Mathieu Laurent, Gaillard Christophe, Pellet Nicolas, Bertani Antoine, Rigal Sylvain, Rongiéras Frédéric
Clinic of Traumatology and Orthopaedics, Desgenettes Military Hospital, Lyon, France,
Int Orthop. 2014 Oct;38(10):2175-81. doi: 10.1007/s00264-014-2398-7. Epub 2014 Jun 25.
Definitive management of extremity injuries including soft tissue coverage is seldom achieved in battlefield medical treatment facilities due to limited resources and operational constraints. The purpose of this study was to analyse the French Army Medical Service experience performing such reconstructive surgery in a Combat Support Hospital (CSH) in Afghanistan.
A clinical study was performed in the KaIA (Kabul International Airport) CSH from July 2012 to January 2013.
During this period 23 Afghan patients treated for soft tissue coverage of combat-related extremity injuries were included. They totalled 28 extremity injuries including 18 blast trauma (BT) and ten non blast trauma (NBT). Overall, 35 extremity pedicled flaps were performed. There were 26 fasciocutaneous flaps, eight muscle flaps and one composite flap. Soft tissue coverage was achieved on all patients reviewed with a mean follow-up of 59 days. Five postoperative complications occurred including two deep infections, one partial flap necrosis and two flap failures, without difference according to injury mechanism.
Reconstruction of traumatic soft tissue defect can be achieved in CSHs for local nationals. Pedicle flap transfers provide simple and safe coverage for war extremity injuries in this challenging environment whatever the injury mechanism.
由于资源有限和作战限制，在战地医疗设施中很少能实现对包括软组织覆盖在内的肢体损伤进行确定性治疗。本研究的目的是分析法国陆军医疗服务机构在阿富汗一家战斗支援医院（CSH）进行此类重建手术的经验。
2012年7月至2013年1月在喀布尔国际机场战斗支援医院进行了一项临床研究。
在此期间，纳入了23例接受与战斗相关肢体损伤软组织覆盖治疗的阿富汗患者。他们共有28处肢体损伤，其中18处为爆炸伤（BT），10处为非爆炸伤（NBT）。总体而言，共进行了35例肢体带蒂皮瓣手术。其中有26例筋膜皮瓣、8例肌皮瓣和1例复合皮瓣。所有接受复查的患者均实现了软组织覆盖，平均随访59天。发生了5例术后并发症，包括2例深部感染、1例部分皮瓣坏死和2例皮瓣失败，不同损伤机制之间无差异。
可为当地居民在战斗支援医院进行创伤性软组织缺损的重建。在这种具有挑战性的环境中，无论损伤机制如何，带蒂皮瓣转移都能为战时肢体损伤提供简单而安全的覆盖。
