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!
Tumor surroundings are shown to affect progression of different cancer subtypes
28.05.2015 | Cold Spring Harbor Laboratory
"Hidden" fragrance compound can cause contact allergy
27.05.2015 | University of Gothenburg
Using ultrashort laser pulses, scientists in Max Planck Institute of Quantum Optics have demonstrated the emission of extreme ultraviolet radiation from thin dielectric films and have investigated the underlying mechanisms.
In 1961, only shortly after the invention of the first laser, scientists exposed silicon dioxide crystals (also known as quartz) to an intense ruby laser to...
The only professorship in Germany to date, one master's programme, one laboratory with worldwide unique equipment and the corresponding research results: The University of Würzburg is leading in the field of biofabrication.
Paul Dalton is presently the only professor of biofabrication in Germany. About a year ago, the Australian researcher relocated to the Würzburg department for...
Physicists have developed an innovative method that could enable the efficient use of nanocomponents in electronic circuits. To achieve this, they have developed a layout in which a nanocomponent is connected to two electrical conductors, which uncouple the electrical signal in a highly efficient manner. The scientists at the Department of Physics and the Swiss Nanoscience Institute at the University of Basel have published their results in the scientific journal “Nature Communications” together with their colleagues from ETH Zurich.
Electronic components are becoming smaller and smaller. Components measuring just a few nanometers – the size of around ten atoms – are already being produced...
Development and implementation of an advanced automobile parking navigation platform for parking services
To fulfill the requirements of the industry, PolyU researchers developed the Advanced Automobile Parking Navigation Platform, which includes smart devices,...
The world's first electrical car and passenger ferry powered by batteries has entered service in Norway. The ferry only uses 150 kWh per route, which...
20.05.2015 | Event News
18.05.2015 | Event News
12.05.2015 | Event News
28.05.2015 | Press release
28.05.2015 | Physics and Astronomy
28.05.2015 | Information Technology