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Severe wartime injuries often require microsurgical reconstruction or pedicle flap transfer. The aim of the study is to explore if such reconstructive surgery can be performed under low-resource conditions in a rural area.A clinical intervention study was performed at rural hospital in a war scenario in the Balkans.Thirty-four patients underwent microsurgical postinjury reconstructions for land mine or blast injuries. Five different types of flaps were used. Three patients developed postoperative complications and was reoperated (8.3%, 95% CI 1.8-22.5%).The actual intervention demonstrates that skilled surgical teams can perform advanced reconstructive surgery in low-resource settings. The experience is not only relevant for wartime scenarios, but also in civilian trauma where decentralization of microsurgical service may be feasible.