Plastic Surgery Challenges in War Wounded

Anand R. Kumar,1,2,* Raymond Harshbarger,1,3 and Barry Martin1,3

1Department of Surgery (Plastic Surgery), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland.

2Department of Plastic and Reconstructive Surgery, National Naval Medical Center (NNMC), Bethesda, Maryland.

3Department of Plastic and Reconstructive Surgery, Walter Reed Army Medical Center (WRAMC), Washington, District of Columbia.

Background: Military treatment facilities continue to treat injured personnel supporting the Global War on Terrorism. Optimal reconstruction of massive soft tissue and bone defects of the extremities and craniofacial skeleton secondary to high-energy wounding mechanisms remain poorly characterized.

The Problem: The ideal method to care for these injuries has continued to evolve and has yet to be completely defined. Effects of high-energy blast trauma on tissues, and the unusual bacteria (Acinetobacter baumanii) existing within the wounds, characterize these unique military wounds. Despite the relatively quick triage time, definitive care is delayed, and multiple concomitant injuries exist per patient.

Basic/Clinical Science Advances: In addition to practicing established concepts from prior military conflicts, new technology for the advancement of trauma care has been applied. Treatment with novel flap reconstructions, distraction osteogenesis, bone grafting, and bone-engineering techniques including use of bone morphogenetic protein-2 has led to improved outcomes. Clinical Care Relevance: Modern battlefield care in conjunction with treatment protocols at continental United States Military Treatment Facilities has resulted in improved limb and craniofacial reconstruction.

Conclusion: Successful limb salvage and craniofacial reconstruction can be accomplished in the subacute period using treatment protocols, which incorporate the use of novel flaps, fixation devices, and bone-engineering techniques.

.:: Original Article Here ::.