2025, Vol. 7, Issue 2, Part B

Blast injuries remain a major cause of complex upper extremity soft tissue defects in Iraq, often threatening limb viability and function. At Ghazi Al-Hariri Hospital for Surgical Specialties the leading tertiary trauma and reconstructive center in Baghdad local flaps have been systematically used as a practical, cost-effective solution in a resource-limited setting with high patient volume and no microsurgical capacity.

This retrospective study (January 2017-December 2023) included 112 consecutive patients who underwent upper limb reconstruction with local flaps after blast trauma. Most were young male civilians (mean age: 27.6 years; 92% male), with improvised explosive devices (IEDs) causing 69.6% of injuries. Defects most commonly involved the dorsum of the hand (33%) and forearm (28%), and 92% exposed critical structures (tendon or bone).

Eight local flap techniques were applied based on a standardized, anatomy-driven institutional algorithm. Flap survival was 91.1% (102/112), with partial necrosis in 6.3% and total loss in 2.7%. Functional outcomes improved significantly: mean DASH scores decreased from 28.4 at 3 months to 19.1 at 6 months postoperatively, and 67.9% of patients resumed work or daily activities within six months.

Compared to free tissue transfer, local flaps reduced operative time by 74%, per-case costs by 85%, and eliminated the need for ICU admission in most cases. This single-center Iraqi experience demonstrates that local flaps provide reliable, functional, and durable limb salvage after blast injury. The findings support integrating structured, anatomy-based local flap protocols into national trauma reconstruction guidelines in conflict-affected and resource-constrained settings.