Operation Iraqi Freedom: A Report on a Series of Soldiers Treated With Free Tissue Transfer by a Plastic Surgery Service

Free flaps in combat wounds are predisposed to failure. Few reports are available on their use in American military combat wounds. We present our experience with free flaps during Operation Iraqi Freedom. This is a retrospective review of soldiers treated by plastic surgeons at Brooke Army Medical Center. Eight free flaps were for soft tissue coverage in which local tissue was not available. Causes of the wounds: 2 from a rocket-propelled grenade, 4 from explosive devices, 1 from a fall, and 1 from a helicopter crash. Indications for the flaps were 2 exposed calvaria, 3 lower-extremity fractures, 2 upper-extremity wounds, and 1 exposed Achilles tendon. Four latissimus dorsi muscle flaps and 4 radial forearm fasciocutaneous flaps were used. All flaps were successful. Three flap-related complications required operative intervention. Free flaps can be used successfully in combat wounds, with minimal morbidity, and should be considered in American soldiers with complex wounds.

[1]  T. Patel,et al.  A U.S. Army Forward Surgical Team's experience in Operation Iraqi Freedom. , 2004, The Journal of trauma.

[2]  C. Winslow,et al.  Total nasal reconstruction: utility of the free radial forearm fascial flap. , 2003, Archives of facial plastic surgery.

[3]  Mark H. Gonzalez,et al.  Free Tissue Coverage of Chronic Traumatic Wounds of the Lower Leg , 2002, Plastic and reconstructive surgery.

[4]  L. Levin,et al.  Lower extremity microsurgical reconstruction. , 2001, Plastic and reconstructive surgery.

[5]  M. Şengezer,et al.  Repair of high-energy-induced tissue defects of the dorsal foot by free muscle transfer and skin graft. , 1999, Annals of plastic surgery.

[6]  B. Wertheimer,et al.  Wartime amputations. , 1999, Military medicine.

[7]  Z. Lovrić,et al.  Foot injuries caused by anti-personnel mines. , 1995, Military medicine.

[8]  D. S. Jorgenson,et al.  Advances in the Treatment of Lower Extremity Wounds Applied to Military Casualties , 1995, Annals of plastic surgery.

[9]  Reid Ds,et al.  Reconstructive surgery during Operations Just Cause and Desert Storm. , 1995 .

[10]  S. Suominen,et al.  Free flap failures , 1995, Microsurgery.

[11]  G. Walker,et al.  Reconstructive surgery during Operations Just Cause and Desert Storm. , 1995, Military medicine.

[12]  I. Prpić,et al.  High-Energy War Wounds: Flap Reconstruction , 1993, Annals of plastic surgery.

[13]  A. D. Jabs.  Microvascular Reconstruction of Soft Tissue Defects in the Head and Neck , 1992, Ear, nose, & throat journal.

[14]  P. Manson,et al.  Microvascular Soft‐Tissue Transplantation for Reconstruction of Acute Open Tibial Fractures: Timing of Coverage and Long‐Term Functional Results , 1992, Plastic and reconstructive surgery.

[15]  R. Coupland.  The role of reconstructive surgery in the management of war wounds. , 1991, Annals of the Royal College of Surgeons of England.

[16]  Col. Alan E. Seyfer,et al.  Late Results of Free‐Muscle Flaps and Delayed Bone Grafting in the Secondary Treatment of Open Distal Tibial Fractures , 1989, Plastic and reconstructive surgery.

[17]  P. Manson,et al.  Acute and Definitive Management of Traumatic Osteocutaneous Defects of the Lower Extremity , 1987, Plastic and reconstructive surgery.

[18]  A. Trouwborst,et al.  Medical statistics of battlefield casualties. , 1987, Injury.

[19]  M. Godina.  Early Microsurgical Reconstruction of Complex Trauma of the Extremities , 1986, Plastic and reconstructive surgery.

[20]  W. Byerly,et al.  War surgery in a forward surgical hospital in Vietnam: a continuing report. , 1971, Military medicine.

[21]  J. Parkes,et al.  Early reconstruction of the elbow following severe trauma. , 1970, The Journal of trauma.