Soft tissue coverage using pedicled flap in combat zone: A case series

Laurent Mathieu; Soryapong Plang; Nicolas de l’Escalopier; James Charles Murison; Christophe Gaillard; Antoine Bertani; Frédéric Rongieras

doi:10.1186/s40779-020-00281-5

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Soft tissue coverage using pedicled flap in combat zone: A case series

CASE SERIES | Updated：2023-02-28

- Soft tissue coverage using pedicled flap in combat zone: A case series
- Soft tissue coverage using pedicled flap in combat zone: A case series
- 解放军医学杂志（英文版） 2021年8卷第2期页码：273-277
- Affiliations：
  
  1.Department of Orthopedics, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
  2.Department of Surgery, French Military Health Service Academy, Ecole du Val-de-Grâce, 75005 Paris, France
  3.Department of Orthopedics and Trauma Surgery, Edouard Herriot Hospital, 69003 Lyon, France
- Author bio：
  
  * laurent_tom2@yahoo.fr
- Funds：
- DOI：10.1186/s40779-020-00281-5
  中图分类号：
- 纸质出版：2021-06
- Accepted：
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Soft tissue coverage using pedicled flap in combat zone: A case series[J]. 解放军医学杂志（英文版）, 2021,8(2):273-277.

Mathieu et al.: Soft tissue coverage using pedicled flap in combat zone: a case series. Mil Med Res, 2020, 7: 51.
Soft tissue coverage using pedicled flap in combat zone: A case series[J]. 解放军医学杂志（英文版）, 2021,8(2):273-277. DOI： 10.1186/s40779-020-00281-5.

Mathieu et al.: Soft tissue coverage using pedicled flap in combat zone: a case series. Mil Med Res, 2020, 7: 51. DOI： 10.1186/s40779-020-00281-5.

摘要

Abstract

Background:

Soft tissue reconstruction is typically conducted after evacuation from theater of operations. If circumstances do not allow timely evacuation

however

defect site may need to be reconstructed in the combat zone.

Case presentation:

A total of 41 patients with extremity soft tissue defect were treated using pedicled flaps by a single orthopedic surgeon during four deployments in Chad

Afghanistan and Mali between 2010 and 2017. The mean age was 25.6 years. A total of 46 injury sites in extremities required flap coverage: 19 combat-related injuries (CRIs) and 27 non-combat related injuries (NCRIs). Twenty of the injury sites were infected. Overall

63 pedicled flap transfers were carried out: 15 muscle flaps

35 local fasciocutaneous flaps and 13 distant fasciocutaneous flaps. The flap types used did not differ for CRIs or NCRIs. Mean follow-up was 71 days. Complications included deep infection (

=6)

flap failure (

=1) and partial flap necrosis (

=1). Limb salvage rate was 92.7% (38/41).

Conclusions:

Soft tissue defect can be managed with simple pedicled flaps in theatre of operations if needed. Basic reconstructive procedures should be part of the training for military orthopedic surgeons.

Trial registration:

Retrospectively registered in January 2019 (2019-0901-001).

关键词

Keywords

references

Sabino J , Polfer E , Tintle S , Jessie E , Fleming M , Martin B , et al . A decade of conflict: flap coverage options in traumatic war-related extremity reconstruction . Plast Reconstr Surg . 2015 ; 135 ( 3 ): 895 - 902 .

Connolly M , Ibrahim ZR , Johnson ON . Changing paradigms in lower extremity reconstruction in war-related injuries . Mil Med Res . 2016 ; 3 : 9 .

Klem C , Sniezek JC , Moore B , Davis MR , Coppit G , Schmalbach C . Microvascular reconstructive surgery in operations Iraqi and enduring freedom: the US military experience performing free flaps in a combat zone . J Trauma Acute Care Surg . 2013 ; 75 ( 2 Suppl 2 ): S228 - 32 .

Mathieu L , Gaillard C , Pellet N , Bertani A , Rigal S , Rongiéras F . Soft-tissue coverage of war extremity injuries: the use of pedicle flap transfers in a combat support hospital . Int Orthop . 2014 ; 38 ( 10 ): 2175 - 81 .

Barbier O , Ollat D , Pasquier P , Rigal S , Versier G . Could the orthopaedic surgeon deployed in auster setting perform flaps on the leg? Acta Orthop Belg . 2017 ; 83 ( 1 ): 35 - 9 .

Mathieu L , Potier L , Niang CD , Rongiéras F , Duhamel P , Bey E . Type III open tibia fractures in low resources setting. Part 2: soft-tissue coverage with simple, reliable and replicable pedicle flaps . Med Sante Trop . 2018 ; 28 ( 3 ): 230 - 6 .

Clavien PA , Barkun J , de Oliveira ML , Vauthey N , Dindo D , Schulick RD , et al . The Clavien-Dindo classification of surgical complications: five-year experience . Ann Surg . 2009 ; 250 ( 2 ): 187 - 96 .

Saint-Cyr M , Wong C , Schaverien M , Moiallal A , Rohrich RJ . The perforasome theory: vascular anatomy and clinical implications . Plast Reconstr Surg . 2009 ; 124 ( 5 ): 1529 - 44 .

Sisti A , D’Aniello C , Fortezza L , Tassinari J , Cuomo R , Grimaldi L , et al . Propeller flaps: a literature review . In vivo . 2016 ; 30 ( 4 ): 351 - 73 .

Bonnet S , Gonzalez F , Mathieu L , Boddaert G , Hornez E , Bertani A , et al . The French Advanced Course for Deployment Surgery (ACDS) called Cours Avancé de Chirurgie en Mission Extérieure (CACHIRMEX): history of its development and future prospects . J R Army Med Corps . 2016 ; 162 ( 5 ): 343 - 7 .

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