Risk factors and failures in the management of limb injuries in combat casualties

Grosset, Antoine; Pfister, Georges; l’Escalopier, Nicolas de; Plang, Soryapong; Russo, Anne-Pauline; Murison, James Charles; Laurent, Michel; Rigal, Sylvain

doi:10.1007/s00264-019-04329-7

Cited by 9 publications

(3 citation statements)

References 22 publications

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“…По данным авторов, с риском развития раневой инфекции ассоциированы такие факторы, как ампутации, переливание крови и общая тяжесть травмы, тогда как раннее оперативное вмешательство или введение антибиотика не коррелируют с этим осложнением. Французские специалисты медицинского центра Перси (Hôpital d'instruction des armées Percy), который курирует медицинская служба министерства обороны Франции (Service de Santé des Armées), также провели исследование в целях выявления предикторов осложнений огнестрельных ран конечностей [8]. В работе проанализированы исходы лечения огнестрельных ран, осложненных открытыми переломами, и выявлены два основных предиктора неудачи лечения: связанные с механизмом травмы (минно-взрывная травма) и связанные с условиями на месте хирургического вмешательства (сильное загрязнение раны).…”

Section: Introductionunclassified

Features of NATO’s soldiers limbs combat trauma treatment during armed conflicts on the territory of Iraq and Afghanistan (literature review)

Бесчастнов

2021

Rany i ranevye infekcii

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The article describes armed conflicts on the territory of Iraq and Afghanistan. Improvement of individual and collective protection equipment has reduced the number of cases of soft tissue wounds in the extremities. The main cause of mortality and wound complications is antibiotic-resistant microflora. Purulent complications lead to chronic treatment of the wound healing process and a long period of specialized treatment and rehabilitation, which entails difficulties in the socialization of wounded servicemen, as well as significant financial costs from the state. When providing medical care to wounded military personnel, it is negative pressure wound therapy. Phage therapy is a promising method for treating infectious complications.

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Section: Introductionunclassified

Features of NATO’s soldiers limbs combat trauma treatment during armed conflicts on the territory of Iraq and Afghanistan (literature review)

Бесчастнов

2021

Rany i ranevye infekcii

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“…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

International Orthopaedics (SICOT)

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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.

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“…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.…”

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Conflicts, military medicine and war casualties in international Orthopaedics

Scarlat

Quaile

Waddell

2019

International Orthopaedics (SICOT)

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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...

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Risk factors and failures in the management of limb injuries in combat casualties

Cited by 9 publications

References 22 publications

Features of NATO’s soldiers limbs combat trauma treatment during armed conflicts on the territory of Iraq and Afghanistan (literature review)

Features of NATO’s soldiers limbs combat trauma treatment during armed conflicts on the territory of Iraq and Afghanistan (literature review)

Reconstruction of composite leg defects post-war injury

Conflicts, military medicine and war casualties in international Orthopaedics

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