Combat Trauma of the Shoulder Joint: Reconstruction and Salvage Strategies
Severe combat trauma of the shoulder joint is rarely an isolated orthopedic problem. In this lecture, the speaker discusses how combined damage to bone, soft tissues, vessels, nerves, and the rotator cuff changes the logic of treatment and often makes standard approaches insufficient.
The session follows the practical pathway of care: wound sanitation and radical debridement, external fixation options in anatomically difficult zones, early planning for soft-tissue coverage, and the careful use of negative pressure wound therapy as a temporary bridge rather than a definitive solution. Particular attention is given to local, regional, and free flap options, including deltopectoral, parascapular, latissimus dorsi, and vascularized bone options.
The lecture also explores reconstruction of bone defects with autografts, allografts, alloprosthetic composites, vascularized fibula, the Masquelet technique, 3D-printed titanium implants, and shoulder arthroplasty. A central theme is knowing when reconstruction is no longer the main goal: in selected patients, a salvage strategy may provide a safer, more useful, less painful limb than repeated attempts to restore anatomy.
Clinical cases and discussion highlight subtle but important decisions: when to preserve bone fragments, how cement spacers can protect future reconstructive options, why prolonged VAC therapy may become harmful, and how patient compliance shapes the final outcome. For members, this is a rare, field-informed look at the decision-making behind complex limb preservation in modern military trauma care.
The session follows the practical pathway of care: wound sanitation and radical debridement, external fixation options in anatomically difficult zones, early planning for soft-tissue coverage, and the careful use of negative pressure wound therapy as a temporary bridge rather than a definitive solution. Particular attention is given to local, regional, and free flap options, including deltopectoral, parascapular, latissimus dorsi, and vascularized bone options.
The lecture also explores reconstruction of bone defects with autografts, allografts, alloprosthetic composites, vascularized fibula, the Masquelet technique, 3D-printed titanium implants, and shoulder arthroplasty. A central theme is knowing when reconstruction is no longer the main goal: in selected patients, a salvage strategy may provide a safer, more useful, less painful limb than repeated attempts to restore anatomy.
Clinical cases and discussion highlight subtle but important decisions: when to preserve bone fragments, how cement spacers can protect future reconstructive options, why prolonged VAC therapy may become harmful, and how patient compliance shapes the final outcome. For members, this is a rare, field-informed look at the decision-making behind complex limb preservation in modern military trauma care.