Nature and results of treatment of war wounds caused by cluster bombs

Abstract

The aim of this study is to describe the nature of war wounds with fracture caused by cluster bombs and to suggest treatment options for such injuries. The nature of wounds caused by cluster bombs differs from those caused by conventional arms (they are more severe). The sides of the wounds are represented by conquasated soft tissues (such as fat and muscle) with thick dead tissues, ordinarily with a thickness of 0.5-4.5 cm. Another main characteristic of such injuries is the high percentage of amputations needed due to the high rate of neurovascular damage. This paper investigates the cases of 81 patients who sustained a total of 99 war wounds with fractures. The average age of the patients was 32.7 years while the youngest was 20 and the oldest, 77. According to The International Committee of the Red Cross (ICRC) classification of war wounds, 14 patients had grade I injuries, 48 patients grade II, and 29 patients, grade III. Mitkovic external fixation system, known also as the "War Fixator" was used for all fractures fixation. One protocol, which was a modification of the ICRC's protocol adapted to our specific conditions, was used throughout the study. For solving soft tissue defects, a rotator fasciocutan flap was the most frequently used. For solving of bones defect Mitkovic reconstructive external fixation device was used. All fractures we treated healed. We concluded that shortening the procedural time and being a very simple, immediate using of Mitkovic versatile external fixator ("War Fixator") is, leads to desirable results.

Trends in Demographics and Surgical Treatment of Weapon‐Related Limb Injuries Over Two Decades in a Resource‐Scarce Setting

“…Therefore, the external validity of our findings may be limited. The patients were nonetheless treated according to ICRC's treatment protocols that are generally accepted and similar to protocols followed by other humanitarian organizations and surgical care providers in conflicts [32][33][34]. Finally, the study is retrospective and consequently has inherent weaknesses that come with this study design, such as general selection bias and missing data.…”

Expert consensus on the evaluation and diagnosis of combat injuries of the Chinese People’s Liberation Army

“…A simple and rapid determination for the severity of firearm injuries can guide treatments, such as debridement [ 38 , 39 ]. The Red Cross Classification of War Wounds can be applied in battlefield triage and has various advantages, such as being simple, practical, and accurate.…”

“…The classification is based on 6 indicators (injury surface entry/exit diameter, presences of a cavity, fracture, injuries in major organs, such as the brain, and metal residues). These indicators are monitored for the comprehensive assessment of the type and severity of firearm injuries and provide information for wound treatment (Table 3 ) [ 38 , 39 ].…”

“…These indicators are monitored for the comprehensive assessment of the type and severity of firearm injuries and provide information for wound treatment (Table 3 ) [ 38 , 39 ].…”

Damage Control Orthopedics in Mangled Limb and Open Fractures

“…The benefits of his approach have been demonstrated in numerous studies within the past two decades [3][4][5].…”