Use of Pedicled Flap Transfers for Extremity Soft-Tissue Coverage in the Combat Zone

MATHIEU L | JC Murison | A Bouchard | O Barbier

Seance of wednesday 28 june 2017 (Télé-expertise en chirurgie générale : une aide précieuse pour le chirurgien en situation d’isolement)

DOI number : 10.26299/97vr-b517/emem.2017.4.009

Abstract

Background: On theatres of operations military surgeons must deal with complex open trauma requiring soft-tissue coverage. For local patients, these procedures are performed in austere conditions, without microsurgical means, by orthopedic surgeons trained to reconstructive surgery.
Hypothesis: Soft-tissue coverage can be achieved by non-specialized surgeons with limited resources using exclusively pedicled flap transfers.
Methods: A retrospective study was conducted among patients operated by a single orthopedic surgeon during four tours in Chad, Afghanistan and Mali. All patients treated by pedicled flap transfer(s) for extremity soft-tissue defect(s) were included. The flap technical level was evaluated according to the Oberlin’s scale.
Results: During the period study 41 patients with a mean age of 25.6 years-old were included. They represented 12.5% of the patients operated in Chad, 16.5% in Afghanistan and 25% in Mali. Soft-tissue defects were related to recent traumas in 18 cases, ancient traumas in 15 cases and other etiologies in 8 cases. These patients totalized 46 soft-tissue defects with an associated infection in 20 (43%) cases. An overall of 56 flap transfers were carried out: 15 muscular flaps and 41 cutaneous or fascio-cutaneous flaps. Grade 1 transfers were predominant. Most were performed at the leg and hand levels. Ten complications were noticed including 6 deep infections and two partial flap necrosis. The mean follow-up was 71 days [12 days to 1 year]. Two patients sustained a secondary amputation because of persistent deep infections. The cosmetical outcome of the 52 evaluated flaps was very good in 44 cases and acceptable or poor in 8 cases.
Discussion: Pedicled flap transfers are commonly used for extremity soft-tissue coverage in French forward surgical facilities. These reconstructive procedures are reliable in austere conditions. Most of the complications observed are related to failure of bone infection treatment.