Extremity and Mandibular Reconstruction After Gunshot
Trauma-Orthoplastic Strategies from Five Years of Humanitarian
Missions in a Resource-Limited Setting

J 2025

Extremity and Mandibular Reconstruction After Gunshot Trauma-Orthoplastic Strategies from Five Years of Humanitarian Missions in a Resource-Limited Setting

KOENIG, Viktoria; Tomáš KEMPNÝ; Jakub HOLOUBEK; Tomas VOTRUBA; Julian JOESTL et. al.

Basic information

Original name

Extremity and Mandibular Reconstruction After Gunshot Trauma-Orthoplastic Strategies from Five Years of Humanitarian Missions in a Resource-Limited Setting

Authors

KOENIG, Viktoria; Tomáš KEMPNÝ (203 Czech Republic); Jakub HOLOUBEK (203 Czech Republic, belonging to the institution); Tomas VOTRUBA (203 Czech Republic) and Julian JOESTL

Edition

Journal of Clinical Medicine, BASEL, MDPI, 2025, 2077-0383

Other information

Language

English

Type of outcome

Article in a journal

Field of Study

30212 Surgery

Country of publisher

Switzerland

Confidentiality degree

is not subject to a state or trade secret

References:

URL

Impact factor

Impact factor: 3.000 in 2023

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.3390/jcm14144852

UT WoS

001535738400001

EID Scopus

2-s2.0-105011632525

Keywords in English

orthoplastic; lower limb reconstruction; free fibula; gunshot injuries; mandibula reconstruction; microsurgery; humanitarian mission; Tigray war

Abstract

In the original language

Background: Surgical care in conflict regions like Tigray, Ethiopia, faces severe challenges due to limited resources, infrastructural deficiencies, and high trauma burden. From 2019 to 2023, a multidisciplinary team conducted five humanitarian missions focusing on orthoplastic reconstruction of extremity and mandibular injuries from high-energy gunshot trauma. Methods: A retrospective analysis was performed on 98 patients who underwent free or pedicled flap reconstruction. Data included demographics, flap type, technique, complications, follow-up, and early clinical outcomes score as well as mobility scores. Flaps were harvested using loupes anastomosis performed using microscopes, depending on availability. Results: Among 98 patients (25.5% female, 74.5% male), 69 free flaps and 38 pedicled flaps were performed. Free fibula flaps (n = 54) included 33 mandibular and 21 extremity reconstructions. Additional flaps included ALT, gracilis, and LD flaps. Pedicled flaps included 18 fibula and 20 ALT/LD flaps. Mean age was 35.5 years; mean operative time was 429.5 min, with mandibular fibula transfers being longest. Microsurgical techniques were used in 34% of cases. Median follow-up was 10 months. Microsurgical complications occurred in 18.4%, mainly in fibula transfers (25.9%). Non-microsurgical issues included wound infections (n = 15), graft loss (n = 3), and bleeding (n = 5). Flap loss occurred in 16.3% overall. Early clinical outcome results were good (30.6%), acceptable (28.6%), and moderate (24.5%). Conclusions: Orthoplastic reconstruction using both free and pedicled flaps is feasible in low-resource, conflict settings. Despite infrastructural challenges, functional outcomes were achievable, supporting the value of adaptable microsurgical strategies in humanitarian surgery.

Cite

KOENIG, Viktoria; Tomáš KEMPNÝ; Jakub HOLOUBEK; Tomas VOTRUBA and Julian JOESTL. Extremity and Mandibular Reconstruction After Gunshot Trauma-Orthoplastic Strategies from Five Years of Humanitarian Missions in a Resource-Limited Setting. Journal of Clinical Medicine. BASEL: MDPI, 2025, vol. 14, No 14, p. 1-10. ISSN 2077-0383. Available from: https://dx.doi.org/10.3390/jcm14144852.

