Management of Soft-tissue Defects of Hand in a Conflict Combat Zone: A Case Series.

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Managing soft-tissue defects of hand is a challenging problem for any surgical team, even more in a field hospital setting of a conflict combat zone, where resources are scarce and such cases due to blunt trauma, gunshot wound and deep tissue infections are common. We present four different cases, all middle aged males, who sustained injuries due to crush, low velocity gun shot, and defects post-debridement of acute onset infections following abrasions. The first patient was managed with doubled pedicled abdominal flap, the second patient was managed with external fixation for fracture, and cross finger flap for the defect. The third and fourth patients had similar presentations of acute onset deep soft tissue and bony infection, out of which one was managed with full thickness skin graft from anterior abdominal wall and the other with bi-pedicled abdominal flap. All the patients had good functional outcomes with no functional restrictions at follow-up of 12 weeks. All the cases were performed in a challenging situation of a highly active combat field zone, with limited resources and lack of availability of a trained hand surgeon. An early soft-tissue coverage, as soon as possible, was crucial in saving the hand function and guaranteeing a speedy return to function in view of lack of a professional hand surgery team and specialized microsurgery equipment.