Microvascular reconstructive surgery in Operations Iraqi and Enduring Freedom: the US military experience performing free flaps in a combat zone

J Trauma Acute Care Surg. 2013 Aug;75(2 Suppl 2):S228-32. doi: 10.1097/TA.0b013e318299da23.


Background: Local nationals with complex wounds resulting from traumatic combat injuries during Operations Iraqi Freedom and Enduring Freedom usually must undergo reconstructive surgery in the combat zone. While the use of microvascular free-tissue transfer (free flaps) for traumatic reconstruction is well documented in the literature, various complicating factors exist when these intricate surgical procedures are performed in a theater of war.

Methods: The microvascular experiences of six military surgeons deployed during a 30-month period between 2006 and 2011 in Iraq and Afghanistan were retrospectively reviewed.

Results: Twenty-nine patients presented with complex traumatic wounds. Thirty-one free flaps were performed for the 29 patients. Location of tissue defects included the lower extremity (15), face/neck (8), upper extremity (6). Limb salvage was successful in all but one patient. Six of eight patients with head and neck wounds were tolerating oral intake at the time of discharge. There were three flap losses in 3 patients; two patients who experienced flap loss underwent a successful second free or regional flap. Minor complications occurred in six patients.

Conclusion: Microvascular free tissue transfer for complex tissue defects in a combat zone is a critically important task and can improve quality of life for host-nation patients. Major US combat hospitals deployed to a war zone should include personnel who are trained and capable of performing these complex reconstructive procedures and who understand the many nuances of optimizing outcomes in this challenging environment.

MeSH terms

  • Afghan Campaign 2001-*
  • Free Tissue Flaps* / statistics & numerical data
  • Humans
  • Iraq War, 2003-2011*
  • Military Medicine* / methods
  • Military Medicine* / statistics & numerical data
  • Plastic Surgery Procedures / methods
  • Plastic Surgery Procedures / rehabilitation
  • Plastic Surgery Procedures / statistics & numerical data
  • Retrospective Studies
  • Time Factors
  • United States
  • Wounds and Injuries / rehabilitation
  • Wounds and Injuries / surgery*