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

Abstract

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 (n = 6), flap failure (n = 1) and partial flap necrosis (n = 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).