Contemporary Approaches To Definitive Extremity Reconstruction Of Military Wounds

Abstract

The concept of ‘the military wound’ is not an easy entity to define as the wounds seen in conflict can be of many types: those caused by recognised or improvised weapon systems may have similarities to civilian wounds as well as the wounds soldiers sustain outside of battle. This paper will focus on the current treatment approaches to wounds sustained by deployed UK Armed Forces Personnel and caused by a weapon system. Since 2001, the majority of military wounds sustained by UK Armed Forces Personnel have been caused during conflicts in Iraq and Afghanistan. During this time, there have been evolutions in the conduct of the conflicts and modifications to medical care. These have led to a change in the types and severity of injuries now requiring reconstruction. Explosive devices used against coalition forces are increasingly popular owing to their low cost, ease of construction, magnitude of devastation and their ability to be detonated remotely with little or no risk to the perpetrator. Use of such devices has been shown to produce a higher proportion of extremity injuries than seen in previous conflicts fought with conventional firearms [1]. Explosive munitions were the mechanism of injury in 75% of wounds sustained by 1281 US service personnel in Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF) between October 2001 and January 2005. Only 16% of wounds were gunshot injuries [2]. Of 68 Navy and Marine Corps casualties treated at the Naval Medical Centre, San Diego between April 2003 and December 2005, Improvised Explosive Devices (IEDs) were responsible for 55% of wounds treated [3]. 54% of casualties presenting to a British Field Hospital in Iraq between January and October 2006 had sustained injury secondary to improvised explosive devices, representing the most common mechanism [4]. In response to this changing threat, there have been rapid adaptations of Personal Protective Equipment and in design and armouring of vehicles.This has led to a reduction in the proportion of casualties sustaining fatal torso or head penetration. The effects of blast have been fully described [5-7] and the resultant injury patterns are well recognised (Figure 1). These are predominantly traumatic amputations with extensive bony fractures and soft tissue disruption associated with heavy contamination. The limbs are most commonly involved, extremity injury being found in 67.8% of casualties seen at a British Field Hospital in Iraq during the first ten months of 2006 [4]. Geiger et al found that extremity injuries accounted for 91.2% of injuries in OIF 1 and 2 [3]. Figure 1. Extremity injury as a result of close proximity to explosive device