Small Fragment Wounds: Biophysics, Pathophysiology and Principles of Management

Hill, P. F.; Edwards, D. P.; Bowyer, Gavin

doi:10.1136/jramc-147-01-04

Cited by 51 publications

(33 citation statements)

References 44 publications

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“…Blast effect needs to be considered in high-velocity injuries including roughly 25 % of patients in whom renorrhaphy was practiced. The most important factors affecting kinetic energy are the velocity and weight of the bullet in the formula where blastic effect is evaluated as E=1/2 mv 2 (E: energy (joules), m: mass (kg), v: velocity (m/s)) [19]. The use of low-velocity bullets and the small bullet mass in civilian life reveal the differences from the injuries in conflict zones.…”

Section: Discussionmentioning

confidence: 99%

Experiences of Conflict Zone-Related Ballistic Renal Injury

et al. 2015

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To analyze our approaches and experiences in patients with renal injuries accompanying penetrating abdominal injuries admitted to the hospital due to high kinetic energy weapons. Patients including renal injuries associated with penetrating abdominal injuries due to gunshot wounds and fragments of shell treated at our institution between February 2002 and May 2013 were retrospectively analyzed. Total 21 patients were included in this study, 20 of whom (86.2 %) were male and 1 (13.8 %) female. Renal injury was scaled in 2 patients as grade 1, 4 patients as grade 2, 4 patients as grade 3, 8 patients as grade 4, and 3 patients as grade 5. While conservative treatment was applied to patients with grade 1 and 2 injuries, 2 patients with grade 3 injury underwent renal repair and the other 13 patients underwent nephrectomy. The amount of blood transfused in all cases was determined to be mean 8.28 (6-16) units for red blood cells (ES) and 9 (6-17) units for fresh frozen plasma. When patients were assessed according to the Penetrating Abdominal Trauma Index (PATI) scores, the median score and average PATI score were 35 and 37.6 (10-70), respectively. A physical examination along with a quick assessment of vital signs should be made, and unnecessary and time-consuming investigations such as abdominal tomography and angiographic intervention should be avoided. Conservative and organ preservation should be considered absolutely for appropriately selected patients, namely in stable patients in whom kinetic energy transfer is less and who have bullet path away from midline. However, the majority of these patients are considered to be hemodynamically unstable condition, possible complications of the procedure to be applied, and selection of patients should be carefully evaluated.

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Section: Discussionmentioning

confidence: 99%

Experiences of Conflict Zone-Related Ballistic Renal Injury

et al. 2015

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“…The results of reviewed articles [8,[11][12][13][14][15][16][17] are summarized in chronological order in Table 1. Following initial wound care, the next step in the subsequent management of soft tissue injuries usually involves definitive reconstruction.…”

Section: Resultsmentioning

confidence: 99%

“…Although it has been common practice to surgically operate on all ballistic wounds, recent literature suggests that some carefully selected wounds could be treated non-operatively by irrigation, dressing and antibiotics [8,[11][12][13][14]. Such ballistic wounds selected for non-operative management are ideally low-energy wounds, usually involving limited soft tissue damage.…”

Section: Initial Management Of Soft Tissue Injuriesmentioning

confidence: 99%

“…Identified variables influencing clinical outcomes include the nature of the tissue and its sensitivity to injury, the extent of tissue damage caused by the effects of energy transfer, the extent and nature of bacterial and other microbial contamination and the presence of foreign bodies in the wound. Crucially the quality and timing of medical care are also important factors to be taken into account [12]. This paper"s main focus is a review of the management of ballistic soft tissue injuries and excludes visceral and neurological injuries and bone fractures resulting from ballistics.…”

Section: Introductionmentioning

confidence: 99%

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Management of ballistic soft tissue injuries: a review

Goorah¹,

Hindocha²

2013

IOSR-JDMS

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“…(ii) Care at surgical facility -Surgical evaluation of injuries to determine requirement for operative intervention: consideration for conservative management with wound toilet and antibiotics for a limited number of soft tissue wounds only [83][84][85] …”

Section: Infection In Conflict Wounded-evidence From Recent Conflictsmentioning

confidence: 99%

Infection in conflict wounded

Eardley

Brown

Bonner

et al. 2011

Phil. Trans. R. Soc. B

103

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Although mechanisms of modern military wounding may be distinct from those of ancient conflicts, the infectious sequelae of ballistic trauma and the evolving microbial flora of war wounds remain a considerable burden on both the injured combatant and their deployed medical systems. Battlefield surgeons of ancient times favoured suppuration in war wounding and as such Galenic encouragement of pus formation would hinder progress in wound care for centuries. Napoleonic surgeons eventually abandoned this mantra, embracing radical surgical intervention, primarily by amputation, to prevent infection. Later, microscopy enabled identification of microorganisms and characterization of wound flora. Concurrent advances in sanitation and evacuation enabled improved outcomes and establishment of modern military medical systems. Advances in medical doctrine and technology afford those injured in current conflicts with increasing survivability through rapid evacuation, sophisticated resuscitation and timely surgical intervention. Infectious complications in those that do survive, however, are a major concern. Addressing antibiotic use, nosocomial transmission and infectious sequelae are a current clinical management and research priority and will remain so in an era characterized by a massive burden of combat extremity injury. This paper provides a review of infection in combat wounding from a historical setting through to the modern evidence base.

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Small Fragment Wounds: Biophysics, Pathophysiology and Principles of Management

Cited by 51 publications

References 44 publications

Experiences of Conflict Zone-Related Ballistic Renal Injury

Experiences of Conflict Zone-Related Ballistic Renal Injury

Management of ballistic soft tissue injuries: a review

Infection in conflict wounded

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