Floor plan - 2013 Annual Meeting - American Association for Hand ...

Free Tissue Transfer for Complex Extremity War Injuries
Institution where the work was prepared: The Microsurgery Unit, The Department of Plastic Surgery, Tel-Av, Tel-
Aviv, Israel
Arik Zaretski, MD; A. Amir; E. Arad; Y. Barnea; E. Miller; D. Leshem; J. Weiss; E. Gur; Sackler Faculty of Medicine, Tel-
Aviv University
BACKGROUND:
War injury to the extremities due to blast or gunshot injuries are characterized by severe damage to both bony structures and soft tissue.
The common finding is grade III - IV open fractures where concomitant vascular or neural injuries are frequent. The management
of such complicated injuries remains a multi-disciplinary challenge to the orthopedic, vascular and plastic surgeon. If reconstruction is
delayed for more than 48-72 hours, the risk of serious complications rises dramatically. We present a unique group of patients, transferred
from The Palestinian Authority in Gaza Strip to Israel following failed initial treatment in Gaza, with highly complicated and infected
open fractures of the limbs that where treated with free tissue transfer.
PATIENTS/METHODS:
Records were reviewed of patients transferred to our institution from Gaza from February 2006 until April 2007, for treatment of war
injuries grade III open fractures of limbs. Included in this study were all patients that underwent limb salvage procedures using free tissue
transfer.
RESULTS:
A total of ten patients were included. The etiology was blast injury in 5 patients (50%), gunshot injury in 4 patients (40%) and one patient
was hit by a bulldozer (10%). Six patients presented with open tibial fractures (60%), Two had sever foot injury with exposed bones (20%),
one (10%) had open fractures of the humerus, and 1 (10%) had palmar soft tissue defect. All patients had been initially treated in hospitals
in Gaza, and were transferred to our hospital 3 days on average (range, 0.5-4 days) following trauma. Delayed reconstruction was
achieved by microsurgical flaps in all patients included in the current study group. The flaps used where Gracilis muscle free flap (4),
fibula osteo-septo-cutaneous flap (2), Latissimus dorsi muscle flap (2), tensor fascia lata muscle with iliac crest bone (1), tensor fascia lata
myo-cutaneous flap (1) and vascularized fascia lata flap covered with full thickness skin graft (1). There where 3 re-explorations during
the first 24 hours after surgery and one flap was lost. No mortalities were recorded.
CONCLUSIONS:
Limb preserving procedures should be considered for war injuries and grade III open fractures of limbs, even in cases that present late,
with serious wound complications and osteomyelitis. A multidisciplinary approach focusing on proper revascularization, external skeletal
fixation, debridement and control of infection, can achieve good conditions for delayed reconstruction. Microsurgical flaps play a
pivotal role in delayed reconstruction of such complex injuries.
168