RECONSTRUCTION OF UPPER LIMB SOFT TISSUE INJURIES, EXCEPT FOR FINGERTIPS LESIONS

ABSTRACT Objective: The main purpose of this work was to evaluate the advantages and disadvantages of reconstructive procedures applied in upper limb soft tissue injuries according to their location. Methods: The study involved 94 male and 22 female patients (116 total) operated between April 2001 and November 2017 due to traumatic injuries in a upper limb. Individuals were evaluated considering their age, sex, etiology, reconstruction area , applied methodology and complications. The finger injuries were excluded. Results: The performed reconstruction procedures include 29 skin grafts; six advancement flaps; seven rotation flaps; 33 pedicled fasciocutaneous flaps, 9 free fasciocutaneous flaps; 5 pedicled muscle flaps; 12 free muscle flaps, three pedicled musculocutaneous flaps; one free musculocutaneous flap; 11 neurovascular free flaps. Conclusion: Reconstructive procedures in the upper limbs are diverse, varying from skin grafting to free flaps. The indication of the best option depends on the type of injurie and the surgeon. The final goal is to reach the best functional result combined with the lowest possible morbidity. Level of Evidence IV, Case series.

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Management of Hand and Digit Soft Tissue Injuries Using Free Fascia and Fasciocutaneous Flaps with Neo-Syndactylization

Archives of Medicine ◽

10.21767/1989-5216.1000172 ◽

2016 ◽

Vol 08 (06) ◽

Author(s):

Fernando A Herrera ◽

Brennan RBS ◽

Karen M Horton

Keyword(s):

Soft Tissue ◽

Soft Tissue Injuries ◽

Fasciocutaneous Flaps ◽

Tissue Injuries

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The Joint Facial and Invasive Neck Trauma (J-FAINT) Project, Iraq and Afghanistan: 2011-2016

Otolaryngology ◽

10.1177/0194599817725713 ◽

2017 ◽

Vol 157 (4) ◽

pp. 602-607 ◽

Cited By ~ 7

Author(s):

Alexander Lanigan ◽

Brentley Lindsey ◽

Stephen Maturo ◽

Joseph Brennan ◽

Adrienne Laury

Keyword(s):

Soft Tissue ◽

Tertiary Care ◽

Case Series ◽

Soft Tissue Injuries ◽

Published Data ◽

Care Hospital ◽

Neck Injuries ◽

Facial Fractures ◽

Tympanic Membrane Perforations ◽

Tissue Injuries

Objective Define the number and type of facial and penetrating neck injuries sustained in combat operations in Iraq and Afghanistan from 2011 to 2016. Compare recent injury trends to prior years of modern conflict. Study Design Case series with chart review. Setting Tertiary care hospital. Methods The Joint Theater Trauma Registry (JTTR) was queried for facial and neck injuries from Iraq and Afghanistan from June 2011 to May 2016. Injury patterns, severity, and patient demographics were analyzed and compared to previously published data from combat operations during January 2003 to May 2011. Results A total of 5312 discrete facial and neck injuries among 922 service members were identified. There were 3842 soft tissue injuries (72.3%) of the head/neck and 1469 (27.7%) facial fractures. Soft tissue injuries of the face/cheek (31.4%) and neck/larynx/trachea (18.8%) were most common. The most common facial fractures were of the orbit (26.3%) and maxilla/zygoma (25.1%). Injuries per month were highest in 2011 to 2012 and steadily declined through 2016. The percentage of nonbattle injuries trended up over time, ranging from 14.7% to 65%. Concurrent facial/neck soft tissue trauma or fracture was associated with an overall mortality rate of 2.44%. Comparison of our data to that previously published revealed no statistical difference in concurrent mortality (3.5%-2.2%, P = .053); an increase in orbital fractures ( P < .005), facial nerve injury ( P < .0005), and ear/tympanic membrane perforations ( P < .0005); and a decrease in mandible fractures ( P < .005). Conclusion Penetrating neck and facial injuries remain common in modern warfare. Assessing injury characteristics and trends supports continued improvements in battlefield protection and identifies areas requiring further intervention.

