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Background: Combat-related extremity injuries frequently require vascular repair within the combat theater before undergoing definitive reconstruction. This study examines the outcomes of early vascular repair with secondary soft-tissue extremity reconstruction over the past decade of war trauma.

Methods: War-related extremity injuries necessitating a downrange vascular procedure followed by a definitive limb reconstruction were reviewed. Patient demographics, type and location of vascular injuries, vascular intervention, and soft-tissue reconstruction procedures were examined. Outcomes of vascular repair, tissue transfer, and limb salvage were analyzed.

Results: From 2003 to 2012, 79 extremities in 78 patients had a vascular injury requiring in-theater intervention followed by 87 staged flap reconstructions performed distal to the vascular repair. Of the 74 arterial injuries requiring intervention, 27 were proximally located, with 73 percent requiring bypass. The early primary patency rate was 66 percent and the early primary-assisted patency rate was 93 percent for proximal artery repair procedures. The flap complication rate was 31 percent. Overall complications were examined by subtype and were not significantly different compared with flaps performed without a proximal vascular injury in the same limb. The flap success rate (93 percent) and the limb salvage rate (81 percent) were similar to the comparison cohort.

Conclusions: This represents one of the largest series of traumatic extremity injuries requiring secondary limb reconstruction with tissue transfer following a vascular intervention. The authors identified no significant difference in outcomes related to flap coverage or limb salvage for patients with or without vascular injuries. Reconstructive options in combat extremity trauma are not limited by proximal vascular injury.

Clinical Question/level of Evidence: Therapeutic, III.

Titel:	Flap coverage outcomes following vascular injury and repair: chronicling a decade of severe war-related extremity trauma.
Autor/in / Beteiligte Person:	Casey, K ; Sabino, J ; Jessie, E ; Martin, BD ; Valerio, I
Zeitschrift:	Plastic and reconstructive surgery, Jg. 135 (2015), Heft 1, S. 301-308
Veröffentlichung:	<Jan. 2002- > : Hagerstown, MD : Lippincott Williams & Wilkins ; <i>Original Publication</i>: Baltimore : Williams & Wilkins,, 2015
Medientyp:	academicJournal
ISSN:	1529-4242 (electronic)
DOI:	10.1097/PRS.0000000000000769
Schlagwort:	Adult Female Humans Injury Severity Score Male Retrospective Studies Time Factors Vascular Surgical Procedures methods Extremities injuries Extremities surgery Limb Salvage Plastic Surgery Procedures methods Surgical Flaps Vascular System Injuries surgery Warfare
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [Plast Reconstr Surg] 2015 Jan; Vol. 135 (1), pp. 301-308. MeSH Terms: Limb Salvage* ; Surgical Flaps* ; Warfare* ; Extremities / injuries ; Extremities / surgery ; Plastic Surgery Procedures / methods ; Vascular System Injuries / surgery ; Adult ; Female ; Humans ; Injury Severity Score ; Male ; Retrospective Studies ; Time Factors ; Vascular Surgical Procedures / methods References: Owens BD, Kragh JF Jr, Macaitis J, Svoboda SJ, Wenke JC. Characterization of extremity wounds in Operation Iraqi Freedom and Operation Enduring Freedom. J Orthop Trauma. 2007;21:254–257. ; Starnes BW, Beekley AC, Sebesta JA, Andersen CA, Rush RM Jr.. Extremity vascular injuries on the battlefield: Tips for surgeons deploying to war. J Trauma. 2006;60:432–442. ; Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield (2001–2011): Implications for the future of combat casualty care. J Truama Acute Care Surg. 2012;73:S431–S437. ; Markov NP, DuBose JJ, Scott D, et al. Anatomic distribution and mortality of arterial injury in the wars in Afghanistan and Iraq with comparison to a civilian benchmark. J Vasc Surg. 2012;56:728–736. ; Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–196. ; Fox CJ, Gillespie DL, O’Donnell SD, et al. Contemporary management of wartime trauma. J Vasc Surg. 2005;41:638–644. ; Illig KA, Moran S, Serletti J, et al. Combined free tissue transfer and infrainguinal bypass graft: An alternative to major amputation in selected patients. J Vasc Surg. 2001;33:17–23. ; Tukiainen E, Kallio M, Lepantalo M. Advanced leg salvage of the critically ischemic leg with tissue loss by vascular and plastic surgeon teamwork: A long-term outcome. Ann Surg. 2006;244:949–958. ; Swiontkowski MF, MacKenzie EJ, Bosse MJ, et al. Factors influencing the decision to amputate or reconstruct after high-energy lower extremity trauma. J Trauma. 2002;52:641–649. ; Potter BK, Forsberg JA, Davis TA, et al. Heterotopic ossification following combat-related trauma. J Bone Joint Surg Am. 2010;92(Suppl 2):74–89. ; Sheppard FR, Keiser P, Craft DW, et al. The majority of US combat casualty soft-tissue wounds are not infected or colonized upon arrival or during treatment at a continental US military medical facility. Am J Surg. 2010;200:489–495. ; Mody RM, Zapor M, Hartzell JD, et al. Infectious complications of damage control orthopedics in war trauma. J Trauma. 2009;67:758–761. ; Brown KV, Ramasamy A, Tai N, MacLeod J, Midwinter M, Clasper JC. Complications of extremity vascular injuries in conflict. J Trauma. 2009;66(Suppl):S145–S149. ; Johnson EN, Burns TC, Hayda RA, Hospenthal DR, Murray CK. Infectious complications of open type III tibial fractures among combat casualties. Clin Infect Dis. 2007;45:409–415. ; Burkhardt GE, Cox M, Clouse WD, et al. Outcomes of selective tibial artery repair following combat-related extremity injury. J Vasc Surg. 2010;52:91–96. ; Lin CH, Wei FC, Levin LS, Su JI, Yeh WL. The functional outcome of lower-extremity fractures with vascular injury. J Trauma. 1997;43:480–485. Entry Date(s): Date Created: 20141007 Date Completed: 20150309 Latest Revision: 20221207 Update Code: 20231215

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Flap coverage outcomes following vascular injury and repair: chronicling a decade of severe war-related extremity trauma.