Medical and surgical management of lower extremity war-related injuries. Experience of the French Military Health Service (FMHS)

• Published in: Annales de chirurgie plastique et esthétique 2020-11, Vol.65 (5-6), p.447-478
• Main Authors: Baus, A., Bich, C.-S., Grosset, A., de Rousiers, A., Duhoux, A., Brachet, M., Duhamel, P., Thomas, M., Rogez, D., Mathieu, L., Bey, E.
• Format: Article
• Language: English
• Subjects: Amputations; Blessures de guerre; Bone reconstruction, amputations; Damage Control Orthopedics; Free flap; Lambeaux libres; Lambeaux pédiculés; Limb salvage; microchirurgie; microsurgery; Pedicled flap; Reconstruction osseuse; Sauvetage de membre; War lower extremity injuries
• ISSN: 0294-1260; 1768-319X
• DOI: 10.1016/j.anplas.2020.05.008

Lower extremity war wounds are characterized by high-energy trauma occasioning loss of complex and pluritissular substances. The support pipeline put into place by the French defense health service (SSA) is designed to rapidly evacuate the injured person from the scene of injury to mainland France, following initial surgery in the framework of a sequential tactic known as “Damage Control Surgery”. This strategy is aimed at stabilizing the traumatized individual and enabling his evacuation. Patients are subsequently treated in a restorative surgery unit in a Hôpital d’Instruction des Armées (HIA), a level 1 trauma center (HIA Percy, HIA Saint-Anne) Cooperation between the plastic and orthopedic surgery specialties is essential insofar as it allows for surgical optimization aimed at saving the limb while restoring function to the greatest possible extent. Notwithstanding painstaking application of this common strategy, septic pseudoarthrosis remains the principal and most feared complication, at times rendering impossible any therapeutic solution other than amputation. Whether prosthetic or non-prosthetic, the rehabilitation provided by doctor/physiotherapists is conducive to patients’ social and professional reintegration. The nation's duty to assist its wounded veterans is carried out with determination by the French defense ministry. As concerns lower extremity war wounds, the authors detail the reconstruction doctrine based on the 6/7/8/9 rule, in accordance with which strategies for repair of soft tissue and reconstruction of the lost bone substance have been developed. Les blessures de guerre du membre inférieur se caractérisent par des traumatismes à haute énergie cinétique occasionnant des pertes de substances complexes et pluritissulaires. La chaine de soutien santé mise en place par le Service de Santé des Armées (SSA) a pour objectif une évacuation rapide du blessé vers la métropole, après une chirurgie première s’inscrivant dans une tactique séquentielle baptisée « Damage Control Surgery ». Cette stratégie vise à stabiliser le traumatisé afin de le mettre en conditions d’évacuation vers la métropole. Les patients sont ensuite pris en charge au sein d’un Hôpital d’Instruction des Armées (HIA), trauma center de niveau 1 (HIA Percy, HIA Saint-Anne), dans un département de chirurgie réparatrice. Cette coopération entre les spécialités de chirurgie plastique et orthopédique est essentielle puisqu’elle permet une optimisation chirurgicale visant à prés