Experience shows no increase in complications, compared to single-limb salvage techniques
For survivors of severe combat injuries threatening more than one limb, reconstructive surgical procedures using tissue flaps have a good record of safety and effectiveness in avoiding amputation, reports a paper in the August issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
Experience with multiple limb salvage procedures in solders injured in Iraq and Afghanistan shows good success rates, with no increase in complications compared to single-flap techniques, report Dr. Ian Valerio of Walter Reed National Military Medical Center and colleagues.
Encouraging Results with Multiple Limb Salvage Procedures
The researchers analyzed limb salvage procedures in military personnel sustaining combat-related injuries to multiple limbs while serving in Iraq and Afghanistan. "Limb salvage" refers to surgical reconstruction carried out to avoid amputation and maximize functioning of the surviving extremity.
From 2003 through 2012, a total of 359 limb salvage procedures were performed at the National Capital Consortium. Of these, 48 procedures involved attempts to salvage two or more injured limbs. "Critical to each of the cases presented in our series was maintenance of residual limb length and a functioning joint (wrist joint and knee joint)," Dr. Valerio and colleagues write.
The limb salvage procedures were performed an average of about one month after initial injury. About 90 percent of patients were injured by blasts from improvised explosive devices; about 60 percent of the threatened limbs were lower extremities (leg to foot). Injuries were more severe in the multiple-extremity salvage group, based on a standard scoring system.
Yet the overall complication rate was similar between groups: 26 percent for patients undergoing single-extremity salvage versus 33 percent in the multiple-limb group. This was so despite the use of additional tissue flaps for reconstruction in patients undergoing multiple-limb salvage.
With Improvements in Survival, Need for Advanced Reconstruction
The overall flap success rate was about 90 percent in both groups. Long-term amputation rates were similar as well. Complications related to one type of tissue flap (free flaps) were higher in the multiple limb-salvage group.
Advances in forward surgical care have increased the survivability of severe blast-related combat injuries. "The conflicts in Iraq and Afghanistan have highlighted a unique group of patients surviving multiple extremity war injuries complicated by open fractures requiring complex reconstruction," according to Dr. Valerio and coauthors.
The new study is one of the first to focus on the outcomes of limb-salvage procedures in these severely injured patients. For patients who may have already lost one or more limbs, preservation of the remaining limbs is "even more critical" to facilitate early ambulation (walking) as well as potentially optimizing rehabilitation and related activities of daily living goals after reconstruction, the authors note.
"Our experience supports limb salvage in the multiple extremity injured patients with avoidance of higher limb amputation levels, despite a higher injury severity score." Dr. Valerio and coauthors conclude. They hope their experience will contribute to further improving the outcomes of surgical reconstruction—and thus long-term rehabilitation and functioning—for survivors of severe and limb-threatening combat injuries.
About Plastic and Reconstructive Surgery
For more than 60 years, Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery®brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, and cosmetic surgery, as well as news on medico-legal issues.
The American Society of Plastic Surgeons (ASPS) is the world's largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. You can learn more and visit the American Society of Plastic Surgeons at http://www.plasticsurgery.org or http://www.facebook.com/PlasticSurgeryASPS and http://www.twitter.com/ASPS_news.
About Wolters Kluwer Health
Wolters Kluwer Health is a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Serving more than 150 countries worldwide, clinicians rely on Wolters Kluwer Health's market leading information-enabled tools and software solutions throughout their professional careers from training to research to practice. Major brands include Health Language®, Lexicomp®, Lippincott Williams & Wilkins, Medicom®, Medknow, Ovid®, Pharmacy OneSource®, ProVation® Medical and UpToDate®.
Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company. Wolters Kluwer had 2013 annual revenues of €3.6 billion ($4.7 billion), employs approximately 19,000 people worldwide, and maintains operations in over 40 countries across Europe, North America, Asia Pacific, and Latin America. Follow our official Twitter handle: @WKHealth.
Connie Hughes | Eurek Alert!
Organ-on-a-chip mimics heart's biomechanical properties
23.02.2017 | Vanderbilt University
Researchers identify cause of hereditary skeletal muscle disorder
22.02.2017 | Klinikum der Universität München
Cells need to repair damaged DNA in our genes to prevent the development of cancer and other diseases. Our cells therefore activate and send “repair-proteins”...
The Fraunhofer IWS Dresden and Technische Universität Dresden inaugurated their jointly operated Center for Additive Manufacturing Dresden (AMCD) with a festive ceremony on February 7, 2017. Scientists from various disciplines perform research on materials, additive manufacturing processes and innovative technologies, which build up components in a layer by layer process. This technology opens up new horizons for component design and combinations of functions. For example during fabrication, electrical conductors and sensors are already able to be additively manufactured into components. They provide information about stress conditions of a product during operation.
The 3D-printing technology, or additive manufacturing as it is often called, has long made the step out of scientific research laboratories into industrial...
Nature does amazing things with limited design materials. Grass, for example, can support its own weight, resist strong wind loads, and recover after being...
Nanometer-scale magnetic perforated grids could create new possibilities for computing. Together with international colleagues, scientists from the Helmholtz Zentrum Dresden-Rossendorf (HZDR) have shown how a cobalt grid can be reliably programmed at room temperature. In addition they discovered that for every hole ("antidot") three magnetic states can be configured. The results have been published in the journal "Scientific Reports".
Physicist Dr. Rantej Bali from the HZDR, together with scientists from Singapore and Australia, designed a special grid structure in a thin layer of cobalt in...
13.02.2017 | Event News
10.02.2017 | Event News
09.02.2017 | Event News
24.02.2017 | Life Sciences
24.02.2017 | Life Sciences
24.02.2017 | Trade Fair News