Introduction: Severe war wounds still remain a dangerous problem, especially wounds produced by high velocity weapons. They are characterized by the presence of broad zone of injury, tissue loss, debris and high wound contamination. Special consideration must be given to the frequently associated fractures, damaged blood vessels and nerves. About 50-75% of all missile wounds and blast injuries involves the limbs. Lower extremity is the most common site of injury. If the treatment is not highly sophisticated the results can be disastrous with considerable loss of function and the threat of the loss of the extremity. Aim of the study was to evaluate the efficacy of microsurgical reconstruction of severe war injuries of the extremities, combined with Illizarov or Mitkovic bone transport.

Methods: Between 1991- 1999, twenty-eight patients (all male) underwent microsurgical reconstruction of severely injured limb followed by bone transport. All had soft tissue-bone loss. In twenty-five the free tissue transfer was performed. Latissimus dorsi was a flap of choice. External fixation was achieved using first the Mitkovic external fixateur (domestic type) that was later on replaced with the Illizarov external fixateur in the majority of cases. We started bone transport five days after the corticotomy and complete bone debridement. In five patients we performed a bone transport with Mitkovic, unilateral, external fixateur.

Results: All flaps survived. Bone transport was completed with solid bone union in twenty-three patients and they could weight bear at the end of treatment. There was 45.8% complication rate with most common being pin tract infection, epidermolysis, delayed union. In 7 patients we had to make some readjustment of the external fixateur. We could not follow up four patients.

Conclusion: Microvascular reconstruction combined with bone transport can salvage severe war injury of lower extremities. It can also prevent and treat many complications including bone and soft tissue infection and nonunions. This makes an additional improvement in the modern approach to the treatment of war injuries.