Experience with free TRAM breast reconstruction at an American Army Medical Center.

There are many civilian reports on the outcomes of the free transverse rectus abdominis muscle (TRAM) flap for breast reconstruction. There are no published reports by U.S. military surgeons with this technique. The records of patients undergoing this operation from November 2002 to December 2004 at an Army Medical Center were reviewed. Twenty-one women underwent 27 free TRAM flaps during the study period. No flaps were lost. Significant complications were encountered in 47.6% (10/21) of patients. Seven of these 10 patients had surgery for donor site scar revision. Although technically demanding and time consuming, free TRAM breast reconstruction provides an esthetic result. Free tissue breast reconstruction can be successfully performed with minimal morbidity at U.S. Army Hospitals.

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.