Ds. Jorgenson et Ga. Antoine, ADVANCES IN THE TREATMENT OF LOWER-EXTREMITY WOUNDS APPLIED TO MILITARY CASUALTIES, Annals of plastic surgery, 34(3), 1995, pp. 298-303
A review of six patients with severe lower extremity injuries (four of
six with grade IIIB tibia fractures), resulting from combat in Somali
a, was undertaken to identify patterns of injury, treatment, and probl
ems unique to combat injuries. An AK-47 gunshot was the mechanism of i
njury in five of six patients. Muscle flaps were required in all patie
nts (four pedicled muscle flaps and three free vascularized flaps), wi
th five of six patients undergoing flap closure during the subacute ph
ase. Ilizarov devices were used in three of four grade IIIB tibia frac
tures. Five major nerve injuries were identified in three of six patie
nts. The ballistic effect of an AK-47 to the soft tissues of the extre
mity is not a high-energy wound as seen in civilian blunt trauma. Know
ledge of ballistics and the delay in definitive flap coverage secondar
y to evacuation allowed definition of zones of injury and successful u
se of local flaps in the majority of our patients. The high number of
nerve injuries not commonly described with blunt trauma may prevent fu
ll rehabilitation.