• Ian Valerio, Jennifer Sabino, Shane Thomas, Scott Tintle, Mark Fleming, Mark Shashikant, and Anand Kumar.
• Bethesda and Baltimore, Md.; Pittsburgh, Pa.; and Fort Belvoir, Va. From the Walter Reed National Military Medical Center; Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center; Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; Uniformed Services University of Health Sciences; and Fort Belvoir Community Hospital.
• Plast. Reconstr. Surg. 2014 Aug 1; 134 (2): 333-338.

BackgroundExtremity battlefield injuries from Operation Iraq and Enduring Freedom (Afghanistan) requiring multiple limbs salvaged with tissue transfers in the same patient are an understudied population. This study aimed to report the limb salvage outcomes in patients requiring multiple flap procedures for two or more concurrent extremity injuries.MethodsA retrospective cohort comparison of warfare-related extremity injuries treated for limb salvage from 2003 through 2012 at the National Capital Consortium was completed. Number of single and multiple flap limb salvages, Injury Severity Score, success rates, and complications were analyzed.ResultsA total of 359 limb salvage reconstructive procedures were performed, consisting of 311 cases of single extremity salvage and 48 cases of multiple flap or multiple extremity salvage. The Injury Severity Score was significantly higher in the multiple extremity group (23) than in the single extremity group (17; p<0.001). Primary flap failure rate was 9 percent in single and 12 percent in multiple limb salvage cases (p=0.390). The subgroup flap failure rate in the multiple limb salvage cohort was 8 percent, 7 percent, and 25 percent for pedicle flaps, pedicle/free flaps, and free flaps, respectively (p=0.361). The total complication rate was 26 percent and 33 percent for single and multiple limb salvage cases, respectively (p=0.211).ConclusionLimb salvage requiring multiple flap procedures in the polyextremity-injured patent is safe and equally effective when compared with a single-limb-injured cohort despite a significantly higher injury severity score. Overall complication rates were not significantly different, although subgroup analysis demonstrated a trend toward increased flap failure in the multiple free flap cohort.Clinical Question/Level Of EvidenceTherapeutic, III.

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