Advanced reconstructive procedures using tissue flaps can stave off the need for amputation among survivors of severe combat injuries that affect more than one limb, finds a new report in the August issue of Plastic and Reconstructive Surgery®.
The new study is among the first to focus on the outcomes of limb-salvage procedures in these severely injured patients. For patients who may have already lost one or more limbs, preservation of the remaining limbs is considered even more critical to facilitate early ambulation as well as potentially optimizing rehabilitation and related activities of daily living goals after reconstruction.
Researchers led by Ian Valerio, MD, of Walter Reed National Military Medical Center in Bethesda, MD, analyzed limb salvage procedures in military personnel sustaining combat-related injuries to multiple limbs while serving in Iraq and Afghanistan.
From 2003 through 2012, a total of 359 limb-salvage procedures were performed at the National Capital Consortium. Of these, 48 involved attempts to salvage two or more injured limbs. “Critical to each of the cases presented in our series was maintenance of residual limb length and a functioning joint (wrist joint and knee joint),” the researchers write.
The limb salvage procedures were performed an average of about 1 month after initial injury. About 90% of patients were injured by blasts from improvised explosive devices; about 60% of the threatened limbs were lower extremities (leg to foot). Injuries were more severe in the multiple-extremity salvage group, based on a standard scoring system, the study showed.
Yet the overall complication rate was similar between groups: 26% for patients undergoing single-extremity salvage versus 33% in the multiple-limb group. This held despite the use of additional tissue flaps for reconstruction in patients undergoing multiple-limb salvage.
The overall flap success rate was about 90% in both groups. Long-term amputation rates were similar as well. Complications related to free flaps were higher in the multiple limb-salvage group, the study showed.