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Emerging Trends In Limb Salvage Over the Last Decade of War Trauma
Ian Valerio MD, MS, MBA, Jennifer Sabino MD, Scott Tintle MD, Mark Fleming DO, Anand Kumar MD
Walter Reed National Military Medical Center
2012-02-13
Presenter: Jennifer Sabino
Affidavit:
approximately 50%
Director Name: Craig Shriver MD and Ian Valerio MD
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Hand
How does this presentation meet the established conference educational objectives?
Objectives 2 & 3 regarding complex surgical cases and improving care and relevant plastic surgery procedures
How will your presentation be used by practicing physicians in the audience?
improving care of complex limb trauma
Introduction: Over the prior decade of the Iraq and Afghanistan Wars interesting trends in the numbers and types of flap limb salvage procedures have emerged.
Methods: All combat limb salvages performed from 2003-2012 were reviewed. Data assessed included lower versus upper extremity cases and timing of coverage. Outcomes measured included flap success rates and complications (partial or total flap loss, donor and/or recipient hematomas, infections, or wound problems).
Results: 157 limb salvage procedures were performed (73 upper; 84 lower extremity cases). From 2003-2008, lower extremity salvages were 2x more common than upper extremity cases (45 lower; 24 upper). Pedicle flaps were utilized 3x more common than free flaps during this 6-year period (80% of lower; 75% of upper), with average time to definitive coverage being 27 days. From 2009-early 2012, upper limb salvages predominated (3:2 ratio), with free flaps 2x more likely. Average time to definitive coverage was 21days over this 3-year period. Overall flap success rate for the 2 time periods did not significantly differ (95% versus 97.5% p >0.05).
Conclusion: The last decade of war trauma has presented our institution with a high volume of limb salvage cases. It is apparent that a number of interesting trends have emerged including 1) a shift to more upper extremity compared to lower extremity limb salvages, 2) an increase in the use of skin and perforator flaps for extremity limb reconstruction, and 3) reductions in the time to definitive flap salvage procedure.
