Could the orthopaedic surgeon deployed in austere setting perform flaps on the leg?

Area of Science:

• Orthopaedic surgery
• Military medicine
• Reconstructive surgery

Background:

• Military surgeons often perform soft tissue coverage on lower limbs during operations.
• The expertise of non-reconstructive specialists in flap surgery outcomes is often questioned.

Purpose of the Study:

• To evaluate the outcomes of lower limb flap procedures performed by orthopaedic surgeons without specialized reconstructive surgery training in deployed military settings.
• To determine if non-specialist surgeons can achieve good results in reconstructive surgery.

Main Methods:

• Retrospective review of patients who underwent leg flap surgery by French Forward Surgical Teams between 2003 and 2013.
• Inclusion of 49 patients (54 flap procedures) with indications including open fractures and bone infections.
• Analysis of flap outcomes based on type (muscular vs. fasciocutaneous) and indication.

Main Results:

• Over 90% of flap procedures resulted in a favorable outcome.
• No statistically significant difference in outcomes was observed between muscular and fasciocutaneous flaps.
• Outcomes were favorable irrespective of the surgical indication (open fractures or bone infections).

Conclusions:

• Orthopaedic surgeons can successfully perform reconstructive leg flap surgery in austere military environments.
• The study demonstrates that non-specialist surgeons can achieve significant positive outcomes in flap procedures.
• Flap surgery is a viable reconstructive option for lower limb injuries in deployed settings.