Decision-making algorithm for sequential treatment of diaphyseal bone gaps in war-wounded patients in the Middle East

Background In a high conflict region, war injuries to the distal lower extremity are a major source of large composite defects involving bone and soft tissues. These defects are at the edge between using a single free flap [osteo-(+/-myo) cutaneous] vs double free flap reconstruction (bone and soft tissue). In this paper, we present our experience and outcomes in treating patients with leg war injury reconstructed using a single free fibula flap. Methods Fifteen patients with distal leg composite defects secondary to war injuries were treated between January 2015 and March 2016. All patients were reconstructed using single barrel free fibula osteo-(+/-myo)cutaneous flap where single or double skin paddles were used according to the soft tissue defect requiring coverage. Results There were no cases of total or partial flap loss. Complications were limited to three cases including traumatic fibula fracture, venous congestion with negative findings, and residual soft tissue defect requiring coverage. There were no cases of wound dehiscence or infection. Mean follow-up time was 418.8 days. Mean bone healing time was nine months after which patients were allowed full weight bearing. Conclusion A single barrel free fibula osteo-(+/-myo)cutaneous flap is a valid and reliable tool for reconstruction composite lower extremity defects post-war injury. Adequate planning of fibula flap soft tissue components (skin, muscle) rearrangement is essential for success in such challenging reconstructions.

Section: Discussionmentioning

confidence: 99%

“…Segmental bone loss in lower extremity war-related injury is a particular entity. Specifically in lower extremity injuries, bone loss is a risk factor for failure of limb salvage and associated with an increased risk of early complications [12,13]. Data regarding its prevalence and management is lacking [14].…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of composite leg defects post-war injury

Karami

Ghieh

Chalhoub

et al. 2019

“…This chapter was started during Mr. Maurice Hinsenkamp presidency of SICOT and was supported by many countries and institutions, including military hospitals from different countries and "Médecins sans Frontières" a powerful International organization started in France and dedicated to helping people in difficult situations, including war, natural disasters and terror attacks on civilians.The December issue of the Journal published the "war and catastrophy" chapter and included four relevant papers that present different conditions of the osteo-articular system after combat trauma and the different methods of management.The treatment of war wounds is based on a sequential surgical strategy, which frequently faces therapeutic failures, which could compromise or complicate the final functional result. The study published by the French specialty centres [1] is a valuable piece of research that identifies potential risk factors and provides solutions for the management of those specific cases.A paper authored by specialists working with "Medecins sans Frontières" discusses tibial bone gaps after war injuries [2]. Tibial bone loss is common in war and can be managed by different types of surgery, including compression osteosynthesis, bone graft, tibialisation of fibula, bone transportation, and free flaps.…”

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confidence: 99%

“…A paper authored by specialists working with "Medecins sans Frontières" discusses tibial bone gaps after war injuries [2]. Tibial bone loss is common in war and can be managed by different types of surgery, including compression osteosynthesis, bone graft, tibialisation of fibula, bone transportation, and free flaps.…”

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confidence: 99%

Conflicts, military medicine and war casualties in international Orthopaedics

Scarlat

Quaile

Waddell

2019

The recent SICOT world orthopaedic surgery and traumatology congress in Oman was a great meeting with thousands of attendees, brilliant talks, educational lectures, instructional courses and seminars, symposia and many free papers presented by speakers from five continents. The International Council of the SICOT is formed by orthopaedic surgeons who represent their respective countries. At the Annual Assembly of the Council some countries were missing. A few colleagues were unable to attend for specific reasons that are not related with scientific or academic issues. Some colleagues live in places that are in state of war or have no freedom to circulate. Some others belong or work in places where the airports or roads were recently destroyed. Finally, some colleagues were unable to attend due to restrictions of circulation or visa delivery in their local or regional areas. However, the art of Orthopaedic Surgery is a part of our society, everywhere on the planet our colleagues are treating wounded people, military or civilian from every population group of, including their enemies. During difficult times, combat, terror attacks or war our colleagues manage specific casualties, terrible and disabling limb wounds, catastrophic trauma, partial or total limb loss, chemical, thermic burns, penetrating injuries from high-velocity weapons and many other conditions. During these particular periods of time civilians may be "collateral damage" and often they represent more cases than the military personnel. Trauma was considered for many years as the "poor child" of orthopaedics and scheduled routine surgery was the main option in every general hospital except in dedicated trauma centres. The picture changes obviously in time of war or after natural catastrophies when mass causalities become a priority and every orthopaedic surgeon will eventually become a trauma care provider.International Orthopaedics publishes every year papers related to war traumatology and secondary treatment of sequellae. This chapter was started during Mr. Maurice Hinsenkamp presidency of SICOT and was supported by many countries and institutions, including military hospitals from different countries and "Médecins sans Frontières" a powerful International organization started in France and dedicated to helping people in difficult situations, including war, natural disasters and terror attacks on civilians.The December issue of the Journal published the "war and catastrophy" chapter and included four relevant papers that present different conditions of the osteo-articular system after combat trauma and the different methods of management.The treatment of war wounds is based on a sequential surgical strategy, which frequently faces therapeutic failures, which could compromise or complicate the final functional result. The study published by the French specialty centres [1] is a valuable piece of research that identifies potential risk factors and provides solutions for the management of those specific cases.A paper authored by specialists working wit...

“…We acknowledge in the general orthopaedics section efforts made by developing economies to provide quality orthopaedics in specific geographic locations and this stirs debate and comments [9,10]. We provide literature on general emergency principles, war and life threatening injuries [11,12].…”

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confidence: 99%

General and specialized Orthopaedics

Scarlat

2019

The twenty-first Century changed our way of communication and also our way of reading and publishing science. Since Gutenberg our method of learning was associated with reading printed material and the Btraditional^way of being a scholar was associated with attending lectures made by teachers BEx cathedra^where knowledge was almost dogmatic and unquestionable. Universities were in charge of sharing the science. The practice of surgery was taught in the Boperating theatre^where technical manoeuvres were demonstrated by well-dressed attendings that eventually washed their hands after the case. A majority of surgical cases were amputations. [1] Museums and libraries are depositories of the efforts made over centuries to provide healing and hope, keeping medical evidence and sharing our knowledge with the upcoming generations. Medical Journals appeared in the eighteenth century and became rapidly peer-reviewed, this major step opening the way to criticism, doubt, questions and progress.With the Internet and electronic communication our traditions were challenged and new tools were developed. Patient databases became more reliable and easier to understand, medical statistics and meta-analysis became possible. A plethora of medical Journals appeared and competition between publications raised based on the visibility, readership and citations. This drive is associated with inherent growth in new publications that have short life span and have an aggressive behaviour [2] New values were based on the ability of a new publication to impact, change or improve current practice. When a paper is published in our days, the data, text, images and full information are available instantly everywhere. In this acceleration of publications, augmen