Operation Iraqi freedom: A report on a series of soldiers treated with free tissue transfer by a plastic surgery service

Free flaps in combat wounds are predisposed to failure. Few reports are available on their use in American military combat wounds. We present our experience with free flaps during Operation Iraqi Freedom. This is a retrospective review of soldiers treated by plastic surgeons at Brooke Army Medical Center. Eight free flaps were for soft tissue coverage in which local tissue was not available. Causes of the wounds: 2 from a rocket-propelled grenade, 4 from explosive devices, 1 from a fall, and 1 from a helicopter crash. Indications for the flaps were 2 exposed calvaria, 3 lower-extremity fractures, 2 upper-extremity wounds, and 1 exposed Achilles tendon. Four latissimus dorsi muscle flaps and 4 radial forearm fasciocutaneous flaps were used. All flaps were successful. Three flap-related complications required operative intervention. Free flaps can be used successfully in combat wounds, with minimal morbidity, and should be considered in American soldiers with complex wounds.