Flap Coverage Outcomes Following VascularInjury and Repair: Chronicling a Decade of Severe War-Related Extremity Trauma
LCDR Kevin Casey, M.D.; CPT Jennifer Sabino, M.D.; LCDR Elliot Jessie, M.D., M.B.A.; COL Barry D. Martin, M.D.; LCDR Ian Valerio, M.D., M.B.A.
Background: Combat-related extremity injuries frequently require vascular
repair within the combat theater before undergoing definitive reconstruction.
This study examines the outcomes of early vascular repair with secondary softtissue
extremity reconstruction over the past decade of war trauma.
Methods: War-related extremity injuries necessitating a downrange vascular
procedure followed by a definitive limb reconstruction were reviewed. Patient
demographics, type and location of vascular injuries, vascular intervention,
and soft-tissue reconstruction procedures were examined. Outcomes of vascular
repair, tissue transfer, and limb salvage were analyzed.
Results: From 2003 to 2012, 79 extremities in 78 patients had a vascular injury
requiring in-theater intervention followed by 87 staged flap reconstructions performed
distal to the vascular repair. Of the 74 arterial injuries requiring intervention,
27 were proximally located, with 73 percent requiring bypass. The early
primary patency rate was 66 percent and the early primary-assisted patency rate
was 93 percent for proximal artery repair procedures. The flap complication
rate was 31 percent. Overall complications were examined by subtype and were
not significantly different compared with flaps performed without a proximal
vascular injury in the same limb. The flap success rate (93 percent) and the
limb salvage rate (81 percent) were similar to the comparison cohort.
Conclusions: This represents one of the largest series of traumatic extremity
injuries requiring secondary limb reconstruction with tissue transfer following
a vascular intervention. The authors identified no significant difference in
outcomes related to flap coverage or limb salvage for patients with or without
vascular injuries. Reconstructive options in combat extremity trauma are not
limited by proximal vascular injury. (Plast. Reconstr. Surg. 135: 301, 2014.)
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
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