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!
Real-time imaging of lung lesions during surgery helps localize tumors and improve precision
30.07.2015 | American Association for Thoracic Surgery
Experimental MERS vaccine shows promise in animal studies
29.07.2015 | NIH/National Institute of Allergy and Infectious Diseases
Using ultracold atoms trapped in light crystals, scientists from the MPQ, LMU, and the Weizmann Institute observe a novel state of matter that never thermalizes.
What happens if one mixes cold and hot water? After some initial dynamics, one is left with lukewarm water—the system has thermalized to a new thermal...
Physicists from Regensburg and Marburg, Germany have succeeded in taking a slow-motion movie of speeding electrons in a solid driven by a strong light wave. In the process, they have unraveled a novel quantum phenomenon, which will be reported in the forthcoming edition of Nature.
The advent of ever faster electronics featuring clock rates up to the multiple-gigahertz range has revolutionized our day-to-day life. Researchers and...
Researchers have developed an ultrafast light-emitting device that can flip on and off 90 billion times a second and could form the basis of optical computing.
Joint BioEnergy Institute study identifies bacterial protein that is key to protecting rice against bacterial blight
A bacterial signal that when recognized by rice plants enables the plants to resist a devastating blight disease has been identified by a multi-national team...
Researchers in the Cockrell School of Engineering at The University of Texas at Austin are one step closer to delivering smart windows with a new level of energy efficiency, engineering materials that allow windows to reveal light without transferring heat and, conversely, to block light while allowing heat transmission, as described in two new research papers.
By allowing indoor occupants to more precisely control the energy and sunlight passing through a window, the new materials could significantly reduce costs for...
23.07.2015 | Event News
10.07.2015 | Event News
25.06.2015 | Event News
31.07.2015 | Trade Fair News
31.07.2015 | Transportation and Logistics
31.07.2015 | Physics and Astronomy