Shortening and angulation for soft-tissue reconstruction of extremity wounds in a combat support hospital.

Abstract:

BACKGROUND:Bone and soft-tissue loss are common extremity injuries sustained in current military conflicts. Selected host national patients had their definitive orthopedic care performed at our combat support hospital. Soft-tissue reconstruction can be a challenging task in this environment. There are several situations in which free or rotational flap coverage is not possible, including the presence of a single vessel limb, local muscle damage, and/or nonavailability of an experienced flap surgeon. The technique of shortening and angulation for extremity soft-tissue reconstruction is described using tools available in a theater of operations. METHODS:We treated 6 limbs in 5 patients with the technique of shortening and/or angulation to obtain soft-tissue coverage for extremity war wounds at our combat support hospital. Bony stabilization was accomplished using the standard Hoffman II external fixator (Stryker Orthopedics, Mahwah, NJ). The extremities treated included: 2 humerus fractures, 3 tibia fractures, and 1 ankle fracture. Two of the patients required vascular reconstruction. Patients were followed for as long as possible given individual circumstances. RESULTS:One patient in the series died of multiple organ system failure because of intra-abdominal injuries. Average follow-up on the remaining patients was 7.03 weeks (1 to 14 weeks). In the patient with 1-week follow-up, the skin graft had 100% take. All other wounds were healed at the latest follow-up without signs of infection. CONCLUSION:Shortening and/or angulation of extremities with bone and soft-tissue loss is an effective means of obtaining soft-tissue coverage in a theater of operations.

journal_name

Mil Med

journal_title

Military medicine

authors

Hsu JR,Beltran MJ,Skeletal Trauma Research Consortium.

subject

Has Abstract

pub_date

2009-08-01 00:00:00

pages

838-42

issue

8

eissn

0026-4075

issn

1930-613X

journal_volume

174

pub_type

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