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Management of the Upper Limb Soft-Tissue Injuries

Reconstructing the War Injured Patient ◽

10.1007/978-3-319-56887-4_6 ◽

2017 ◽

pp. 49-57

Author(s):

Joseph Bakhach ◽

Hamed Janom

Keyword(s):

Soft Tissue ◽

Upper Limb ◽

Soft Tissue Injuries ◽

Tissue Injuries

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MANAGEMENT OF SOFT TISSUE INJURIES – CASE SERIES

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1709755 ◽

2015 ◽

Vol 05 (01) ◽

pp. 079-082

Author(s):

Muralee Mohan ◽

B Rajendra Prasad ◽

S M Sharma ◽

Tripthi Shetty ◽

Priyadharsana P S.

Keyword(s):

Soft Tissue ◽

Composite Structures ◽

Subcutaneous Tissue ◽

Case Series ◽

Soft Tissue Injuries ◽

Tissue Handling ◽

Aesthetic Sense ◽

Life Threatening ◽

Tissue Injuries ◽

And Function

AbstractSoft tissue injuries, whether isolated or in combination with other injuries, are amongst the most common traumatic craniofacial injuries encountered in our day to day practice.Soft tissue injuries may involve the skin, subcutaneous tissue, underlying muscle or a combination of any of these elements. Although rarely life-threatening, the treatment of these injuries can be complex and may have significant impact on the patients' facial aesthetics and function. Hence one should know the “do's and don'ts”.Disfigurement following trauma, has a detrimental effect on the victim's personality and future. Therefore such cases should be most appropriately managed with thorough knowledge of applied anatomy, an aesthetic sense and meticulous tissue handling, along with surgical skills to repair composite structures.

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Extremity soft tissue coverage in the combat zone: use of pedicled flap transfers by the deployed orthopedic surgeon

Military Medical Research ◽

10.1186/s40779-020-00281-5 ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

Laurent MATHIEU ◽

Soryapong PLANG ◽

Nicolas de l’ESCALOPIER ◽

James Charles MURISON ◽

Christophe GAILLARD ◽

...

Keyword(s):

Soft Tissue ◽

Pedicled Flap ◽

Soft Tissue Coverage ◽

Soft Tissue Reconstruction ◽

Fasciocutaneous Flaps ◽

Muscle Flaps ◽

Reconstructive Procedures ◽

Orthopedic Surgeon ◽

Orthopedic Surgeons ◽

The Mean

Abstract Background In theaters of operation, military orthopedic surgeons have to deal with complex open extremity injuries and perform soft-tissue reconstruction on local patients who cannot be evacuated. Our objective was to evaluate the outcomes and discuss practical issues regarding the use of pedicled flap transfers performed in the combat zone on local national patients. Methods A retrospective study was conducted on data from patients treated by a single orthopedic surgeon during four tours in Chad, Afghanistan and Mali between 2010 and 2017. All pedicled flap transfers performed on extremity soft-tissue defects were included, and two groups were analyzed: combat-related injuries (CRIs) and non-combat related injuries (NCRIs). Results Forty-one patients with a mean age of 25.6 years were included. In total, 46 open injuries required flap coverage: 19 CRIs and 27 NCRIs. Twenty of these injuries were infected. The mean number of prior debridements was significantly higher in the CRIs group. Overall, 63 pedicled flap transfers were carried out: 15 muscle flaps, 35 local fasciocutaneous flaps and 13 distant fasciocutaneous flaps. The flap types used did not differ for CRIs or NCRIs. Complications included one flap failure, one partial flap necrosis and six deep infections. At the mean follow-up time of 71 days, limb salvage had been successful in 38 of the 41 cases. There were no significant differences between CRIs and NCRIs in terms of endpoint assessment. Conclusions Satisfying results can be achieved by simple pedicled flaps performed by orthopedic surgeons deployed in forward surgical units. Most complications were related to failure of bone infection treatment. The teaching of such basic reconstructive procedures should be part of the training for any military orthopedic surgeon. Trial registration Retrospectively registered on January 2019 (n°2019–090 1-001).

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