ADVANCES IN THE TREATMENT OF LOWER-EXTREMITY WOUNDS APPLIED TO MILITARY CASUALTIES

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.