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Combat related injuries bring untold misery to the victims and their loved ones. While injuries to vital organs cause immediate death, delayed mortality after reaching a hospital may occur due to several reasons, rhabdomyolysis or the crush syndrome being the most important. Crush syndrome predominantly affects the kidneys leading to renal failure, but the clinical picture may include acute respiratory distress syndrome, dyselectrolytaemia, disseminated intravascular coagulation, hypovolemic shock, arrhythmias and psychological trauma. Rescue, resuscitation and rehabilitation are onerous tasks and so a coordinated strategy with well trained team of professionals through various chains of evacuation is advocated. This article addresses these issues drawing upon the experience of the writer in combat casualty care in active operations.

Negative pressure wound therapy (NPWT) has emerged as a cutting-edge technology and provides an alternative solution to the problem of wounds. This study was undertaken to assess the efficacy of this technique in the treatment of chronic wounds. A prospective clinical study was used to evaluate our experience in use of NPWT in the healing of pressure ulcers and chronic wounds over 2 years. The primary end point of the study group was the time taken for appearance of healthy granulation tissue and full reepithelialisation without drainage. All patients with sepsis were excluded from the study. The statistical analysis of the data was carried out. Of the 60 patients studied, 41 had associated comorbidities including diabetes mellitus. The commonest site of occurrence was the lower limb. Coverage in the form of a flap was required at presentation in 63·33% of patients. However, after initiation of NPWT, none of them required the procedure and they healed spontaneously either by secondary intention or by skin grafting. The time taken for appearance of healthy granulation tissue was 14·36 ± 4·24 days. Complete healing of wounds occurred by 33·1 ± 10·22 days. There was a statistically significant difference in the volume of the wounds before and after the intervention (P = 0·000). Complications resulting from NPWT were minimal. This technique is an excellent adjunct to surgical debridement.