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Standard Wound Coverage Techniques for Extremity War Injury

Dr. Kumar is Lieutenant Commander, Medical Corps, United States Navy, and Division Chief, Plastic and Reconstructive Surgery, Department of General Surgery, National Naval Medical Center, Bethesda, MD.

Neither Dr. Kumar nor the department with which he is affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Views expressed in this article are those of the author and do not reflect the official policy or position of the Department of the Navy, Department of Defense, nor the US Government.

Reconstruction of extremity war injuries begins with aggressive forward resuscitative care and stabilization of the trauma patient. After serial care in progressively better supported medical environments, definitive management is done at the level V military treatment facility. Aggressive forward care coupled with rapid air transport has enabled increasingly complex care to be administered at the continental United States military facilities; however, it has also made the decision between limb salvage and amputation more challenging. Yet to be determined are (1) the optimal timing of definitive wound closure or coverage in coordination with fracture stabilization and (2) the optimal types of flap for both upper and lower extremity reconstruction. Records of patients with complex lower and upper extremity wounds who were treated at the National Naval Medical Center between September 2004 and June 2006 reveal useful short-term data. Longer-term data, such as fracture union rate, time to ambulation, range of motion and global function of salvaged limbs, patient satisfaction with limb salvage, and average cost, are not yet available.

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