@article{2511224,
   author = {Koenig, Viktoria and Kempný, Tomáš and Holoubek, Jakub and Votruba, Tomas and Joestl, Julian},
   article_location = {BASEL},
   article_number = {14},
   doi = {http://dx.doi.org/10.3390/jcm14144852},
   keywords = {orthoplastic; lower limb reconstruction; free fibula; gunshot injuries; mandibula reconstruction; microsurgery; humanitarian mission; Tigray war},
   language = {eng},
   issn = {2077-0383},
   journal = {Journal of Clinical Medicine},
   title = {Extremity and Mandibular Reconstruction After Gunshot Trauma-Orthoplastic Strategies from Five Years of Humanitarian Missions in a Resource-Limited Setting},
   url = {https://www.mdpi.com/2077-0383/14/14/4852},
   volume = {14},
   year = {2025}
}

TY  - JOUR
ID  - 2511224
AU  - Koenig, Viktoria - Kempný, Tomáš - Holoubek, Jakub - Votruba, Tomas - Joestl, Julian
PY  - 2025
TI  - Extremity and Mandibular Reconstruction After Gunshot Trauma-Orthoplastic Strategies from Five Years of Humanitarian Missions in a Resource-Limited Setting
JF  - Journal of Clinical Medicine
VL  - 14
IS  - 14
SP  - 1-10
EP  - 1-10
PB  - MDPI
SN  - 20770383
KW  - orthoplastic
KW  - lower limb reconstruction
KW  - free fibula
KW  - gunshot injuries
KW  - mandibula reconstruction
KW  - microsurgery
KW  - humanitarian mission
KW  - Tigray war
UR  - https://www.mdpi.com/2077-0383/14/14/4852
N2  - Background: Surgical care in conflict regions like Tigray, Ethiopia, faces severe challenges due to limited resources, infrastructural deficiencies, and high trauma burden. From 2019 to 2023, a multidisciplinary team conducted five humanitarian missions focusing on orthoplastic reconstruction of extremity and mandibular injuries from high-energy gunshot trauma. Methods: A retrospective analysis was performed on 98 patients who underwent free or pedicled flap reconstruction. Data included demographics, flap type, technique, complications, follow-up, and early clinical outcomes score as well as mobility scores. Flaps were harvested using loupes anastomosis performed using microscopes, depending on availability. Results: Among 98 patients (25.5% female, 74.5% male), 69 free flaps and 38 pedicled flaps were performed. Free fibula flaps (n = 54) included 33 mandibular and 21 extremity reconstructions. Additional flaps included ALT, gracilis, and LD flaps. Pedicled flaps included 18 fibula and 20 ALT/LD flaps. Mean age was 35.5 years; mean operative time was 429.5 min, with mandibular fibula transfers being longest. Microsurgical techniques were used in 34% of cases. Median follow-up was 10 months. Microsurgical complications occurred in 18.4%, mainly in fibula transfers (25.9%). Non-microsurgical issues included wound infections (n = 15), graft loss (n = 3), and bleeding (n = 5). Flap loss occurred in 16.3% overall. Early clinical outcome results were good (30.6%), acceptable (28.6%), and moderate (24.5%). Conclusions: Orthoplastic reconstruction using both free and pedicled flaps is feasible in low-resource, conflict settings. Despite infrastructural challenges, functional outcomes were achievable, supporting the value of adaptable microsurgical strategies in humanitarian surgery.
ER  -

KOENIG, Viktoria; Tomáš KEMPNÝ; Jakub HOLOUBEK; Tomas VOTRUBA and Julian JOESTL. Extremity and Mandibular Reconstruction After Gunshot Trauma-Orthoplastic Strategies from Five Years of Humanitarian Missions in a Resource-Limited Setting. \textit{Journal of Clinical Medicine}. BASEL: MDPI, 2025, vol.~14, No~14, p.~1-10. ISSN~2077-0383. Available from: https://dx.doi.org/10.3390/jcm14144852.

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