Shortening and angulation for soft-tissue reconstruction of extremity wounds in a combat support hospital

Bone and soft-tissue loss are common extremity injuries sustained in current military conflicts. Selected host national patients had their definitive orthopedic care performed at our combat support hospital. Soft-tissue reconstruction can be a challenging task in this environment. There are several situations in which free or rotational flap coverage is not possible, including the presence of a single vessel limb, local muscle damage, and/or nonavailability of an experienced flap surgeon. The technique of shortening and angulation for extremity soft-tissue reconstruction is described using tools available in a theater of operations.

We treated 6 limbs in 5 patients with the technique of shortening and/or angulation to obtain soft-tissue coverage for extremity war wounds at our combat support hospital. Bony stabilization was accomplished using the standard Hoffman II external fixator (Stryker Orthopedics, Mahwah, NJ). The extremities treated included: 2 humerus fractures, 3 tibia fractures, and 1 ankle fracture. Two of the patients required vascular reconstruction. Patients were followed for as long as possible given individual circumstances.

One patient in the series died of multiple organ system failure because of intra-abdominal injuries. Average follow-up on the remaining patients was 7.03 weeks (1 to 14 weeks). In the patient with 1-week follow-up, the skin graft had 100% take. All other wounds were healed at the latest follow-up without signs of infection.

Shortening and/or angulation of extremities with bone and soft-tissue loss is an effective means of obtaining soft-tissue coverage in a theater of operations.