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Skin and Perforator Flap Options in the Management of Traumatic Extremity Soft-Tissue Injury
Gabriel F. Santiago MD, Andrew Kim MD,Jennifer Sabino MD, Patrick Basile MD, Robert Howard MD, Ian Valerio MD, MS, MBA
Walter Reed National Military Medical Center, Department of Plastic Surgery - Academic Hospital
2012-02-15
Presenter: Gabriel F. Santiago M.D.
Affidavit:
The presenting resident and first author designed the study, assisted with data acquisition and analysis, and drafted the majority of the abstract.
Director Name: Ian Valerio M.D., M.S., M.B.A.
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: General Reconstruction
How does this presentation meet the established conference educational objectives?
This abstract presents data supporting use of muscle-sparing flaps; and shows that they are a viable option for reconstruction of high-velocity trauma and complex injuries in a unique patient population
How will your presentation be used by practicing physicians in the audience?
The reconstructive technique described in this presentation has been successful in a patient population subjected to high-velocity & ballistic trauma. Although the exact mechanism of injury is unique to this population, the complexity of injury in this patient population is often seen in the civilian world. Practicing physicians will be able to apply the techniques in this presentation to their own trauma patients.
Introduction: Penetrating and avulsive type trauma due to blasts and high velocity ballistics are the most frequent cause of soft tissue injury (STI) in our service members serving in war conflicts. The degree of STI from high-velocity trauma is often extensive; requiring autologous tissue transfer to achieve definitive wound coverage. Our rationale & outcomes for skin and/or perforator flap procedures is described.
Methods: A retrospective chart review was performed of all patients who underwent a flap procedure as a result of war-related trauma by the Department of Plastic Surgery between 2009 and 2012. Data examined included anatomical sites of injury, flap types, and success rates. Outcomes evaluated included flap success and complications such as total and partial flap failure, donor or recipient site infections, hematomas, and/or wound healing issues.
Results:
A total of 79 flaps to the extremity were performed in our department between 2009-2012. Of these 34 (43.0%) were skin or perforator based flaps. The majority (85.3%) of these flaps were for upper extremity reconstruction. The trunk and upper extremity were used as donor sites in 67.6% of cases. Complications consisted of 1 complete flap loss, 2 partial losses, and one flap requiring revision.
Conclusions: Autologous Tissue Transfer with skin and perforator flaps has evolved within our military practice to address major extremity soft tissue injuries. Use of these flaps types have increased secondary to increased poly-limb, and more proximally based amputations; with consideration of "sparing" those muscles important to the lifelong rehabilitation goals of the wounded warrior.
