ABSTRACT
This chapter focuses on the remit of injury to the soft tissues and introduces the principles of soft tissue reconstruction, employed by plastic reconstructive surgeons, which can be translated to austere environments. Trauma mechanisms of injury are discussed with reference to the response of each tissue type. The principles of adequate debridement are highlighted to obtain an optimal wound for closure and ensure infection-free healing. Other complications, such as haematoma and seroma, are referred to and the rationale for active management is explained with regard to the biological impact on the microenvironment.
Compartment syndrome is highlighted as a limb-threatening complication. The techniques for two incision fasciotomies with four compartment release in the lower limb, and three compartment release in the forearm, are explained. Introducing the plastic surgery reconstructive ‘elevator’ — formally identified as a ‘ladder’ — enables the appropriate surgical reconstructive technique to be applied so that a defect can be optimally closed.
The concepts of closure are discussed, including split and full-thickness skin grafts and local flaps, whereby classification can aid in the understanding and implementation of such techniques.
Finally, as we move around the body, we describe the local flap options for filling a defect with tips and tricks for the resource-poor environment.
