Changing paradigms in lower extremity reconstruction in war-related injuries

Margaret Connolly; Zuhaib R. Ibrahim; Owen N. Johnson III

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Changing paradigms in lower extremity reconstruction in war-related injuries

REVIEW | Updated：2026-03-12

- Changing paradigms in lower extremity reconstruction in war-related injuries
- Military Medical Research Vol. 3, Issue 2, Pages: 104-109(2016)
- Affiliations：
  
  1.Department of Surgery, University of Maryland Medical Center, 22 S Greene St., Baltimore, MD 21201, USA
  2.Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, 601 N Caroline St., Baltimore, MD 21287, USA
  3.Johns Hopkins University School of Medicine, 601 N Caroline St., Baltimore, MD 21287, USA
- Author bio：
  
  *: zibrahi2@jhmi.edu
- Funds：
- DOI：
  CLC：
- Published：2016-06
- Accepted：
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Margaret Connolly, Zuhaib R. Ibrahim, Owen N. Johnson III. Changing paradigms in lower extremity reconstruction in war-related injuries[J]. Military Medical Research, 2016, 3(2): 104-109.
DOI：

Margaret Connolly, Zuhaib R. Ibrahim, Owen N. Johnson III. Changing paradigms in lower extremity reconstruction in war-related injuries[J]. Military Medical Research, 2016, 3(2): 104-109. DOI：

摘要

Abstract

Background:

Ballistic 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.

Methods:

A 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.

Results:

Extremity 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.

Conclusion:

Lower 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.

关键词

Keywords

references

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