Limb reconstructive surgery in austere settings: use of flaps in French forward surgical facilities.

INTRODUCTION

Military surgeons deployed abroad must achieve soft tissue coverage under austere conditions.

HYPOTHESIS

A non-specialized surgeon can achieve soft tissue coverage with good results.

MATERIAL AND METHOD

This is a retrospective study of all patients who underwent soft tissue coverage in French forward surgical units between 2003 and 2013.

RESULTS

In all, 81 flaps were constructed. Open fractures (39%) were the leading indication, followed by osseous infections (35%). Most flaps were for legs (70%) and hands (25%). Only pedicle flaps were used. The success rate was 91%.

DISCUSSION

Flaps can be constructed by orthopedic surgeons who are not specialized in reconstructive surgery, in austere settings and with good results. This procedure must be part of a global strategy of limb reconstruction, especially in cases of bone and joint infection. Pedicle flaps, especially muscular, appear more reliable and are to be preferred. The training of the surgeons deployed abroad must include flap surgery.