The Management of War Wounds to the Extremities

Abstract

We present our experience in the treatment of war wounds in 174 patients treated in the Institute of Plastic and Reconstructive Surgery, Department of Surgery, Clinical Hospital Center in Zagreb. The wounds were divided into four categories depending on the type of injury and the extension of the soft tissue defect which showed the differences in primary excision and reconstruction of wounds. Patients were placed in one of two groups depending on their primary treatment and time of definitive reconstruction. Group A comprised 79 patients who were initially treated by plastic surgeons and whose reconstructive procedure was done within five days. Group B comprised 95 patients who were initially treated in a field hospital and referred later to the plastic surgery unit for definitive reconstruction more than five days after the injury. Sixty-nine (87%) of the patients in group A had only one or two debridements before definitive closure and stayed in hospital 20 days or less. In group B, 59 (62%) of the patients required three or more debridements before definitive closure and remained in hospital more than 21 days (p < 0.001). Proper primary treatment and early reconstruction result in significantly shorter duration of hospital stay and lead to more effective rehabilitation and recovery of the patients. A knowledge in terminal ballistics is important in the understanding of the pathophysiology of war wounds.

Reconstruction of foot defects due to mine explosion using muscle flaps

“…Most doctors plan re-examination and debridement 24 or 48 hours after injury. 2 Free tissue transfer is the only method for repairing such extensive soft tissue defects of the foot after these serial debridements. The skin and subcutaneous tissues of the sole are different from elsewhere in the body.…”

“…18 Stanec et al favour primary or delayed primary closure within 3 to 5 days of war injury. 2 Godina advocates early microsurgical reconstruction within 72 hours since it provides low free-flap failure rate, and decreases infection, bone healing, and hospitalisation. 19 Unfortunately, our patients could be admitted only after 5-14 days (mean 8 days) from the time of injury.…”

Reconstructive challenges in war wounds

“…High velocity missiles not only produce extensive soft tissue and osseous destruction, but also lead to heavy contamination of the wounds with possible vascular and neural damage. [12] The introduction of gun powder in the 14 th century dramatically changed the nature of battlefield injuries. Conventionally, war wounds have been managed by an early debridement and delayed primary closure.…”