This narrative review describes the injury patterns, reconstructive principles, and emerging technologies prompted by dismounted complex blast injury (DCBI), a new wound constellation arising from the 2010 Afghanistan surge. It summarizes limb salvage experience at Walter Reed (2003–2011) and reviews evolving strategies for segmental bone loss, soft-tissue coverage, invasive fungal infection, and peripheral nerve reconstruction.
DCBI patients arrive with limited donor tissue, which forces reconstructive surgeons to rethink standard algorithms built around available local flaps and autograft.
When you encounter a combat casualty with bilateral high transfemoral amputations and perineal injury, treat invasive fungal infection as a diagnosis to actively rule out — not a rare afterthought. Extensive necrosis on any serial débridement in this population warrants immediate tissue histopathology, culture, and empiric dual antifungal therapy (liposomal amphotericin B plus voriconazole).
For segmental bone defects, size drives your staged plan: defects under 4 cm can accept BMP-2 or BMP-7 at closure, while anything larger needs an antibiotic spacer first to build the Masquelet membrane before definitive grafting or bone transport.
For nerve gaps, the 3 cm threshold for synthetic conduits is a hard ceiling. Polytrauma patients routinely exceed it, so autograft or emerging biologic conduits must be planned from the outset rather than as a fallback.
This narrative review describes the injury patterns, reconstructive principles, and emerging technologies prompted by dismounted complex blast injury (DCBI), a new wound constellation arising from the 2010 Afghanistan surge. It summarizes limb salvage experience at Walter Reed (2003–2011) and reviews evolving strategies for segmental bone loss, soft-tissue coverage, invasive fungal infection, and peripheral nerve reconstruction.
DCBI patients arrive with limited donor tissue, which forces reconstructive surgeons to rethink standard algorithms built around available local flaps and autograft.
When you encounter a combat casualty with bilateral high transfemoral amputations and perineal injury, treat invasive fungal infection as a diagnosis to actively rule out — not a rare afterthought. Extensive necrosis on any serial débridement in this population warrants immediate tissue histopathology, culture, and empiric dual antifungal therapy (liposomal amphotericin B plus voriconazole).
For segmental bone defects, size drives your staged plan: defects under 4 cm can accept BMP-2 or BMP-7 at closure, while anything larger needs an antibiotic spacer first to build the Masquelet membrane before definitive grafting or bone transport.
For nerve gaps, the 3 cm threshold for synthetic conduits is a hard ceiling. Polytrauma patients routinely exceed it, so autograft or emerging biologic conduits must be planned from the outset rather than as a fallback.