Soft tissue care about the knee in high-energy war injuries

On account of the composite nature of blast injuries and high-velocity projectile wounds, combat war injuries around the knee present a significant challenge to orthopedic traumatologists and reconstructive plastic surgeons. The tremendous magnitude of soft tissue destruction and systemic illness that accompanies these injuries mandates a comprehensive and cooperative effort among trauma, vascular, orthopedic, and plastic surgeons to achieve optimal outcomes. The open wounds that accompany wartime traumatic knee injuries leave large soft tissue voids and may involve injury to the stabilizing structures around the knee. In these situations, well-vascularized soft tissue coverage of the bone, ligaments, and tendons of the knee must be achieved. Reconstruction of the open fractures and the lost or traumatized skin and soft tissue must be achieved to salvage a functional joint. Frequently, this includes the reconstruction of the stabilizing ligaments and may involve a requirement for reconstruction of the extensor mechanism of the knee. This study will review preoperative assessment, complications, and recent advances in the management of soft tissue trauma around the knee in war-injured patients treated at level 5 treatment facilities.