Primary outcomes included complications, flap success, post-reconstruction vascular interventions, limb salvage, and ambulatory status. Results: One hundred thirteen patients with PVD were identified, of which 60.2% received fasciocutaneous (n = 68) and 39.8% received muscle flaps (n = 45). Fortytwo patients (37.2%) underwent pre-flap endovascular interventions. Flap success rate was 98.2% (n = 111). Overall complication rate was 41.2% following fasciocutaneous flaps compared to 24.4% in muscle flaps (p = 0.067). Fasciocutaneous flaps had higher odds of ulceration requiring repeat angiogram within 1 year of reconstruction compared to muscle flaps (OR 3.4, 95%

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A Decade of Conflict

Abstract: Therapeutic, III.

Cited by 51 publications

References 18 publications

Changing paradigms in lower extremity reconstruction in war-related injuries

Changing paradigms in lower extremity reconstruction in war-related injuries

A Case Report of the First Nonburn-related Military Trauma Victim Treated with Spray Skin Regenerative Therapy in Combination with a Dermal Regenerate Template

A comparative analysis of fasciocutaneous versus muscle free flaps in peripheral vascular disease patients

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