Soft tissue management of war wounds to the foot and ankle.

Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center, Washington, DC 20307, USA.
Foot and ankle clinics (Impact Factor: 0.84). 03/2010; 15(1):113-38. DOI: 10.1016/j.fcl.2009.10.006
Source: PubMed

ABSTRACT This article details the experiences of United States military reconstructive surgeons in the soft tissue management of war wounds of the foot and ankle resulting from the conflicts in Iraq and Afghanistan. War wounds from this conflict are commonly caused by blast and fragmentation, and are characteristically extensive, heterogeneous, and severe. Multiple serial débridement episodes are routinely necessary because of deterioration of the wounds over time, which is in contrast to civilian trauma wherein fewer débridement episodes are generally required. Wound therapy adjuncts, such as subatmospheric wound dressing and synthetic dermal replacement, have been used extensively with favorable results. Pedicled flaps, such as the distally based sural neurofasciocutaneous flap, are reliable, and avoid the risks and technical demands associated with microsurgery. Free tissue transfer, such as the anterolateral thigh flap, the latissimus dorsi muscle flap, and the rectus abdominis muscle flap, are powerful reconstructive tools, and have been extensively used in the reconstruction of war wounds of the foot and ankle.

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    ABSTRACT: Introduction In 2009, the French took command of the Medical Hospital (MH) or Role 3 Hospital at KaIA (Kabul International Airport) within the framework of its role in the military mission Operation Pamir in Afghanistan. The goal of this study was to analyze the volume of orthopedic surgical activity for the last four years, to identify its specificities and to improve training of military orthopedic surgeons. Hypothesis Orthopedic surgery is the most important activity in the field and surgeons must adapt to situations and injuries that are different from those encountered in France. Patients and methods All patients operated on between July 2009 and June 2013 were prospectively included in an electronic database. The analysis included the number of surgical acts and patients, the types of injuries and the surgical procedures. Results Forty-three percent (n = 1875) of 4318 procedures involved orthopedic surgery. Half of these were emergencies. French military personnel represented 17% of the patients, local civilians 47% and children 17%. Half of the procedures involved the soft tissues, 20% were for bone fixation and 10% for surgery of the hand. The rate of amputation was 6%. The diversity of the surgical acts was high ranging from emergency surgery to surgical reconstruction. Discussion The activity of this Role 3 facility is comparable to that of other Role 3 facilities in Afghanistan, with an important percentage of acts involving medical assistance to the local population and scheduled surgeries as well as primary and/or secondary management of the wounded. The diversity of surgical acts confirms the challenge of training military orthopedic surgeons within the context of the hyperspecialization of the civilian sector. Specific training has been organized in France by the École du Val de Grâce. Specific continuing education is also necessary. Level of evidence IV (retrospective review).
    Orthopaedics & Traumatology Surgery & Research 10/2014; 100(6). DOI:10.1016/j.otsr.2014.06.010 · 1.17 Impact Factor
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    ABSTRACT: Aim: Open fracture-dislocation of the ankle is a high-energy limp-threading injury, almost always associated with vary grades of soft tissue damage. Stabilization of the tibiotalar joint by Steinman pins is retrospectively evaluated and seems to favor the management of the soft tissue damage and probably minimize the rate of complications in diabetic patients. Study Design: Retrospective case series study. Place and Duration of Study: From 2003 to 2011, Department of Orthopedics and Traumatology, University of Athens Medical School, KAT Hospital Athens, Greece. Materials and Methods: 17 patients were admitted with a fracture dislocation of the ankle. Twelve were featured as Oestern-Tscherne type III and 5 as type V. There have been used Steinmann pins to provide a rigid stabilization of the ankle in anatomic position, and available enough space to observe, follow and manage the soft tissue damage during the entire period of treatment. Two groups were confronted according to associated co-morbidity of diabetes mellitus.Results: At their last follow up visit, 14 patients were evaluated and the mean AOFAS score was 86, 5. The mean follow up period was 18, 1 months. Five patients underwent secondary arthrodesis of tibiofibular joint and in 4 patiens were observed non union of the fibula. Intra operatively in 10 patients were observed osteochondral post-traumatic lesions. In 3 patients the talus demonstrated signs of AVN at 7 months after trauma. There was no statistical difference between the two groups studied. Conclusions: Immediate débridement, irrigation, antibiotic therapy and use of Steinmann pins to stabilize the tibiotalar joint are indicated in a way to reduce the complication rates in diabetic patients. This technique seems to be effective and low cost, evidenced by the unnecessary use of further wound and soft tissue treatment operations.
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    ABSTRACT: Fractures with associated soft tissue injuries, or those termed 'open,' are not uncommon. There has been much discussion regarding there management, with the guidance from the combined British Orthopaedic Association and British Association and Aesthetic Surgeons teams widely accepted as the gold level of therapy. We aim to discuss the current evidence about the initial management of this group of injuries, taking a journey from arrival in the accident and emergency department through to the point of definitive closure. Other modes of therapy are also reviewed.
    The Open Orthopaedics Journal 10/2014; 8(1):399-408. DOI:10.2174/1874325001408010399


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