J Trauma
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Penetrating sciatic nerve injuries resulting from gunshot wounds (GSW) or blast injuries are rare. The role of operative treatment of these injuries remains obscure, and to date, specific outcome measures after this type of injury are still missing. ⋯ High-energy injury to the sciatic nerve, although devastating, can result in a reasonable long-term functional level.
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Historical Article
History of infections associated with combat-related injuries.
Despite the innumerable variations in war-making throughout the millennia, wounds have always been characterized by devitalized tissue, the presence of foreign bodies, clots, fluid collection, and contamination by microorganisms. Even in the postantibiotic era, infections of these wounds remain a significant contributor to both morbidity and mortality. Shifts in causal organisms and their resistance profiles continue to challenge each new generation of therapeutics. This article reviews the history of war wound infections, with an emphasis on wound microbiology and combat casualty management during US conflicts from World War I through the end of 20th century.
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Practice Guideline
Guidelines for the prevention of infection after combat-related injuries.
Management of combat-related trauma is derived from skills and data collected in past conflicts and civilian trauma, and from information and experience obtained during ongoing conflicts. The best methods to prevent infections associated with injuries observed in military combat are not fully established. Current methods to prevent infections in these types of injuries are derived primarily from controlled trials of elective surgery and civilian trauma as well as retrospective studies of civilian and military trauma interventions. ⋯ These guidelines may be applicable to noncombat traumatic injuries under certain circumstances. Early wound cleansing and surgical debridement, antibiotics, bony stabilization, and maintenance of infection control measures are the essential components to diminish or prevent these infections. Future research should be directed at ideal treatment strategies for prevention of combat-related injury infections, including investigation of unique infection control techniques, more rapid diagnostic strategies for infection, and better defining the role of antimicrobial agents, including the appropriate spectrum of activity and duration.
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Fasciocutaneous flaps, whether of the upper or lower extremity, have certain distinct advantages. These flaps are very simple to raise, quick to execute, and have a high reliability. On the basis of experimental studies, it is reasonable to accept that a fasciocutaneous flap has a 15% to 20% increased survival over comparable cutaneous flaps. ⋯ The versatility, advantages, and disadvantages of this new flap in the reconstruction of defects of the lower leg and foot are discussed.