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: 0.76). 03/2010; 15(1):113-38. DOI: 10.1016/j.fcl.2009.10.006
Source: PubMed


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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    • "In Achilles tendon injuries, granulation tissue cannot substitute for specialized fascia, subcutaneous, or dermis tissue, nor can it replace other highly specific tissues (bones, cartilage, and tendons). In addition, granulation tissue is relatively inelastic and its adherence and potential tendon tethering can cause further dysfunction of the lower extremity.33 The prolonged immobilization of the ankle necessary to achieve granulation tissue could further hamper range of motion and may require longer physical therapy postoperatively. "
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    • "Severe muscle injury often involves nerve damage, and this leads to denervation atrophy and permanent functional disability (Baechler et al., 2010; Fan et al., 2008; Grogan and Hsu, 2011; Jarvinen et al., 2005; Vekris et al., 2008). Current management options for traumatic injuries to muscle and nerve employ a vascularized muscle flap, which contains intact nerve to provide anatomical and functional tissue restoration. "
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