Microvascular reconstructive surgery in Operations Iraqi and Enduring Freedom: The US military experience performing free flaps in a combat zone
Microvascular reconstructive surgery in Operations Iraqi and Enduring Freedom: The US military experience performing free flaps in a combat zone
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DOI：
10.1097/ta.0b013e318299da23
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发表时间：
2013-08-01
影响因子：
3.4
通讯作者：
Schmalbach, Cecelia
中科院分区：
文献类型：
--
作者：
Klem, Christopher;Sniezek, Joseph C.;Schmalbach, Cecelia
背景技术背景：在“伊拉克自由”和“持久自由”行动中因创伤性战斗损伤而造成复杂伤口的当地国民通常必须在战区接受重建手术。虽然使用微血管游离组织移植（游离皮瓣）用于创伤重建在文献中有很好的记载，当这些复杂的外科手术在战区进行时，存在各种并发症因素。方法：回顾性分析了2006年至2011年期间在伊拉克和阿富汗部署的6名军事外科医生的微血管经验。结果：29名患者出现了复杂的创伤性伤口。29例共施行游离皮瓣31例。组织缺损部位包括下肢（15），面/颈（8），上肢（6）。除1例患者外，所有患者均成功保肢。8例头部和颈部伤口患者中有6例在出院时可耐受口服摄入。3例患者有3个皮瓣丢失; 2例发生皮瓣丢失的患者成功进行了第二次游离或区域皮瓣移植。轻微并发症发生在6 patients.CONCLUSION：微血管游离组织转移复杂的组织缺损在战区是一个至关重要的任务，可以提高东道国患者的生活质量。部署到战区的美国主要作战医院应该包括受过训练的人员，他们能够执行这些复杂的重建程序，并且了解在这种具有挑战性的环境中优化结果的许多细微差别。版权所有（C）2013由Lippincott威廉姆斯& Wilkins
BACKGROUND: Local nationals with complex wounds resulting from traumatic combat injuries during Operations Iraqi Freedom and Enduring Freedom usually must undergo reconstructive surgery in the combat zone. While the use of microvascular free-tissue transfer (free flaps) for traumatic reconstruction is well documented in the literature, various complicating factors exist when these intricate surgical procedures are performed in a theater of war.METHODS: The microvascular experiences of six military surgeons deployed during a 30-month period between 2006 and 2011 in Iraq and Afghanistan were retrospectively reviewed.RESULTS: Twenty-nine patients presented with complex traumatic wounds. Thirty-one free flaps were performed for the 29 patients. Location of tissue defects included the lower extremity (15), face/neck (8), upper extremity (6). Limb salvage was successful in all but one patient. Six of eight patients with head and neck wounds were tolerating oral intake at the time of discharge. There were three flap losses in 3 patients; two patients who experienced flap loss underwent a successful second free or regional flap. Minor complications occurred in six patients.CONCLUSION: Microvascular free tissue transfer for complex tissue defects in a combat zone is a critically important task and can improve quality of life for host-nation patients. Major US combat hospitals deployed to a war zone should include personnel who are trained and capable of performing these complex reconstructive procedures and who understand the many nuances of optimizing outcomes in this challenging environment. Copyright (C) 2013 by Lippincott Williams & Wilkins