Review of PRS Global Open Article: “Extensive Mine-Shrapnel and Gunshot Wound Closure Using Keystone Island Perforator Flaps”

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by Mark Fisher, MD (@DrMarkFisher)

Wartime injuries can be some of the most devastating injuries that a Plastic Surgeon encounters in his or her career. Despite the significant trauma that improvised explosive devices and large caliber weapons can cause, improved front-line medicine means that a significant number of soldiers survive their immediate injuries. Thus, more and more soldiers require treatment of devastating injuries that were previously not survivable.

Once these patients are stable and can undergo surgery to treat their wounds, the plastic surgeon must decide how to replace missing muscle, skin, and bone. Previously, large soft tissue injuries were either allowed to heal on their own – a process that takes significant amounts of time and can result in an unsightly scar – or were treated by moving tissue from another part of the body.

Moving tissue from another part of the body is a complicated procedure requiring hours of surgery and special equipment. With recent advancements, a new technique known as a “Keystone Perforator Flap” has been described. This particular technique involves picking an area of skin adjacent to the wound, finding small blood vessels that feed that area of skin, and then carefully dissecting and moving this skin over the wound while preserving its blood supply.

In the May issue of PRS Global Open, Sliesarenko et al. describes using this technique to treat extensive soft tissue battlefield injuries in Ukraine. They report a series of 25 patients aged 22 to 52, all male, who suffered extensive gunshot and mine blast injuries ranging from small (2.5 x 7.5 cm) to very large (12 x 22 cm). Using Keystone Perforator Flaps, they were able to treat these patients and provide them with the tissue needed to cover their wounds. This was done with relatively minor complications and an average surgery time of 68 minutes.

Although sometimes complex problems require complex solutions (such as in cases where large portions of bone are missing), often the simplest solution is best. This is especially true in the setting of wartime injuries where time is of the essence and resources are limited. In this article from PRS GO, we see a great example of a simple solution being applied to treat complex injuries.
REFERENCES
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Article Reviewed:
“Extensive Mine-Shrapnel and Gunshot Wound Closure Using Keystone Island Perforator Flaps.” Sliesarenko, Sergii V. MD, PhD; Badiul, Pavlo O. MD, PhD; Sliesarenko, Kirill S. MD. Plastic and Reconstructive Surgery – Global Open: May 2016 – Volume 4 – Issue 5 – p e723.

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