Type III open tibia fractures in low-resource setting. Part 2: soft-tissue coverage with simple, reliable and replicable pedicle flaps

Correction to: Extremity soft tissue coverage in the combat zone: use of pedicled flap transfers by the deployed orthopedic surgeon

“…The overall success rate for flap coverage performed in the field was over 90%, a figure comparable to various other authors' reports about warrelated extremity reconstructions performed in patients after evacuation out of the combat zone [1,2]. In our opinion, the relatively high success rate could be attributed to the near-exclusive use of simple, reliable, and replicable pedicled flap transfers, which were perfectly suited to both CRIs and NCRIs in a non-specialist surgical MTF [4][5][6]. Transposition, or rotational, fasciocutaneous flaps and muscle flaps were the two types most often used, regardless of the injury location or cause.…”

“…Factors that affect treatment decisions include the surgeon's expertise and available resources (e.g., surgical equipment, antibiotics, laboratory analysis facilities and the number of available beds) [4]. For these reasons, the simplest solution for coverage is always preferred [4,6]. In our experience, pedicled flaps combined with skin grafts allowed reconstruction of almost all types soft tissue extremity injuries, even large ones.…”

“…Additional skin grafts were carried out together with flap transfers in most patients but were deferred in cases at risk of early infection. Simultaneous local, or distant, pedicled flaps were used successfully in this cohort as an alternative to free transfers [4,6]. This decision was based on our limited experience with such procedures, as well as the following 2 considerations.…”

“…Due to the lack of plastic surgeons in the battlefield, orthopedic surgeons often find themselves alone when managing local patients who present with complex extremity injuries requiring multi-tissue reconstruction. In this austere environment, they routinely perform soft tissue coverage procedures using "simple, reliable and replicable" techniques [4][5][6].…”

Limb Salvage for Musculoskeletal Tumors in the Austere Environment: Review of the Literature With Illustrative Cases Regarding Considerations and Pitfalls

“…Discussion of limb-salvage surgery in the austere environment is limited to the trauma literature. 13 14 15 16 When resources are not limited, limb salvage is the standard for extremity tumor resection when adequate function can be maintained. 17 In areas where resources are limited and care may be delayed, limb salvage may not always be possible.…”